Laser Therapy

The Companion Therapy Laser System

Part 1

The doctors and staff of the Kenosha Animal Hospital are proud to introduce the newest technology available for companion animals to our area. It was recently approved by the FDA for use on animals (as well as with humans) to provide drug-free, surgery-free and pain-free relief through the use of a laser.

LASER is an acronym for Light Amplification by Stimulated Emission of Radiation. By definition, a LASER is any devise which can be made to produce or amplify electromagnetic radiation in the wavelength range from 180nm to 1 mm, primarily by the process of controlled stimulated emission. Lasers are classified into different categories (Class I - Class IV), depending on their power output and potential to cause body harm if used inappropriately. We live in a world dependant on lasers, often used in manufacturing, construction, printing, reading bar codes, playing music, or surgery.

Recently a new and important use was researched and developed for use with humans and animals. This technology, known as Laser Therapy, uses laser light at a specific wavelength and power to stimulate damaged tissue cells for faster healing and repair. The science behind this novel therapy is fascinating and although the concept is simple, it has been around since the beginning of time. Two very basic examples are photosynthesis in the plant and Vitamin D conversion in our skin using sunlight.

With all these benefits, people often wonder, "Does it hurt?" The answer is no, if it is used properly. It actually feels like gentle warm heat to the patient, which is often comforting, especially with soreness and inflammation; but the real action is more complex, occurring at the cellular level. This activity is known as "photobiomodulation" and "photobiostimulation;" simply put, physical and chemical changes made within the tissue cells using a light source.

Anytime there is an injury within the body, regardless of location, Laser Therapy can be of great value. Depending on the power setting applied, it can be focused anywhere from the superficial layers of the skin to the far deeper tissues, including bone, when a higher wattage is employed. I'm extremely excited with the results that I've already seen with my patients, and for the endless possibilities that exist with our ability to help them through their recovery from surgery. Some of the many disorders that I have already treated patients with include, osteoarthritis, injured ligaments and tendons, spinal back pain, ear infections, anal gland diseases, skin infections and other skin disorders such as chronic lick sores, bladder infections, stomatitis and gingivitis (inflammation of the mouth and gums), traumatic wounds, and for post surgical pain relief and accelerated healing.

As you consider treatment plans for your pet, this now gives you another alternative to discuss with your veterinarian. It can be used in conjunction with other therapies, and in some cases, can be a truly stand-alone therapy. In most situations (except in the some of the chronic, long-standing disorders) it can often provide immediate results with only one or two treatments; and most importantly, without any dangerous side effects.

Next month, I'll delve into the science behind this fascinating technology.

William T. Carlisle, DVM

Part 2

In Part 1, we were introduced to a new and exciting technology, laser therapy. In the next few articles I hope to be able to explain the science behind it, but first a little history lesson.

The knowledge that light is not only beneficial, but actually a necessity for good health has been known for centuries. In fact, as early as the 6th century B.C., light was used in the treatment of diseases, known as heliotherapy. It was at this time that Herodotus determined that sunlight was required for normal bone growth. Once Sir Isaac Newton discovered the visible spectrum with the separation of light using a prism in the 1660's, a new age in the understanding of light began; but up until 1903, sunlight was still the only available source for therapeutic applications. This changed when a Danish medical doctor was awarded the Nobel Prize for successfully treating surgical tuberculosis, rickets and lupus vulgaris with ultraviolet light. Thirteen years later, the theory of lasers was postulated by Albert Einstein in an assumption necessary to support the Theory of Relativity, when he correctly proposed, "when a photon of the correct energy level collides with an atom that has been energized under the right conditions, two photons of precisely the same energy would be emitted." This theory would require another forty-four years of research before the technology could be developed to prove Einstein correct, when in 1960; the first Ruby laser was developed. The Uranium laser and Helium Neon laser followed soon after.

In 1967, a breakthrough in the application of the use of the laser in medical therapy occurred when Dr. Endre Mester, a researcher from the Budapest University in Hungary, discovered the biostimulating effects of the laser. He was trying to determine whether laser irradiation could cause cancer with an experiment using two groups of mice. After shaving the hair off the backs of the mice in both groups, and subsequently exposing one group to energy from a low powered Ruby laser, he was surprised to find the laser exposed group grew the hair back much faster than the unexposed group. More importantly, none of the mice developed cancer. Unfortunately, this medical research never made its way to the West during this era of the Iron Curtain; however, these new discoveries in the benefits of laser therapy was quickly spreading through Eastern Europe, China and the Soviet Union during the 1970's and early 1980's. After the collapse of the Soviet Union, research documents regarding laser therapy became available to Western Europe and eventually made their way to the U.S. with a flurry of interest by researchers. In 1993, the first Independent Research Board for Laser Acupuncture Research was established in Boston, Massachusetts; and finally in 1998, the North American Association for Laser Therapy was established with the mission to improve the understanding of the photobiological mechanisms, basic laser physics, treatment parameters and protocols, techniques and regulatory issues.

To be continued next month.

William T. Carlisle, DVM

Part 3

In the last twelve years since the establishment of the North American Association for Laser Therapy, a preponderance of published scientific evidence is now available for review supporting the therapeutic value of this exciting new technology. In addition, with the thousands of practitioners around the world utilizing it with their patients on a daily basis and receiving positive feedback, the question should no longer be, "Does it work?" but instead, "How can I best utilize this new technology?" And today, with the recent FDA approval of the more powerful Class IV laser, I continue to find new answers to that question. In the past seven months, after personally treating hundreds of patients suffering from a wide variety of ailments, I am no longer surprised by the positive results that I am seeing, in fact, I've come to expect it. On the other hand, I also realize that it is just another tool that we can utilize to help our patients; it is truly not a panacea for every problem. Everything has its own limitations, and laser therapy is no exception. For example, chronic, longstanding conditions will often require several treatments before any positive results are seen; and in some cases, the pain may actually get slightly worse before any improvement is made, as the tissue begins to heal. A second example would be partially torn or stretched ligaments. While I have witnessed phenomenal results after treating damaged knee and other joint ligaments, if the patient re-injures it before it is completely healed, a return to lameness is expected. At any point, if the ligament sustains a complete tear, the only hope for repair is surgery; although the laser can still be employed throughout the rehabilitation, aiding the speed of recovery.

So how does this relatively small box (with the price tag of a nice automobile) actually work? In order to properly answer this question, I need to break the machine down into three main components: an energy source - electricity; a lasing or amplifying medium - which stores the energy supplied to it; and a resonating cavity that is bounded by mirrors - with one end less than 100% reflective, allowing the release of charged photons (energized light) of a single wavelength to pass through it and down the cable connected to the working hand piece, where it is directed into the damaged or inflamed tissue. Essentially, as energy is supplied to the lasing medium, collisions of an energized atom and a spontaneously emitted photon results in stimulated emission of two photons. These two photons in turn collide with other atoms and a result of this chain reaction is an avalanche of photons all with the same photon energy and wavelength, resulting in the production of the laser light.

Next month, with some understanding of this background information, I want to discuss how laser light affects abnormal tissue.

William T. Carlisle, DVM

Part 4

Now that we have a brief understanding of what laser light is and how it is produced, this month I want to spend some time discussing how laser light affects abnormal tissue; after all, this is the reason why we are so excited about this new technology.

As the laser photons penetrate deep within the tissues, they stimulate cell membranes and internal cellular structures, such as the mitochondria, of unhealthy individual cells. The mitochondria are the "factories" that produce energy for the cell. They contain a substance (chromophores) that absorb the photons and in turn increase the production of ATP (Kreb's Cycle), which normalizes cellular function, decreases pain and has a profound affect on healing, through increased production of DNA and RNA. The laser photons are also absorbed by the membranes of the cells, which has an important effect on controlling pain and decreasing swelling. These photons are not absorbed by the chromophores or membranes of healthy cells and therefore do not have any effect on them.

The therapeutic laser has many benefits far beyond our current understanding; in this article, I will list ten scientifically documented biological effects on abnormal tissue. Although an individual article could be written focusing on the physiology of each item, I will spare you the details and briefly discuss each. These include:

1. Pain Relief - Activates acupuncture points, reduces the activity of trigger points, relaxes the musculature, stimulates the release of B endorphins and stabilizes the cell membranes of nerve cells.
2. Reduction of Inflammation - Increases microcirculation through vasodilatation, improves lymphatic flow and decreases edema and inhibits the synthesis of inflammatory prostaglandins
3. Acceleration of Tissue Repair and Cell Growth - Increases cellular energy through increased production of ATP, increases cellular mitosis, activates synthesis of collagen and activates production of various types of tissue repair cells, stimulates regeneration of nerves and remodeling of scar tissue.
4. Circulation Improvement - Stimulates the growth of new capillaries (blood vessels) into damaged tissue and increases blood flow through temporary vasodilatation, reducing bruising and edema.
5. Cellular Metabolic Activity Increased - Direct chromophore stimulation results in increased production of ATP and other important cellular enzymes.
6. Reduction of Fibrous (Scar) Tissue - Increases wound healing minimizing scar tissue formation and stimulates remodeling of old scar tissue into normal elastic tissue.
7. Nerve Function Improvement - Increases the regeneration of damaged nerve cells and normalizes impulse transmission through the stimulation of the cell membranes.
8. Wound Healing Accelerated - Increased production of fibroblasts and other tissue cells that aid in the repair of damaged tissue, increased blood supply to bring necessary nutrients and blood cells such as macrophages that "clean-up" damaged tissue debris.
9. Immune System Stimulated - Stimulates production of immunoglobulins and lymphocytes that are responsible for controlling infection.
10. Stimulation of Acupuncture and Trigger Points - The laser photons have a direct photobiostimulation effect on these points which is often referred to as "needleless" acupuncture.

Next month, I will begin a short series discussing some of my own case reports.

William T. Carlisle, DVM

Part 5

Now that we have a better understanding of the history of light therapy, what laser is and how it is produced, and the benefits achieved through its effects at the cellular level, we are nearly ready to begin our discussion of actual clinical cases. These will include "Shadow", an extremely active Black Labrador Retriever, that ruptured her Cranial Cruciate Ligament (CCL), had surgery and once she started to feel better, sustained a minor post-op setback after getting too excited and slipping, but following treatments with the therapeutic laser made a full recovery; "Zeus", a German Shepherd whose owners were prepared to have his partially torn CCL of his right knee surgically corrected, but elected to first consult with me for a second opinion. I discovered that Zeus had also strained his left CCL and offered his owners the option of laser therapy for both knees. They agreed and today Zeus walks without any noticeable lameness on both of his hind legs; "Snoopy" and his sister "Peanut", two Dachshunds with Spinal Disc Disease that were close to requiring spinal surgery, are now happy and pain free as a result of their laser treatments; Haley" an abused and rescued Pit Bull that I wrote about a few years ago, who had surgery on both of her knees to repair torn ligaments and cartilage. Since the laser was not available back in 2006 when I performed her operations, I decided to treat her in an attempt to break down some of the built-up scar tissue and increase her range of motion with excellent results; "Doobie", a Beagle that after years of a chronic recurring ear infection had one of the most dramatic outcomes that I have witnesses so far; "Sara", a rescued "Katrina Kitty" that now enjoys a pain free mouth after a severely debilitating stomatitis; "Thumper" a Pomeranian that sustained a complicated fracture of his front leg, developed a non-union, but following treatment runs and plays on all four legs; "Trooper" a Rat Terrier that presented with a complex fracture of his Humerus with massive surrounding muscle contusions and bleeding leading to severe swelling of approximately three times normal. Two days after surgery (four days after the injury) and following three laser therapy treatments - most of the swelling and bruising was gone and "Trooper" was walking almost normally; and many, many more that I hope you will enjoy reading about as I much as I enjoy recalling and writing about.

But before I get started with the details of these cases, I would be remiss if I failed to discuss some of the basic principals of using the Therapeutic Laser next month.

William T. Carlisle, DVM

Part 6

General Principles of Clinical Use

• The clinical application of the Therapeutic Laser is to minimize and control pain, swelling and inflammation; aid and increase the rate of healing; and most importantly - alleviate the cause or source of the pain, inflammation or pathological lesion.
• The laser photons will only stimulate or affect the cells already damaged, leaving the normal, healthy cells unchanged.
• Each therapy session is cumulative - generally after 3 - 4 sessions, a good response to the therapy can be noted, and with each successive treatment, continued improvement is expected until resolution of the clinical problem is accomplished.
• Early, aggressive treatment in the course of the disease will optimize the clinical outcome. After the first several weeks, when the initial symptoms are diminished, the frequency of treatment can be reduced to a schedule designed to maintain the desired results.
• In certain conditions, especially chronic, musculoskeletal disorders, the patient may experience an increase in pain or discomfort after the first and/or second session. This is evidence that the damaged tissue cells are being stimulated and that the initiation of healing has begun. By the third session, these patients usually realize the benefit of the therapy.
• Several different disorders or conditions on the same patient can be treated simultaneously.
• The established goal or desired outcome following laser therapy needs to be realistic and expressed at the beginning of treatment. It is impossible to make an old patient young again, but with the help of the therapeutic laser, they may begin to feel that way.
• Most importantly, healing cannot begin with the patient until therapy is initiated. In veterinary medicine today (as well as human medicine) the focus is an evidence-based (scientifically proven) practice of medicine. With laser therapy, since the photons only affect abnormal cells, treatment can be started with only a tentative or working diagnosis. If and when a definitive diagnosis is made, adjustments to therapy can be made as indicated.

In Nike's words, "Just do it" - I'll think that you and your pet will be grateful that you did. You should expect a relief of their symptoms, a restoration of their joints' range of motion and function, a reduction in the usage of medications, and a noticeable improvement in your pet's quality of life.

As I begin to discuss specific case studies in future articles, I hope that you will gain a better understanding of the phenomenal benefits of laser therapy, that may help in your decisions regarding the care of your pet.

William T. Carlisle, DVM

Case Reports - Part 1

In Part V, I mentioned a few of my clinical cases that I would be discussing in future articles. I would like to start with one of the most common orthopedic injuries in the dog, the Cranial Cruciate Ligament (CCL) injury of the stifle (knee) joint. The CCL injury in the dog closely resembles the ACL injury in humans and often requires surgical intervention to stabilize the joint, control the pain and improve mobility for the patient. Frequently, the associated pain and lameness following the injury is so severe, that without surgery, it can become quite debilitating.

Today, with the introduction of the therapeutic laser, there is another option to help patients with a partial tear of the ligament, stimulating the tissue to repair itself, thus preventing the tear from progressing to a complete rupture. If this happens, the laser can still be used to decrease surgical pain and swelling, as well as to stimulate faster healing of the tissue.

In this article, I'll be discussing both of these scenarios with the same patient, a high energy, nine year old female Black Lab named Shadow. Shadow lives with an equally energetic yellow lab, Dawn, and their owner, Susan. Shadow first sustained an injury to her left knee, a partially-torn CCL two years ago. Laser therapy was not available for use with her as our practice was only in the early stage of investigating the safety and value of this new technology. She was put on leash-restricted exercise and Rimadyl, an anti-inflammatory medication, but approximately two months later she re-injured the leg, only this time she completely ruptured the ligament, creating joint instability which required surgery. In December of 2008, I took Shadow to surgery to stabilize her joint.

Despite Susan's and my best attempts to keep Shadow restricted and calm with low doses of a sedative, she slipped four weeks post-op before the leg was fully healed and created a minor set-back to her healing. Eight months later, after another slip, she injured both of her knees. Luckily, the "artificial ligament" in the left knee did not fail, which would have required another procedure to replace it; but she did suffer moderately severe soft tissue damage surrounding the joint that would have normally taken weeks to months to heal. She also had swelling and a minor partial-tear of the CCL of her right knee. The Kenosha Animal Hospital had just purchased the Companion Therapeutic Laser, so I immediately started treatment with the laser on both of her knees. We were impressed by how smooth and fast her recovery was from her injuries. I recently examined Shadow and found her to be healthy and completely free of any lameness. As a result of her laser therapy, both of her knees are now fully healed.

Next month, I will introduce you to a few more of the many dogs with CCL injuries that I've had excellent results using the therapeutic laser.

William T. Carlisle, DVM

Case Reports - Part 2

In these next two articles, I will briefly discuss six more dogs with injured Cranial Cruciate Ligaments (CCl), four with partial tears that healed completely without surgery and two with complete ruptures of the CCL which required surgery. All dogs responded very nicely with the laser therapy, returning to a lame-free gait. As mentioned last month, if the ligament is only partially torn, I have found that in the majority of cases, laser therapy with restriction of activity has been a successful and affordable option for the treatment of this common orthopedic injury.

In Part V, I introduced Zeus, a beautiful, black German Shepherd with a partially torn right CCL, whose owners were ready to proceed with surgery; decided to consult with me for a second opinion, and after I also found joint effusion in the left knee due to a strained CCL, elected to give laser therapy a "try". After the first six treatments, according to his owners, "he was almost back to normal." Today, seven months after his injury, he has had a total of twelve treatments, including a few maintenance treatments; for less than 1/10 the cost of the CCL surgery, Zeus enjoys life once again with long walks with his owners free of any lameness.

Bak, a working black/tan German Shepherd owned by the Kenosha County Sheriff's Department injured his left CCL, developing a partial tear after jumping. Bak also went through a similar laser treatment program as Zeus and we were very pleased that eight months after his injury, the outcome was as successful as Zeus. Even though Bak's right knee was not injured, I will often treat both knees to prevent inflammation from potential overuse since these dogs are usually quite lame on the injured leg.

Libby is a friendly and energetic Yellow Labrador Retriever that over the years put on too much weight. Her owners scheduled an appointment with me because she would become stiff and uncomfortable after exercising. After diagnosing her with an almost complete tear of the left CCL, her owners elected to proceed with laser therapy as compared to surgery, with the understanding that surgery may inevitably be needed. After five treatments, she was doing so well that her owners elected to wait and see how she did before scheduling additional sessions and remarkably she healed completely without any further treatment. I would still advise an occasional treatment to insure long-term success, but Libby has now been free of lameness for ten months.

- to be continued next month

William T. Carlisle, DVM

Case Reports - Part 3

continued from last month...

Lola is a two year old, happy and friendly American Bulldog, who injured her right CCl almost one year ago. Her owner was ready to proceed with surgery, but requested a second opinion with me. After my evaluation, I determined that she actually had a problem with both knees. The laser therapy vs. surgery discussion followed and her owners decided on the more conservative approach, Laser therapy. After eight laser treatments of both knees, Lola responded with a lame-free gait. She continues to have occasional treatments as a precautionary and preventative measure, since she still has the energy of a puppy and tends to be a little rough on her joints. I have often said that the best orthopedic patients are the easy-going ones; however the patients that we usually need to treat are the extremely active, high energy, athletic dogs. Guess which one Lola is?

Kaiya is a very well-mannered and obedient German Shepherd that has had a number of orthopedic problems. In June of 2009, I performed a left hip surgery to eliminate the pain and discomfort of severe osteoarthritis secondary to hip dysplasia. She recovered quickly and returned to full mobility. Seven months later, when she suddenly started to experience pain with walking, we wondered if she was having trouble with her other hip, so we scheduled an appointment for a lameness evaluation. I discovered the source of her pain, an almost completely torn CCL, which we confirmed with radiographs; and an inflamed lower back. We were on the road to recovery with the laser treatments; unfortunately three weeks out, after jumping off a bed, Kaiya developed a complete tear of her right CCL, which required surgery. I continued her laser therapy post-op and her owners and I were amazed at how fast she healed. Today, she is once again running and playing with her sister, Zayda, who also had a right CCL surgery with me three years ago.

Haley was an abused Pit Bull that I wrote about a few years ago, who was rescued by Sue, our head receptionist, and her husband Chuck. I performed surgery on both of her knees to repair torn ligaments and cartilage back in 2006. Even though Haley is not showing any lameness yet, but had a slight decrease in her range of motion, I decided to treat her with the laser since it was not available back then. I am very pleased with the results that we are seeing.

The seven dogs discussed in the last three articles represent only a small percentage of the dogs with ligament injuries that I have had tremendous success with employing the use of our therapeutic laser; in many cases to prevent the need of surgical intervention or speed up the recovery in those patients that required surgery. With the knowledge and experience that I have been able to acquire over the last one and one half years in this new field, I can confidently recommend it for any patient with an orthopedic problem. I know my clients are as pleased as I am with the results that we are achieving.

Next month, I'm excited to tell you about a remarkable and much-loved German Shepherd named, Arwen. Actually, she wasn't just a dog, she was a queen. Oh, and yes, she was also a laser therapy patient.

William T. Carlisle, DVM