Laser Therapy Blog

“Red Blood Cells, Neutrophils and Platelets – A closer look at cell types and how they affect PRP treatments”

Blood is arguably the most important life sustaining component of the body. For our companion animals, blood comprises on average 7% of the dog’s body weight and carries out several critical functions including transportation of oxygen and nutrients to the cells, removal of waste products and healing of damaged tissues. Each component of blood is responsible for a specific function to maintain homeostasis. Red Blood Cells (RBCs) transport oxygen and carbon dioxide between tissues and lungs. White Blood Cells (WBCs), including neutrophils, eosinophils, basophils, lymphocytes and monocytes, function as part of the body’s defense mechanism to fight off infections and disease. Platelets, as we have learned from our previous blogs, are important for their clotting abilities as well as their growth factors for tissue repair and healing. Last but not least, plasma, which is the fluid portion of blood, is responsible for transporting the above cell types along with delivering important proteins and other dissolved nutrients to various tissues of the body.

Although each cell type has a specific and beneficial function in the circulating blood, their inclusion in the PRP sample can be detrimental to the tissue it is being used to treat. RBCs make up approximately 45% of the blood’s volume. Although they are important for the exchange of gas substances in tissues when circulating, they can also be damaging to cartilage and synovium. When RBC’s are exposed directly to any tissue without the barrier provided by a vessel, they produce harmful Reactive Oxygen Species and also increase the concentration of unwanted inflammatory mediators including IL-1 and TGF-α. Injection of RBC’s directly into a tissue would result in further tissue damage and could lead to increased pain for the patient. In short, we want to effectively exclude RBCs from our PRP sample to reduce the possibility of damaging the tissue and negating the positive effects of the PRP.

Neutrophils, which are the most abundant WBC, are the first line of defense against invading microorganisms. Typically observed in the early stages of infection, neutrophils have the ability to kill microorganisms immediately and non-specifically, without having a “learned” immune response. Although this is beneficial for the control of infections, neutrophils are detrimental to cartilage and synovium as observed in autoimmune diseases including Rheumatoid Arthritis and common tick-borne diseases including Lyme Disease. Neutrophils increase the concentrations of unwanted inflammatory mediators which include IL-1β, TNF-α, IL-6 and IL-8. It has also been observed that neutrophils, when included in a PRP sample, correlate with an increased concentration of MMP-9 which degrades collagen and other extracellular material. We can reason with this knowledge that neutrophils should also not be included in our final PRP sample due to their harmful effects on the tissue.

So what about the other White Blood Cell types? The jury is still out on whether there is an ideal concentration for monocytes, lymphocytes and the other cell types. Their elimination or inclusion is still under investigation and as regenerative medicine continues to evolve, our knowledge and understanding of what the “perfect” PRP sample will become clearer. What we do understand from our current knowledge of these cells and how they function is that in an ideal PRP sample, we want a higher concentration of platelets for their beneficial growth factors and we want a reduced number of RBC’s and neutrophils. For more information about the Companion Regenerative Therapies (CRT) System or to learn more about PRP therapy, please click here.

Stay tuned for our next blog where we look at the 5 most important things every vet should know about regenerative medicine!

“What to Ask When Deciding if Pet Insurance is Right for Your Pet”
Guest Post by Diane Miller

My first foray into the world of pet insurance was when it first came out in 1982. I purchased it for my dog, Thor. Back then the benefits were limited and they reimbursed on a flat rate per condition. They also divided it up by Wellness Plans and Emergency Plans. If I spent the time and did the math, I am not sure that I really benefited from the insurance. But psychologically, I did make different medical decisions for Thor. Knowing that I would receive “some” reimbursement, I think I was a little freer to buy into the treatment plans offered by my veterinarian. Because, in the long run, I wanted to provide care, keep Thor healthy, and give him a long and happy life.

Today the world of pet insurance is drastically different than it was back in the early 80’s:

• First, it’s gone from 1-2 companies to probably more than 15 that I know of.
• Second, the reimbursement structure more closely mimics the human medical insurance. I pay my veterinarian once the service is complete, I submit my documents via their app, and I get a check in the mail. Very simple process. The monthly or yearly insurance costs vary based on your pets’ age, preexisting conditions, breed, and other factors. Most of the companies have online questionnaires on their site that (after completing your pet’s profile) allow you to get an estimate of insurance. Then you pick the reimbursement plan and deductible that fits your needs, and voila – you have pet insurance.

Finding the right pet insurance company is more of a challenge than getting the best rate. Several years ago, I made a big production about finding the right pet insurance. And I mean BIG. I had charts, graphs, questions, calculations, etc. just for pet insurance for 2 dogs. I don’t spend that much time or attention to detail for myself but I was more than happy to do it for my dogs. Go figure. I have 2 German Shepherds, of course, not the healthiest of breeds, especially considering the hips and joints. So the genetic pre-disposition for hip dysplasia and consequently arthritis is definitely a consideration. One of my German Shepherds, Donar, was a puppy when I got his plan and my other dog, Joker, was 4 years old. So asking the RIGHT questions is the key (and thinking ahead). Remember you are planning for the future, or in my world – it’s the accident that is waiting to happen when I least expect it.

Before I share with you the questions I asked and my final decision, I want to give you a little understanding about what I was looking for. I like alternative medicine, I try to “go natural” as much as possible but I will not do anything that does not have solid science behind it. My motto is “Prove it – then I’ll do it”. Don’t get me wrong, I use prescribed meds for pain, topicals, antibiotics, etc. I am not against them, but I know that with every drug comes the possible of a side effect. As the dogs get older, I worry about long term use and the effect of pain meds on their kidneys. Also, I work long hours, so anything I can do to speed the healing process is a win in my book. So my hope is to find a more natural approach whenever possible.

In my quest for natural options I found a number of things I really like. I am all about researching, and the internet is a wonderful resource, but I also know that everything I read on the internet is not the truth.

• First fact – there is no magic cure for anything. If someone touts that it will solve all the problems make sure that you see a study that proves it.
• Second fact – although natural options make a lot of sense on a lot of levels, make sure that if it doesn’t work ,(remember every pet is different -so what works for one may not be as effective for another), that your pet is not in a worse predicament than before.

Some of the natural modalities I’ve used are:

• Natural Supplements – I like Platinum Performance nutraceuticals. They have been used in the equine world for a long time and I have had good success in using them for skin conditions, itching, yeast infections, and general conditioning. Not the cheapest product out there but certainly a good one. If you can get your vet to write a script or order it, as long as it comes from the vet there’s a good chance that the insurance will cover it.
• Acupuncture – This can be an awesome tool and a lot of pets respond really well to it. I used it on one of my cats once when he came down off the couch wrong and twisted his leg. I was amazed that the cat was actually really receptive to it. However, this requires a lot of expertise to get a little needle in a precise place. I wouldn’t be anxious to be someone’s pin cushion unless they were trained. So you need to locate a vet that has been trained in it and has been certified by a reputable organization.
• Chiropractic – This one can be a tough one to locate a qualified person. I know people with sport dogs that have done this and had great success. My first use was back in the 1990’s and it was a guy that was trained in human chiropractic and not veterinary. Although it wasn’t a bad experience, I am not sure it really helped. Also, since he wasn’t familiar with canine anatomy in hindsight he could have done a lot of damage. So again if you opt for this make sure its through your veterinarian and they have certification.
• Laser Therapy – This is one of my favorite modalities. My veterinarian has treated my dogs with laser in order to relieve pain, reduce swelling, and speed healing. I have used it for arthritis, abrasions, post surgeries, wounds, ear infections, hot spots, and all sorts of conditions. The other benefit is that if he pulls a muscle or has surgery that require rehabilitation, laser therapy is absolutely wonderful in getting him back on his paws (all 4 of them) quickly. My dogs love laser therapy treatments and it is a fast and simple treatment with my veterinarian, Dr. Kathryn. Also, I have seen the studies, read the literature and understand what I need. Since my dogs are big and there is a lot of muscle, I am a firm believer that a Class IV laser is the best, especially to get deep into my dogs’ joints. Also, they look really cool in their laser safe Doggle glasses that they wear during laser therapy treatments.

So here are the questions I asked:

• Do you cover alternative therapies like laser therapy, acupuncture, nutraceuticals, chiropractics, etc.? – I was specific about mentioning laser therapy, you might have to explain that it is not laser surgery, so do a little research in advance to be able to explain the difference. THERE IS A BIG DIFFERENCE.
• If I travel, will my pet be covered at any veterinary hospital throughout the US? – Most don’t care where you are but it is always good to ask
• What do you consider genetic pre dispositions and are they covered? What documentation is needed in the medical records to ensure that it’s covered? – This is a big issue, your insurance may need specific verbiage in the medical records or tests to cover the condition. Do a little research on your breed or talk to your vet in advance so you can make sure that you document correctly for coverage.
• Is rehabilitation covered or do I have to purchase a separate rider for the policy? Is laser therapy covered with rehab? – This is one of those things where you have to be thinking in advance. Using an underwater treadmill looks like a lot of fun for the pet (most love it) but it does have an impact on getting your pet back to health quicker.
• Do I max out coverage for the year? By condition? By total spent? Is it only for that year? Or the life of that condition? – This may be important if I have something like hip surgery. Between the surgery and rehabilitation and potential maintenance treatment plan I might max out for the calendar year and I want to make sure that I don’t have to stop treatment.
• What do you call a preexisting condition and if it is resolved, say an ear infection or wound, how long before it can be covered again? – Each insurance company has their own definition. This is also more applicable for getting an older pet enrolled where they have already had treatments.
• Are new technologies or treatments covered as the medicine improves? – There is a great new field of regenerative medicine, which consists of treatments using stem cells (from the dog itself) and platelet rich plasma (which is processed blood from the pet). Both are awesome in joint improvement for pets but are relatively new so the vets performing this are ones that are really looking for new ways to help their patients and investing in it.

I know there a host more of questions, so don’t be afraid to ask. Make sure to ask about injury and rehabilitation coverage, your pets will love you for it.

In the end I chose PetPlan out of Philadelphia. I asked my questions, and their answers were in alignment with the plan I was looking for. They have been great to work with. Donar ate kitty litter and went into emergency surgery to get it all removed, yes, it was clumping. They needed a spoon to get it out. While they had him open they lasered his internal structures and then when he was closed. He also got 5 treatments afterwards since his tummy was sore from the surgery and the scooping. All of it was covered. In the long run, what I received back from Pet Plan paid for 2 years’ worth of his insurance premiums. It’s a win – win for everyone (especially the pet) so check it out!

“Using Laser Therapy to Maximize Perioperative Treatments”

Any surgical or dental procedure will cause acute inflammation, a need for tissue repair, and a certain level of post-procedural pain or discomfort. For this reason, patients scheduled for a surgical or dental procedure should be considered for perioperative laser therapy treatments in order to set up these tissues for success, potentiate tissue healing, and minimize post – procedural pain.

The dental patient will benefit from a treatment applied to any extraction site or gingivectomy sites. Gingivitis and stomatitis should also be treated while the patient is under anesthesia. Selecting the “wound treatment” protocol of appropriate surface area is optimal when dealing with extraction sites or gingival resections. The ginigivitis/stomatitis protocol may also be used if the operator desires to treat the entire mouth and should be carried out in both “open mouth” and “closed mouth”protocols to ensure that all tissues including the oral mucosa are adequately illuminated. These treatments will need to be done off-contact, except for the extra oral treatment with “closed mouth” protocol, the latter is best applied with a contact technique. These treatments are easily carried out as the patient will be anesthetized. It is important to remember that we are working near the eyes, so they should be protected, as well as to place a clean / dry towel under the patient’s head to prevent reflection of the laser light from a metallic dental table.

The surgical patient should be treated prior to, possibly during, and post-operatively. For example, a neuter or spay will benefit from treating the site of primary incision (the “wound treatment” protocol of appropriate surface area is sufficient for this) several hours before the procedure and immediately after surgery. Use a contact technique pre-op & non-contact post-op. Performing a preoperative treatment hours prior to the procedure will enable the vasodilation caused by photobiomodulation to subside by the time primary incision is being made, while the neural blockade will remain present at the time of surgery. The same can be applied to an open wound or laceration repair but a contact technique may not be possible due to internal tissues being exposed.

A patient scheduled for a more invasive procedure, such as an extracapsular repair, should also be treated prior to the procedure and immediately post – op, but since we are dealing with deep tissues here, the “pain/trauma” protocol would be more appropriate. A contact technique is also recommended here, with the exception of directly over the incision – it is best to treat incisions non-contact.

An intraoperative treatment should also be done on internal sites while they are still visible prior to the surgeon closing the body wall. Examples include an enterotomy, gastrotomy, cystotomy, or anastomosis. Selecting the “wound treatment” protocol of appropriate surface area is adequate for these sites. A non-contact technique is required here.

It is imperative to maintain a constant scanning technique while treating any of these in order to fully illuminate the target tissues and nearby healthy tissue margins. Several inches of “healthy margin” around the incision should always be treated and the laser therapist should never “hover” directly over the incision line itself. Tissue adhesive and suture material will not be negatively affected as long as this scanning technique is applied during treatment. Metal skin staples will only reflect a small amount of the laser light. The patient and all personnel in the surgical / dental suite, or treatment room need to be wearing the appropriate laser-safe eyewear while any laser therapy treatment is being carried out.

Performing these treatments will not only set up the tissues for success, but potentiate active tissue healing, and provide immediate additional pain relief post-operatively as well.

To learn more about how laser therapy works, click here.