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Learn tips about Class IV laser therapy and other health related topics on the Companion Therapy Lasers blog!  Check back weekly for updated posts.

Regardless of the condition being treated, a thorough and comprehensive documentation of medical care and patient response are a crucial part of the patient’s daily record (PDR). Yet, lack of complete documentation is one of the most common oversights in medical care. Although sometimes easier said than done, this oversight can be easily be prevented by simply taking the time to stay current on each patient’s record.

Thankfully, keeping up with patient records is a task we can make easier for ourselves by taking advantage of several allied technologies that are now available to us. Learning when and how to use these technologies will greatly decrease the time needed to provide a higher level of documentation (and care) for our patients.

Humans are very visual creatures, so it follows that documenting a case with pictures and short videos is of great value. Depending on the software being used by the practice, there are many ways to incorporate this data into most system platforms. For example, Avimark, Impromed, and Cornerstone (among others) can easily import pictures or videos from a camera, iPad, or other digital devices into a specific patient’s PDR. To the trained eye, these pictures can reveal a myriad of minute yet crucial details that would otherwise be left undocumented.

Stance Analyzer_ROM MeasurementAnother tool to consider is a goniometer. With this simple tool, we can accurately quantify the range of motion a specific joint allows. Not only can we assess level of debilitation with this tool, but we can also monitor a patient’s glide path of response to medical care as we treat the patient.

The goniometer is commonplace in veterinary practice, but is also oftentimes combined with another tool primarily utilized by rehabilitation practitioners – the Gulick device. This is a tape measure like tool used to measure the girth of an appendage. This is a very valuable tool to use when treating patients where a certain amount of muscle atrophy and cachexia have occurred. Learning to use tools like a Gulick device is not complicated and provides a valuable way to gauge a specific aspect of the patient in an objective manner.

Stance Analyzer_Golden Retriever 4_SmallA more advanced piece of equipment, called a Stance Analyzer, can accurately measure the percentage of total body weight being placed on each limb at standstill. Again, since we know the commonly accepted range for these values, the stance analyzer gives us another way to assess, and thus better treat, each patient as per their presentation and response to medical care. Similar technologies include the latest force plate analysis devices and gait analyzers, which additionally allow us to analyze a dynamic patient instead of a static stance and thus can help us possibly detect other gait abnormalities such as changes in stride length, etc.

Digital thermal imaging (DTI) is another example of an allied technology with which we can better assess our patients. This device allows us to visualize variances in thermal radiation being emitted from a patient. With this tool, we can detect not only areas that may be inflamed, but those where there may be other changes to blood flow as well. This technology can also be very useful in detecting tissue asymmetry, thus coordinating with our other tools in assessing any potential sites of overcompensation.

Utilizing and recording the results of these allied technologies not only helps us to provide thorough case documentation, but also allows the clinician to provide optimal care for each patient. The clinician and technician can better follow each case’s glide path of response and adjust further medical care accordingly. As with other modalities in veterinary medicine, all of these latest advancements in allied technologies are continuously being improved upon, so it would be advantageous to remain current on these developments and consider investing in technologies like these that are able to save staff time, while simultaneously improving standard of care.

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Elevating Multimodal Treatment by Making Laser Therapy Standard of Care Blog Post Photo_Owl and ElephantNext to its unique characteristics allowing patient stress, fear, and pain to be reduced, photobiomodulation therapy (PBMT) also has the ability to be utilized as an adjunct to standard of care for a myriad of conditions affecting species ranging from the smallest avian to the biggest elephant. PBMT offers us not only a noninvasive and painless tool, but it also affords the operator certain flexibility in its applications, as per the level of tissue disruption involved.

Certainly, each case is an individual instance and must be approached with an individual treatment design and delivery plan. Just as no two patients are the same, neither are the specifics surrounding the etiology / progression / current status and treatment care / etc. of each case. PBMT offers us the flexibility of addressing cases where there is any level of pain, inflammation, and/or tissue disruption. Most, if not all the patients we see, regardless of species, are likely to fit the bill in at least one of the three categories cited. Let’s take a look at some of the commonly-used ways in which a clinic can implement a successful PBMT program as an adjunct to standard of care.

Typically, a new adopter the modality will begin by using it for cases responsive to a short treatment course. Usually, these include acute conditions involving superficial tissues, such as pyotraumatic dermatitis and post-operative incisions. Naturally, as the operator’s knowledge base grows, so will the daily applications of the modality. Most operators report a positive experience in delivering this level of care. It is as therapeutic for the operator to provide this leading-edge level of care as it is for our patients to undergo it. The most challenging part of starting a successful and multifaceted PBMT program in a clinical setting is to overcome inertia. Once the ball gets rolling, it will naturally pick up speed.

Companion -739Once the operators have applied the early stages of making PBMT a core part of their multimodal approach to pain management, then the next natural evolution is to incorporate it with routine anesthetic procedures. Here, we see patients undergoing either a surgical or dental health procedure. In this setting, the therapy laser platform can again be utilized in a series of ways, from conditions such as gingivitis (the only reversible dental disease), going all the way up to multiple extraction sites or stomatitis. With surgical procedures somewhat more involved, like an extracapsular cruciate repair, a pre-op and post-op treatment would also prove to be of value. PBMT should also be highly considered as part of a convalescent care plan, especially when dealing with invasive or orthopaedic procedures (e.g. – FHO, TPO, TPLO, TTA, limb amputation, etc).

As with anesthetic patients, hospitalized patients should be given specific consideration and be offered the benefits of PBMT, especially while they are on location. Such examples that have shown the value of PBMT to standard of care include pancreatitis, HBC, degloving injuries, and snakebites, just to name a few. Typically speaking, “time is tissue” when it comes to injury to tissues (both soft and dense). The savvy laser operator is able to embrace this concept and thus understands to have a certain window of fluidity in the application of the modality. The operators’ knowledge base in PBMT and ability to be flexible with an in-patient approach treatment design and delivery, enables them to best address the individual needs and caveats of each case as a separate application (i.e. special considerations such as: active hemorrhage, neoplasia, or active growth plates).

Once a practice has reached this level of understanding and has applied a level of commitment in incorporating PBMT with their core values and message, and confident in its application, the final step is to incorporate it with long-term care plans. In this setting, the focus is on outpatient appointments, scheduled much as they would be for a DVM seeing outpatients. These are the long-term patients with incurable conditions where our goal (and reasonable expectation) is to manage the condition and prevent an active decline. Often, once a clinic gets to this level of focused care, a specific “daily designated laser operator” is usually assigned to the task of handling the daily appointments (larger practices with a sizeable technical staff will incorporate a rotation of daily operators so as to have everyone remain proficient in their technique).

Most practices successful in their integration and implementation of PBMT within their departmental daily modus operandi, in addition to the current standard of care, have proven the modality a synergistic behemoth in our ability to continue to adapt to, adopt, and successfully implement a dynamically evolving aspect of veterinary medicine. The successful and practical applications of PBMT are limited only by the specifics of the case and the ability of an operator to perceive the modality’s application for a specific case presentation. The initial inertia previously mentioned is quickly overcome and replaced by a momentum which will help propel any practice to the next level of patient care when PBMT is allowed to fully develop as a medical modality in clinical practice.

 

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The surprising facts about resident stem cells

What purpose do resident stem cells serve in the body? This is a fair but yet complicated question as our knowledge has only reached the “tip of the iceberg” with stem cell biology. Previously we have discussed adult stem cells, their use as a therapy, and made mention of the recruitment of resident stem cells to a site of injury. But what do we know about the stem cells that reside in the numerous tissues of the body? In today’s blog, we will explore the current scientific knowledge of resident stem cells, what they do (and do not do) and uncover some little facts that might even surprise you!

 

1. What are resident stem cells?
Every individual (both two legged and four legged) has stem cells residing in their tissues and organs. Also referred to as adult stem cells, these cells are characterized by two very important attributes1:

1. Self- renewal: the ability to divide without differentiation
2. Multipotency: the capacity to specialize in different cell types

2. Where can these resident stem cells be found?
Almost every tissue in the body has resident stem cells housed in what is called a “stem cell niche”. This niche is generally understood to be a “micro-environment” where stem cells reside and where they receive signals from other cells in the body to activate, self-renew or remain dormant2.Stem cell niches can be equated to an operator providing assistance. They receive “calls” from the tissue, direct the message to the appropriate “department” (stem cell) and determine the action that is needed for resolution (“pick up the call”-stem cell to activate/ differentiate, “set up meeting”- self renew or “send to voicemail”- stay dormant).

  • Bone Marrow
  • Adipose
  • Brain
  • Peripheral Blood
  • Blood Vessels
  • Skeletal Muscles
  • Skin
  • Teeth
  • Hair
  • Gut
  • Liver
  • Reproductive Tissues

3. What purpose do resident stem cells serve in the body?
The primary role of resident stem cells is to maintain and repair the tissue in which they are found1. As discussed above, these stem cells are signaled through their niche to differentiate and respond to the area of damage.

4. Why are degenerative conditions and injuries treated with platelet rich plasma and stem cell therapies if resident stem cells are already present near the injured tissue?
Chronic conditions such as arthritis and DJD have a multitude of factors that contribute to the progression of the disease, many of which are beyond the scope of this blog. While stem cells may be located near the area of injury, there are several reasons why they may not be renewing the damaged cells in the tissue. Hypothesized reasons for this include:

1. Resident stem cells make up a very small number of cells in each tissue3. In the instance of a degenerative disease, the rate at which cells are replenished through resident stem cells can be suboptimal compared to what is necessary to fully repair the tissue. This constant demand for “repair mode” may also lead to the exhaustion of the regenerative potential of the tissue2.
2. As the body ages, so do the communication pathways between the tissues and the resident stem cells. These communication pathways, which are influenced by growth factors, can become disrupted or dysregulated, which can lead to slowed/halted renewal (stem cells stay dormant and/or limited in numbers) or unregulated production (ex. cancer)2.Regenerative medicine shows great promise in benefiting tissues where these communication pathways and imbalances are present. Platelet Rich Plasma provides beneficial growth factors which aid in the recruitment of resident stem cells while stem cell treatments have the potential to restore tissue homeostasis and structure.

5. What tissues have resident stem cells?
In the early days of research, few tissues were thought to have stem cells, which included bone marrow, fat, skin and muscle. Now, that list has grown exponentially to encompass1:

While more research is needed to fully understand the functions and purpose of resident stem cells, it is easy to see they are an important part of tissue biology and diseases. Stay tuned for our next blog where we will travel back in time to the early years of regenerative medicine!

1. NIH Stem Cell Information Home Page. In Stem Cell Information [World Wide Web site]. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services, 2016 [cited August 15, 2017] Available at < //stemcells.nih.gov/info/basics/7.htm>
2. Adv Exp Med Biol. 2010 ; 695: 155–168. doi:10.1007/978-1-4419-7037-4_11.
3. Adult mesenchymal stem cells and cell-based tissue engineering. R.S.Tuan, G. Boland and R.Tuli Arthritis Res Ther. 20025:32. https://doi.org/10.1186/ar614© BioMed Central Ltd 2003

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