Over the past nine months we have started a new journey in our lives, we left part of our passion behind in clinical practice to try something new that was close to our hearts. Walking into veterinary clinics every day and learning how each practice operates, we have shockingly learned that a lot of clinics sadly no longer ice their patients after most procedures.
Our first question is, “Why did this animal need a certain procedure? Was it because they were injured, thus causing them pain?” Well, in the human world we all know what we turn to first to relieve pain and swelling – ice. If any of you have ever had any type of injury or surgery, the moment you sprain your ankle or come out of anesthesia, you wake up to a cold feeling because you are being iced or are instructed to continue icing yourself.
If we ice ourselves to relieve pain and/or inflammation, why are we forgetting this simple step with our pets? Ice has a local anesthetic effect to reduce pain and can be considered one of the easiest and least expensive methods to help our pets post-surgery or injury due to a sprain or strain.
Again, we ask, if we ice ourselves to relieve pain and/or inflammation why are we forgetting this simple step with our pets? The number one reason we see this happening is due to time. Many of the clinics we see are small with only one to three technicians. And really, who has time to stand still for twenty minutes holding a bag of ice on a cruciate repair when the waiting room is filling up with appointments or pet owners are waiting on medications to be sent home? We all know that there are always other things to do besides standing around holding ice for twenty minutes, but are we forgetting how important that simple task is in benefiting our patients?
Instead of avoiding the task we should be considering another modality that will allow us the ease of incorporating that protocol back into our practices, such as a portable cold compression unit. Because this device attaches directly to the area that is being treated and has a pre-set twenty minute time limit, it will free you up from having to sit there and hold the ice in place during the treatment. By occasionally checking on the patient while the cold compression is being used, you can get those take-home medications ready or clean the surgical instruments that were just used. Cold compression eliminates the typical micromanagement involved with icing while improving the standard of care for your patients.
Meet the Authors:
Trista M. Zink, Product Specialist – I have always had a passion for all animals, but my strongest passion is for horses and dogs. I grew up showing horses (mostly the quarter horse circuit and some USEF) competing in everything from showmanship to equitation over fences, and also competed with Jack Russells in go-to-ground and agility. I started working in vet clinics at the age of 14, cleaning stalls and kennels, and basically doing whatever I could to help. Knowing I wanted to continue working in the veterinary industry, I studied to become a technician, where I developed an interest in lameness/pain management and reproduction. After graduation, I successfully managed a 5-doctor practice until I was offered a wonderful opportunity to work at Companion Animal Health. I now pride myself on educating clinics on different types of pain management protocols they can integrate into their practice.
Brooke Clark, Product Specialist – I became a vet tech in 2011 and worked in general practice for 5 years before joining the Companion Animal Health team. I have always had a passion for veterinary rehabilitation, and now I am able to pursue that passion everyday by introducing practices to the wide range of rehabilitation products that Companion has to offer. When I am not focused on improving clinical outcomes for veterinary practices, I enjoy singing and spending time with my husband and 3 dogs.
To this day, “How frequently should we treat?” remains one of the common questions from operators in the field. This is an important facet of laser therapy, as the operator can induce a quicker response as well as a more sustained response long term when being flexible in treatment session frequency. Laser therapy provides the leeway for the operator to be creative and responsive to a patient’s “glide path” of response to the modality as we initiate laser therapy.
In the past, the “3-2-1″ protocol was a popular treatment approach. In this scenario, the patient would receive three treatments the first week, two the next week, and a single treatment on the third week. Although this is not an ineffective protocol per se, we have since come to see the value in treating patients with a more individualized approach to the frequency of treatment.
If a patient is in pain, we need to address that pain and treat for it. Thus, a daily treatment schedule is recommended here. However, when a patient remains in intractable pain despite standard of care, such as FLUTD cats / pancreatitis / severe degloving injuries / snake bites, a more frequent approach may be indicated. For these patients, it may be advantageous to treat twice or even three times daily. These patients are usually hospitalized, so the opportunity is there for the patient to receive treatment as often as needed in a non-invasive manner. Here, we will provide an overview of some of the common approaches in choosing a treatment frequency. Specific approaches to acute conditions and chronic conditions will be discussed separately.
Once we have attained a significant clinical improvement, it is at that time that we should consider reducing the frequency of treatments. Depending on the specifics of the case and our goals, the patient will undergo either a short course of treatments or continued long term treatment phases. When we have an acute condition such as a laceration or hot spot, our goal is resolution, and a short course is recommended. In this instance, we expect complete resolution. However, when dealing with an incurable condition such as arthritis, our goal is to prevent an active decline while minimizing debilitating symptoms and inducing significant clinical improvement. In this instance, we will begin with an induction phase of frequent treatments until a peak plateau effect is noted. Once we have attained this, we can initiate a less frequent transition phase of treatments. As long as the patient continues to thrive, we can continue to taper this treatment frequency to a long term maintenance phase. These long term maintenance treatments may need to be done as frequently as weekly, or may only be needed every few months. The timeframe of these treatments is individual to the case and the laser operator will need to be flexible, observant, and realistic, as we often see our patients suffering from arthritis having a harder time seasonally (some may be worse in summer vs. winter months).
The client needs to understand our approach with treatment frequency and be open to our setting realistic goals as well. Because therapy laser treatments have a cumulative effect, we can continue to move treatment sessions further apart into a maintenance phase as long as the patient does not have any setbacks. The plan is only the plan – it is crucial for the client to understand that if there is a setback prior to the next scheduled treatment, they need to return as soon as possible to address any decline. Depending on the individual patient, some may be prone to overdoing it due to the fact that we are accelerating their healing while minimizing pain.
It is important to remember that the laser is best applied as an adjunct to standard of care, it is not meant to be a replacement for NSAID, opioid, etc. as per the case specifics, but works best as part of a multimodal approach for pain management. The adept laser operator will be able to design and deliver an optimal treatment frequency as per the patient’s presentation and ensuing glide path of response to laser therapy. Laser therapy as a modality offers the operator the leeway to be flexible in treatment frequency, and this is useful as no two patients are exactly the same in their presentation and physical ability to respond to laser therapy. For example, a young and otherwise healthy patient is expected to have a quicker and more pronounced response than a geriatric patient with a chronic condition and concomitant disease. The young adult field trial dog with a laceration needs to be approached differently than the geriatric Cushingoid patient dealing with arthritis. The addition of laser therapy will enable a quicker return to function while minimizing pain or discomfort during the convalescence period.
As we continue to treat an increasingly wide variety of species and conditions, it is clear that we must be flexible in our approach so as to best address the individual needs of each case.
It is important to remember that laser therapy is a noninvasive modality of medical care. In turn, it is just as important to design a treatment area to be as therapeutic as the treatment itself. Doing so will create an atmosphere closer to a fear-free practice, beneficial not only to the patient, but the client and laser operator as well.
Our primary concern deals with providing medical care on the leading edge of medicine in a safe environment. Whenever a therapy laser is used, any door leading in or out of the treatment area is labelled with a sign indicating that laser therapy is being performed in this area. Within the treatment room, the laser operator and patient will be wearing laser-safe eyewear, as well as anyone else present in the treatment room. Oftentimes, the laser-safe Doggles™ used to protect the patient’s eyes actually have a soothing and calming effect for the patient.
The majority of patients receiving laser therapy will have some level of discomfort and mobility impairment, so it is important to remember that these patients would benefit from an easy-to-navigate treatment area. A variety of patients can be effectively treated with a few options for treatment positioning: the floor, a treatment table about waist high, or a raised platform large enough to accommodate the patient and laser operator. Regardless of whichever treatment positioning is chosen, it is crucial that all treatments be done with a comfortable substrate for the patient to be on. A popular option is to use a thick and comfortable fleece. Rolls of these can be purchased and cut to size for any treatment design. They are durable, provide a comfortable environment for the patient, and enhance the therapeutic setting. Also, the fleece is effective in wicking away urine when dealing with incontinent patients. In contrast, performing laser therapy on old, frayed, stained towels detracts from the therapeutic environment.
Some practices also utilize the benefits of white noise in the background, as well as natural lighting by having sky lights installed. The use of aromatherapy has also been documented but its use remains a personal choice for each practice. While it has been shown that some smells like vanilla or mint can have a calming effect, we should remember that the sense of smell is closely associated to the limbic system. Thus, what may be a benign or soothing smell to one person may actually bring up negative memories for someone else.
Setting apart an area which is quiet and has little traffic is the perfect setting for laser therapy treatments. The entire experience from check in to check out should be a positive and therapeutic experience for all of those involved. An adept laser operator has a non-threatening body language and adjusts the treatment positioning and delivery as the patient’s body language indicates. A good operator will also be comfortable in discussing the modality and the patient’s progression with the client since the owner is usually present for these treatments. Involving the client for the treatments enhances the fear-free setting for the patient, which in turn enables the operator to deliver an optimal treatment.
The advent of laser therapy promotes a fear-free setting for the patients.
The ability for operators to deliver these treatments is as therapeutic for the operator as it is for the patients entrusted to our care. Designing a therapeutic treatment environment is easily achieved and will greatly enhance the effectiveness.
