Therapeutic lasers have come a long way since their introduction to veterinary medicine over a decade ago. Back then, so many yet-to-be-studied beneficial claims were made that veterinarians commonly responded with dubiousness.<\/p>\n
\u201cThere is far less skepticism whether it works now because there has been confirmation that it does, both peer to peer and in numerous studies,\u201d said John Mercurio, vice president of Companion Animal Health, which offers therapeutic lasers for use on people, horses and small animals.<\/p>\n
Where does a practitioner who wants to add this modality to her practice start?<\/p>\n
Make a plan before even looking at a laser product, advised Aaron Bakken of Summus Medical Laser (formerly K-Laser USA). \u201cThe plan should include not only equipment but the implementation process, training and client education.<\/p>\n
\u201cThen do your research,\u201d he said. \u201cTalk to your colleagues, look at products at trade shows, ask questions on the Veterinary Information Network.\u201d<\/p>\n
He said the most important factor in choosing a vendor is to make sure the equipment is backed by a reputable company and comes with a warranty, installation, training and customer support. A list of veterinarians a prospective buyer can call to ask about their experience is key, too.<\/p>\n
J. Mark Strong, global director for business development, human and veterinary, at Multi Radiance Medical, said research into laser therapy is important.<\/p>\n
\u201cThere\u2019s a lot of peer-reviewed evidence that laser therapy actually does what it says it does,\u201d he said, advising practitioners to ask a vendor for studies on the effectiveness of its products at their power levels.<\/p>\n
Mercurio recommended that practitioners ask peers what products they use or recommend, and ask about the financial impact that laser therapy had on the practice.<\/p>\n
When it comes to choosing a\u00a0specific therapy laser, a comparison is important.<\/p>\n
\u201cThe consumer has to be careful to compare apples to apples,\u201d said Jennifer Johnson, VMD, CVPP, president-elect of the International Veterinary Academy of Pain Management and an early adopter of the modality. \u201cShe will be disappointed if she doesn\u2019t see success. And if she doesn\u2019t, it may be because of the equipment she bought.\u201d<\/p>\n
Current research, Dr. Johnson said, boils down to most studies showing that dose is the most important factor in treatment efficacy. This thinking has evolved over the past 10 to 15 years.<\/p>\n
\u201cWith the advent of higher- powered lasers used at appropriate doses, we see better results,\u201d she said. \u201cWith lower power, we can\u2019t generate the needed dose in a practical period of time. Twelve to 15 watts generates joules necessary for efficacy.\u201d<\/p>\n
The U.S. Food and Drug Administration bases laser classifications on how dangerous the laser can be to the human eye, she noted.<\/p>\n
\u201cWhat is important in choosing a laser is that the practitioner be able to determine two things,\u201d Dr. Johnson said. \u201cFirst, that the vendor can say what wavelengths the laser is producing to stimulate a cellular response \u2014 basically, is it going to work? The second is, can I calculate a dose and know what dose I\u2019m putting into tissue?<\/p>\n
\u201cOtherwise,\u201d Dr. Johnson said, \u201cit\u2019s as if you\u2019re buying prednisone without knowing the milligrams in each tablet. If you can\u2019t determine your dose, how do you know what you bought is going to work?\u201d<\/p>\n
Many publications and supporting research now suggest a \u201ctherapeutic window\u201d of appropriate near-infrared wavelengths to stimulate the photobiochemical process in the cell, she said.<\/p>\n
\u201cMost researchers agree that 810 to 980 nanometers creates less chance of absorption by other pigments such as melanin and hemoglobin,\u201d Dr. Johnson said.<\/p>\n
Software featuring an advanced user interface makes a therapeutic laser easy to use, Bakken said, suggesting that prospective buyers ask what a unit\u2019s software is capable of.<\/p>\n
\u201cIt allows easier integration into your practice and provides feedback data on usage,\u201d he said. \u201cThis helps the clinician make better decisions and augment the use of laser. It can be a performance tracker,\u201d capturing usage data that can flag underutilization.<\/p>\n
\u201cIf it says you should have made $1,800 this month, you\u2019ll know you have a missed-billing situation,\u201d Bakken said.<\/p>\n
To determine proper dose and treatment time, the practitioner enters into the software the patient\u2019s species, condition being treated, weight, and coat or skin color. The unit recommends the total treatment time and dose.<\/p>\n
Another area to investigate is the training offered by vendors.<\/p>\n
\u201cOnsite training is really important,\u201d Bakken said. \u201cThe biggest question today isn\u2019t \u2018Does laser work?\u2019 It\u2019s \u2018Is it going to work in my practice?\u2019 We focus on implementation and integration, contraindications, how to use it, how to talk about the laser. We include everyone from the front desk to nurses to doctors.\u201d<\/p>\n
Buy-in from the entire staff helps promote the modality, said Strong, of Multi Radiance.<\/p>\n
\u201cAsk staff who have aches and pains, who have old, arthritic pets. You can introduce the laser to staff for their own aches and pains, then their pets,\u201d he said, and they often become vocal proponents when interacting with clients.<\/p>\n
Training isn\u2019t that difficult, Dr. Johnson said.<\/p>\n
\u201cIt has to cover the effective use of the laser, and it has to be performed by trained personnel,\u201d she said. \u201c[Trainees] need to know anatomy and be trained to apply the dose appropriately. It isn\u2019t hard, but should be done by trained professionals for best success.\u201d<\/p>\n
Look for vendors that will never stop coming back for retraining, said Mercurio, of Companion Animal Health.<\/p>\n
Protocol manuals, online interfaces, webinars and a social media presence are offered by many therapy laser companies to augment onsite training.<\/p>\n
Many vendors suggest pricing strategies for their clients. A common one is to bundle treatments, as multiple sessions might be required, depending on the animal\u2019s ailment.<\/p>\n
Companion offers a business model that helps the veterinarian implement pricing and marketing. Common uses are post-surgical and to alleviate acute and chronic conditions. Suggested fee for post-op therapy, to assist in wound healing, is $10 to $20; for acute conditions, $30 to $40; and for chronic, $40 to $60.<\/p>\n
\u201cYou can compare it to drug pricing, financially and long term,\u201d Mercurio said. \u201cIt\u2019s affordable and less impactful to the patient.\u201d<\/p>\n
Clients who have seen improvement in their pets are often amenable to monthly maintenance sessions, he added.<\/p>\n
Summus Medical Laser presents veterinary clinics with a business plan that includes pricing and marketing training, Bakken said.<\/p>\n
A small wound or anal gland abscess might need one or two treatments of under 10 minutes, Dr. Johnson said. If more treatments are warranted, she suggests bundling them into one week and then rechecking in two weeks.<\/p>\n
A condition such as osteoarthritis likely will need to be treated chronically.<\/p>\n
\u201cAn old dog with OA probably needs treatment not just for bad hips, but in secondary and tertiary areas,\u201d she said. \u201cHis knees and spine need treatment, too. You can charge per time, or in six- or 10-packs.\u201d<\/p>\n
The experts agreed that the return on investment is almost unparalleled with therapy lasers.<\/p>\n
Class 4 units cost in the range of $20,000 to $30,000, Bakken said, depending on the power, wavelength and other features. Lower-level units can range from about $2,000 to $15,000.<\/p>\n
\u201cI\u2019m not aware of any modality in veterinary medicine that can bring as much new revenue into a practice, in relation to its cost, as laser therapy,\u201d Bakken said.<\/p>\n
Smaller practices, he said, have increased revenue by $1,000 to $3,000 a month.<\/p>\n
Dr. Johnson bought her first laser a decade ago, thinking it would be \u201cawesome for Labradors on Rimadyl.\u201d She was interested in treating pain.<\/p>\n
\u201cMy first laser was paid off in less than four months,\u201d she said. \u201cThen I traded it in for a newer model. When I sold the practice, I had three lasers, used among six veterinarians and 45 team members. One was used in surgery and recovery, one in rehabilitation, and the third went from room to room to room for both sick and well visits. It was completely tech-driven, and follow-up appointments would be scheduled with the technician.<\/p>\n
\u201cThere really isn\u2019t much you can\u2019t use it on as an adjunct. When you add it to your practice, you\u2019re having faster returns to normal healing. A hot spot used to itch for a few days after treatment, but a laser provides a faster return to normal. It dries up faster, stops itching sooner.\u201d<\/p>\n
Among conditions suitable for\u00a0laser therapy are musculoskeletal conditions, degenerative joint\u00a0disease, drains, sprains, intervertebral disc disease, degloving injuries, dermatological conditions, bacterial and fungal otitis, and intra-abdominal and thoracic conditions. Postoperative therapy is often included automatically\u00a0as part of a clinic\u2019s standard\u00a0of care.<\/p>\n
\u201cToday\u2019s pet owner is very open to drug-free, surgery-free alternatives,\u201d Bakken said. \u201cThey are much more open to this type of treatment. There has been real growth in the past 11 years, and we\u2019ve seen that change in pet owner adoption of these procedures.\u201d<\/p>\n
Laser therapy has become almost the standard of care in most small animal practices, according to Dr. Johnson.<\/p>\n
\u201cI was originally interested in it to treat painful conditions,\u201d she said. \u201cIt\u2019s a good adjunct for pain management as opposed to pharmacological options. Anything inflammatory should respond to therapy laser. It reduces inflammation and promotes healing. That\u2019s the basis of all the response to laser therapy, a particular wavelength of light.\u201d<\/p>\n
When Dr. Johnson started lecturing at conferences, most questions were about how photobiomodulation<\/a> works and its validity.<\/p>\n \u201cThere was a lot of skepticism for non-pharma treatments, similar to acupuncture,\u201d she said. \u201cBut now, most people in my lectures come to learn about how else they can use it and how others are implementing it in their practices.\u201d<\/p>\n Laser therapy improves veterinary patient care, boosts clinic revenue and can deliver an excellent return on investment.<\/p>\n","protected":false},"author":66,"featured_media":6693,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":0,"footnotes":""},"categories":[316],"tags":[],"class_list":["post-6692","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-december-2019-january-2020","column-features","clinical_topics-innovation-technology"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"\n
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