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.

Laser Treatment_Dog Laying DownThe 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.

Laser Treatment_Dog SittingSetting 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.

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Guest Post by Matt Brunke, DVM, CVRPP, CVA, CVPP

I am a big proponent of rescue groups. There are many “discarded” dogs and cats, most of which are absolutely wonderful pets.  I have worked with Peppertree Rescue for many years and really appreciate their dedication to dogs with medical needs.  Peppertree will find out about them and screen them, and then have them transported to the Albany area where they can be attended to.  This was the case with Glinda, a sweet, 8-ish year old Golden Retriever cross.

Glinda 2Upon physical exam, I found some areas of concern. While Glinda weighed in at a reasonable 74 pounds, her body condition score was abnormal. She had poor muscle mass in her back legs and was carrying more fat than she should. I also noted that she had decreased extension in both of her hip joints and was uncomfortable when I manipulated them. As I palpated her knees, I found chronic thickening in both the left and right knee with discomfort and mild instability.  These findings are consistent with arthritic change in both the knees and hips.

Often times the hip arthritis is a consequence of hip dysplasia, while the arthritis and instability in her knees was consistent with chronic damage to her cruciate ligaments. I discussed this with the owners and we started with a conservative management program. I prescribed a course of therapy for her in the Rehabilitation Program’s Underwater Treadmill and an Adequan injection series for her. The buoyancy the underwater treadmill provides would allow Glinda to exercise and lose weight, while the Adequan injection series would be twice a week for 4 weeks, then one injection a month thereafter. This would help to improve her joint fluid in all of her joints, as well as reduce the damage to her cartilage.

Over the next 3 months, Glinda worked in the underwater treadmill twice a week, gradually increasing her time and distance with each session. Her comfort level improved and she lost 9 pounds. While she was moving well, I noted further instability in both of her knees. It was time for a sedated orthopedic exam and radiographs. Peppertree Rescue agreed to help with her costs and a short while later we had our answers.

Glinda had partially torn the cruciate ligament (ACL) in both of her knees. The right was not as stable as the left, and both had moderate arthritic change. She also had hip dysplasia, characterized by poor coverage of her femoral heads, and consequently had developed arthritis in her hips as well. The right knee needed stability. With hip arthritis in both legs and arthritis in both of her knees, the instability in the right needed surgical correction. My plan was to correct that with a procedure called a TPLO: TIbial Plateau Leveling Osteotomy. This would eliminate the need for the cruciate ligament and allow stability in the knee that would allow her to walk on the leg appropriately and slow the progression of arthritis forming in that knee. I was unsure if her left knee would need the same correction down the road.

Surgery was a success for Glinda. The TPLO gave her right knee the stability her body needed. She did very well in her post-operative rehab program, going through laser therapy treatments and underwater treadmill sessions. During her therapy she was always a smiling, happy patient. After 12 weeks of restricted activity, her tibia healed and I started to increase her overall activity. We would manage the arthritis in her knees and hips as an ongoing condition.

Glinda 1

She has become an avid hiker with her owners. She goes for 30-45 minute walks every day and enjoys being outside. While her arthritis has progressed, her multimodal pain management regimen has kept her from having any further surgeries at this time.

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Using Laser Therapy Over Surgical Implants_Photo for Blog Post

The application of laser therapy to sites containing surgical implants is perfectly safe. These implants will not heat up or be affected in any negative way when the treatment is carried out appropriately. Laser therapy is used to decrease postoperative pain while enabling the patient to experience a shorter convalescence period before returning to function.

Let’s consider what happens with tissue sites that have metal hardware. The laser light will be reflected from the implant and sent back through the tissues. Thus, if a bone surface has a metal implant over it, the tissues between the surface of the implant and the surface of the tissues will be exposed to more photons than the rest of the target site. To account for this, the laser operator simply needs to 1) increase their scanning speed when they are treating over an implant overlaying a bone and 2) treat 360° around the limb to ensure light penetrates to underlying fracture lines or osteotomy sites.

Target sites with cerclage wire and IM pins can certainly be treated as well. Because cerclage wire will cause minimal reflection, there is no need to increase scanning speed with these sites. The same is true for IM pins since they are located inside the bone itself, not on its surface.

Regardless of the specific case, the laser operator will constantly monitor the patient for any signs of discomfort and may possibly adjust the power settings down and/or increase scanning speed accordingly, as some very superficial implants (or very small patients with little soft tissue overlying the implant) may be uncomfortable.

The conscientious laser operator will be mindful when treating any patient with surgical implants, as these sites often develop arthritic changes as time goes on. In this manner, the presence of surgical implants actually predisposes patients for laser therapy in their later years.

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