ADMINISTERING a magic bullet
would be an appealing treatment
option for any veterinarian.
Unfortunately, while the expression
is in common use, such products are
not – and so the term is more likely
to be found in the pages of a Harry
Potter novel than the NOAH data
sheet compendium.
From his days as a practitioner in
Cheshire, 1999 Glasgow graduate
Stephen Barabas can remember how
frustrating it can be to treat
chronic
conditions like
osteoarthritis
and how clinical
progress will
usually rely on
using a range of different treatments.
So when he set up his veterinary
supplies company, VBS Direct Ltd, in
2010 his goal was to provide colleagues
with the tools needed to develop a
multimodal strategy for treating OA and
other challenging conditions.
The company began by importing a
range of long-established nutritional
supplements from North America for use in managing various small animal
conditions. More recently, it has become
the UK agent for a novel cell therapy
for joint disease cases seen in small
animal and equine practice [see report on
previous pages]. But the company is
becoming better known as the UK
supplier of a laser treatment technology
described at a meeting in London in
January.
Two years ago, the company started
importing therapeutic lasers produced by the Tennessee-based company K-
Laser and providing training and
technical support in using the kit. The
lasers are available to both human and
veterinary practitioners and are in
regular use at around 50 small animal
clinics across the country, Mr Barabas
said.
Far from being a new idea,
therapeutic lasers have been used by veterinary staff since the
1960s, he points out.
But the low power
output from earlier
technologies meant that
treatment sessions
would take far too long
to be cost effective.
These were Class 3
lasers delivering less than
0.2W in power while the
current technology is a
Class 4 device providing
up to 12W. So it is
capable of administering
energy as red and infrared light to
deeper-lying tissues and within a much
shorter period of a few minutes.
Along with the power output, the
other important factor for a clinical laser
is wavelength. The K-Laser machines
are designed to produce waves at the
peak absorption frequencies of three
key intracellular constituents: water,
haemoglobin and the enzyme
Cytochrome-C. As a result, irradiation
has a number of different effects,
creating a temperature gradient within
the cell, increasing local blood flow,
causing the haemoglobin molecule to release its oxygen load and
stimulating the enzyme to
increase local levels of
adenosine triphosphate.
Together these have a
bio-stimulatory effect
which studies suggest can
accelerate healing of a wide
range of injuries. Those
practices currently using
the equipment most
regularly apply it to musculoskeletal conditions
and both pre- and post-
operatively to encourage healing of surgical wounds. But there are
many other potential applications in
treating chronic injuries such as lick
granulomas and lymphocytic-plasmacytic
gingivitis stomatitis, he suggests.
At higher doses, laser therapy has also
been shown to have analgesic effects,
which practitioners have found to be
valuable in providing quality of life
improvements in severely arthritic dogs.
This may be linked to reduced levels of
inflammatory cytokines, such as tissue
necrosis factor, but Mr Barabas
acknowledges that here the mechanism of
action is something of a mystery. That certainly shouldn’t preclude the use of
laser therapy in those patients.
“In truth, we still don’t really
understand everything about the way
NSAIDs function. There are loose ends
with the science for many of the things
that we routinely use in practice.”
Applying an energy source to living
tissue would always have the potential
for causing harm although the worst
that might be expected with the laser is
some singeing of hair and surface
tissues. This is best avoided by giving
appropriate training for the vets and
VNs likely to be using the equipment.
His company provides both face-to-
face and on-line education based on the
systems introduced for technicians in
human hospitals. The US company also
provides regular software updates for
client practices as knowledge
accumulates and new treatment
protocols are devised.
Most of that information comes
from trials in human patients or from
preclinical studies in rodents. Mr
Barabas is confident that the evidence
from small animal studies will start to
come through but in the meantime
practitioners, clients and their animals
can safely make use of the benefits
derived from work on human guinea
pigs.
One important subject for future
trials would be an attempt to explain the
sustained benefits seen in some studies
which are unlikely to result from short-
term effects such as blood flow and
local oxygenation levels.
One recent Hungarian study, for
example, in human patients with severe
osteoarthritis of the knee joint
suggested that patients experienced a
71% reduction in pain levels and a 10%
improvement in joint mobility two
months after a single laser treatment.
Individualised treatment plans
Mr Barabas thinks it unlikely that such spectacular progress is likely to be
achieved with such minimal input in
many canine OA patients.
Indeed, clinicians are encouraged to
draw up individualised treatment plans
for these patients involving other forms
of therapy. But a typical protocol for a
dog with an elbow problem may involve
a thrice-weekly laser treatment in
combination with standard NSAIDs, a
further fortnight of twice weekly
sessions and a maintenance treatment
thereafter every second week.
Yet there is one area where the
benefits of laser therapy in veterinary
patients may outweigh those for
equivalent cases in human medicine.
Encouraging wound healing following
surgery is one area where the
technology is commonly applied for
both species but human patients are
generally more grateful for the
surgeon’s efforts.
“Animals don’t appreciate that you
have performed heroic surgery – it is
itchy and they want to chew the stitches
out. So anything that improves the rate
of wound healing and reduces
inflammation is a very positive thing,”
he notes.
The company website
(www.klaser.co.uk) features testimonials
from a number of UK client practices
highlighting the clinical value of the
technology. But are all users of the
equipment likely to be so positive, and
would those making a fairly expensive
acquisition be able to recoup the
investment?
“I don’t recall any case where the
technology hasn’t paid for itself within
nine months. Clients are very
enthusiastic about this service and are
happy to bring their animals into the
practice. There are other benefits as
well because the staff are seeing the
clients on a regular basis and can
explain the other services that will
improve the animal’s health.”
