Clinical Guide to MLS Laser Therapy

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Merilyn Dawson
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1 Clinical Guide to MLS Laser Therapy MLS Laser Therapy is a therapeutic approach to treating pain, inflammation, edema and wounds. The fundamental parameters that characterize MLS Laser Therapy are: frequency of pulses, repetition, treatment time, and emission intensity. This guide will help you to determine the best parameters for the condition being treated. While it is by no means a complete list of treatable pathologies, it is designed to help the user develop a comfort level in applying the device over a broad range of indications. The following operating tips and terminology will assist you in using the guide. Terminology = Point to Point This treatment method allows the probe to rest lightly on the skin for the duration of each timed point to allow maximum saturation of tissue at depth. This technique will NOT result in overheating of tissue = Three treatments the first week, two the second, and one the third SID x 4-5 = Once per day for 4-5 days Acute generally refers to an orthopedic condition that is less than 10 days old, or a medical condition 1-2 days old. Chronic generally refers to an orthopedic condition that is more than 10 days old or a medical condition more than 2 days old. Maintenance = 1 treatment every 2-4 weeks F/B = Followed by Operating tips Device The MLS device never needs calibration; however, a simple performance check may be performed by setting the device to Sprain & Strain setting, pointing it at a non-reflective surface, and viewing the emissions pattern through an inexpensive digital camera. All energy is developed in the MLS handpiece, rather than being sent through a fragile fiber-optic. While this eliminates costly cable breakage, it does mean that the handpiece is independently cooled. Be sure to keep the cooling slots on the handpiece unobstructed. The legs on the back of the device should be deployed during use, to assist display readability and to allow cool air to enter the vents under the unit. The MLS Laser will generally operate for about 3 hours of treatment time on a full charge, and approximately 2 hours with the larger Equine Probe. Average treatment time is a few minutes, so generally a full charge will last all day. The unit may be left plugged-in indefinitely, and does not need to fully discharge prior to recharge. Thus, when possible, leave the unit plugged-in to top off. When using the probe intraoperatively or in a sterile environment, if contact is desired, any sterile, clear membrane may be used to protect the sterile area from the probe tip, by either covering the treatment area, or the probe tip itself. Be sure to keep the ventilation slots unobstructed on the handpiece if applying for greater than 90 seconds. Settings MLS Laser settings are indicated in boldface. Generally, mode is used for maximum saturation of energy to depth, and/ or when the precise location of the treatment area is known. Scan mode is used for treating indications requiring less energy to deep seated pathology, or when precise target area is difficult to establish. Scan mode will provide more complete surface coverage and less energy to depth. The Small / Medium / Large setting describes treatment area size, not patient size. The default size is composed of 6 points (1 business card), 12 points (a 3 x5 index card), and 18 points (a 5 x7 recipe card). The scan setting will be the same overall default sizes, but without any pauses during the treatment cycle. Some incidental emissions overlap is perfectly normal and presents no problems, as emissions levels are well within known safe parameters. If the treatment area does not match the default (6, 12 or 18 points), two options are possible. At the end of the default selected (small, medium or

2 large), the treatment regimen may simply be shortened by the appropriate number of points, or restarted and applied for the remaining additional number of points until complete. Models without S/M/L selection may simply use a second or third consecutive treatment duration (whole or partial) as needed to accommodate either the required number of points (as determined by the treatment size area), or the desired scan area. If a specific dosage target is desired, but with fewer or greater points, simply note the total default treatment time indicated, and add or subtract points until the target number of points appears. Then add or subtract treatment time to match the original default time. On models without self-calculation of points, the total treatment time should be divided by six points, pausing (with the probe trigger switch) and relocating the probe at the conclusion of each point duration, and then retriggering the probe at the new point. Total dose may be increased by up to 25 Joules when addressing persistent chronic conditions. On applicator with phototype setting, W and B refers to the patient s skin color, NOT fur/hair color. Be sure to place probe next to skin. While the MLS Laser presets were determined based on the results of 30 years of research, the device is completely customizable in terms of its emissions. If you wish to establish custom protocols, simply refer to the manual, dial in the parameters, and save. Positioning When the device is used in Scan mode, there is no need to move the probe quickly, as there is no concern for overheating. Rather, a steady, measured movement over the target area is ideal. Light skin contact should be maintained, except in the case of a sterile environment, in which case drawing the probe slightly away from the surface is perfectly acceptable. This is especially true if used intra-operatively. Knowledge of anatomy, and utilization of palpation to optimally locate the probe will maximize treatment results. Fur does not need to be clipped or shaved, and it is NEVER necessary to wet the fur. MLS Laser does not create thermal concerns due to interaction with water. When using the probe, it is advised to move against the grain of the fur when in scan mode to optimize penetration, and in the case of, to establish the point location of the probe. Focal distance for Multidiodic Applicator (MDA) is 8 from tissue surface. Other tips Always conduct a proper workup of the animal prior to treatment. For example, pain/mobility loss may be a result of neoplasia or other immuno-compromised conditions, and use of the laser is contraindicated in such cases. Protective eyewear should always be worn according to the manufacturer s specifications. Doggles are provided for the animals, or a dark cloth may be used to cover eyes. There is no compromise in treating dark skinned patients with the MLS Laser; rather, a special variance method is used to accommodate the different absorption characteristics of increased melanin presence in the dermis. This results in precisely the same energy and impulse pattern, with no sacrifice in performance, but a slight increase in time, to allow maximum saturation of the target tissue. Animals may be treated for multiple indications with no concern of overexposure. When treating for mobility related issues, it is recommended that consideration be given to treating some related, but non-indicated areas as well. For example: an animal being treated for a wound may also be placing stress in inappropriate places, introducing inflammation or pain during the course of favored movement. Addressing both areas will yield better clinical results. Please be aware that MLS Laser Therapy will often result in substantial pain relief and mobility gain after as little as one treatment; however, the animal should continue to be kept in a low activity state until the treatment protocol has been completed, or re-aggravation is risked. This is especially true of large animal applications. In general, treatments should be given no more than once every 24 hours. DISCLAIMER It is the responsibility of the practitioner to gain the knowledge of and comply with federal, state and local laws regarding the use of lasers for the treatment of any condition. The content and information in this Guide is educational only and is designed as an addendum to training. This Guide is not a substitute for professional medical advice, care, diagnosis, or treatment. The treatment of any disease or syndrome should be under the supervision of a qualified veterinarian. Cutting Edge and ASA do not warrant or assume any legal liability or responsibility for the accuracy, completeness, or usefulness of any information, apparatus, product or process disclosed in this Guide. Therefore, the companies are not liable for any kind of loss, risk, or other problem that is sustained as a result of consulting this Guide, or from using information obtained in this Guide.

3 Abscess Incision, Drainage and Flush Small Animal F/B Acute/Chronic inflammation /Scan/ SID x 4-5 Abscess with Cellulitis, Incision, Drainage, and Flush F/B Acute/Chronic inflammation Scan SID x 5-6 Allergic Pododermatitis Chronic inflammation Scan 2-3x / week or As needed Amputation Post surgical 1x, F/B Acute pain 2-3x, F/B Chronic pain (PRN) Immediate Post Surg 1x, Acute pain 2-3 days, Chronic pain PRN Anal Sacculitis / Acute 2-3x / week or Anal Sacculitis / Chronic Chronic inflammation 2-3x / week or Then monthly Anterior Cruciate Ligament Tear - Chronic Chronic inflammation 2x / week 8-10 treatments, then PRN Anterior Cruciate Ligament Tear, Full - Acute 1-2x Until surgery or bracing (See special notes) At three weeks, switch to Chronic inflammation, then 3-2-1, then monthly Anterior Cruciate Ligament Tear, Partial - Acute for 1-2x, then alt 3x / week 1-3x per week for 3 weeks. Exercise restriction

4 Arthritic Conditions Post Aural Hematoma (Surgery) Burns Cauda Equina Syndrome Small Animal Arthritis /Scan/, or Alternate 2-3x / week or Post surgical 1 followed by Wound healing Chronic inflammation Alternate Start with Daily 3-5x then 2-3x / week until healed if location identified. Scan if not. Follow up with 1 treatment every 3-4 weeks for maintenance. 1x. Immobilize ear, treat cause Cover probe with plastic wrap or bag. Very light contact or hold slightly off tissue. Maintenance every 3-4 weeks Cystitis/Interstitial Acute or Chronic inflammation Scan Maintenance every 2-4 weeks Cystitis/Urethritis/Feline Lower Urinary Tract Disease Acute or Chronic inflammation Scan Maintenance as needed Cystotomy Chronic inflammation Scan During surgery Decubital Ulcers 1-2x, then Wound healing 3-5x, then 2-3x / week until healed Cover probe with plastic wrap or bag. Keep probe off wound.

5 Small Animal Indication /Scan/ Degenerative Disc Disease IVDD & Timeline Daily to every other day, 5x, then 2-3x / week. PRN Degenerative Joint Disease Chronic inflammation, then Alternate 2-3x / week or Maintenance every 3-4 weeks Degloving Wounds Daily 3-5 days then 2-3x / week until healed Cover probe. Very light contact or hold slightly off tissue. Dewclaw Removal Post surgical 1x, then Acute pain 1x Immediately post-op Dorsolateral Hemilaminectomy Back injury Immediately post-op, then 2-3x more Edema Edema 1-2x Enterotomy Scan During surgery Feline Acne Chronic inflammation Scan 2-3x / week or Be careful of thyroid Feline Declaw Post surgical Immediately post-op Also next day if in hospital Feline Tail Pull 2-3x / week or Femoral Head Ostectomy Post surgical 1x, then Immediately post-op Also next day if in hospital FLUTD - Blocked Urethra Chronic inflammation Scan 1x to relieve blockage for cystitis if needed (will not break up crystals but small ones may pass)

6 Fractures - After Surgery Gingivitis Hernia Repair Small Animal Post surgical, then Chronic inflammation Post surgical, then /Scan/ 2-3x / week or or Scan 2-3x, based on severity Determine acute or chronic (Not a substitute for cleaning) 2-3x / week or Post-op Hip Dysplasia Chronic pain for 1-2x, then alt 2-3x / week or Every 3-4 weeks as needed Hot Spots Inflammatory Bowel Disease Chronic inflammation 2-3x / week or Insect Bite/Snake Bite 1-3x, then 1-3x or Scan 1x, may need Treat with other modalities, pharmaceuticals 1-3x, depending on bite severity Intervertebral Disc Disease IVDD 2-3x / week or May need follow up treatment Intra-abdominal Wound healing Scan 1x during Surgery Joint Injury - Acute Acute pain for 1-2x, then alt Once - up to 6x Lesions Wound healing or Lick Granulomas 2-3x / week or Daily or 2-3x / week or Cover area or probe w/ clear sterile material Frequently improves after 1 treatment Determine if contaminated. Address until resolved. Depends on size. Determine S,M,L

7 Luxating Patella Small Animal Post surgical 1x, then /Scan/ Musculoskeletal Pain Sprain/Strain Scan 1-3x, once daily Myofascial Pain Acute or Chronic pain Alternate 2-3x / week or Nerve Regeneration Chronic inflammation Scan 2-3x / week or Neuropathies Acute pain Scan 2-3x / week or Orchidectomy Canine and Feline Post surgical Immediately post-op 1x Otitis - Acute 2-3x / week or Otitis Externa - w/infection Chronic inflammation 2-3x / week or Otitis Externa - w/o Infection 2-3x / week or Otitis Media / Externa - Chronic Ovariohysterectomy Canine and Feline Chronic inflammation 2-3x / week Post surgical Perianal Fistulas Chronic inflammation Immediately post-op 1x Daily for 3-5 days, then 2-3x / week Treat after surgery, not as a substitute. Scan or, depending on area size Then every 3-4 weeks, if chronic 3-2-1, then once every 3-4 weeks Use with pharmaceuticals Periodontal Diseases Chronic inflammation 2-3x / week or Determine acute or chronic

Small Animal /Scan/ Post Performance Soreness Immediately, then once daily for 2-3 days, if needed Post surgical Post surgical Alternate Immediately post-op Puppy Tail Dock Post surgical 1x, then

8 Small Animal /Scan/ Post Performance Soreness Immediately, then once daily for 2-3 days, if needed Post surgical Post surgical Alternate Immediately post-op Puppy Tail Dock Post surgical 1x, then Acute pain 1x Immediately post-op Do not use after cancer surgery Pyotraumatic Dermatitis Chronic inflammation Scan Daily for 3-5 days Lower as healing progresses Rhinitis/Sinusitis Chronic inflammation 2-3x / week or Ringworm Lesions Wound healing or 2-3x / week until healed Routine Dental with Extraction Post surgical 1x, F/B Acute pain 1x Once Stay away from eyes. Contraindicated if tumor or epistaxis. Determine If contaminated Sciatica IVDD 2-3x / week or Maintenance Scoliosis Back injury 2-3x / week or Maintenance Self Mutilation Wound healing 2-3x / week or Pharmaceuticals, Barrier Sprain or Strain - Minor Sprain/Strain Once Sprain or Strain - Severe Sprain/Strain Scan or 2-3x week if location identified, scan if not

Small Animal /Scan/ Staph Infections -Local Scan 2x / week Sterile Pyogranulomatous Syndrome Stifle Surgery TPLO/TTA Chronic inflammation Post surgical immediately 1x, then Scan Stomatitis Chronic

joint w/, then Chronic inflammation. Avoid tightrope area.

9 Small Animal /Scan/ Staph Infections -Local Scan 2x / week Sterile Pyogranulomatous Syndrome Stifle Surgery TPLO/TTA Chronic inflammation Post surgical immediately 1x, then Scan Stomatitis Chronic inflammation Daily for 2-3x, then 2-3x / week Daily (Depends how chronic) Tendon & Ligament Injury Acute pain or Sprain/Strain or Scan 2-3x / week or Tightrope/Extracapsular Treat knee joint w/, then Chronic inflammation. Avoid tightrope area Traumatic & Overuse Injuries Acute/Chronic pain Scan 2-3x / week or Trigger Point 10Hz, 50% intensity 4 seconds per point (See special notes) Put plastic wrap over probe. Use in conjunction with topical and immuno-boosting medication Can also use (6-12 treatments, then maintenance) if location identified, scan if not Wait 6 weeks for scar to form, then Chronic inflammation Repeat every 2 days until disappearance of reactivity Vasculitis - Non-infectious Chronic inflammation 2-3x week or Be careful of possible thrombosis Wounds / Wound healing Daily 3-5x Decrease treatments as healing progresses

11 AVIAN Indication /Scan/ Avian Vesicular Dermatitis Chronic inflammation 3+ Until healed Egg Peritonitis 1 Gangrenous Dermatitis 3+ Until healed Self Mutilation 3+ Depending on severity

EXOTICS Indication /Scan/ Gastritis and Enteritis Acute/Chronic inflammation Scan 3-2-1 Maintenance as needed

on how chronic Daily, depends on how chronic Can use 3-2-1 (6-12 treatments, then maintenance) Can use 3-2-1

12 EXOTICS Indication /Scan/ Gastritis and Enteritis Acute/Chronic inflammation Scan Maintenance as needed Mouth Rot (Stomatitis) Chronic inflammation Pododermatitis (Bumblefoot) Acute/Chronic inflammation Daily, depends on how chronic Daily, depends on how chronic Can use (6-12 treatments, then maintenance) Can use (6-12 treatments, then maintenance) Wounds - Snakes 2-3x per week or For best results, wait for snake to shed skin

Bone Spurs LARGE ANIMAL /Scan/ Phase 1: 73 Hz, 2 J/point, 4 sec/point, 0.

64 J/cm 2 1-2x/wk for 3 wks, stop for 1 wk, then repeat if needed Bowed Tendons - Acute 4+ Treatment in two

Bowed Tendons - Chronic Chronic inflammation 6+ May have to follow up Epiphysitis 6+ May have to follow up Hoof

Navicular Acute pain 3+ Until healed Ringbone Chronic pain 6 every other day Once a month Stifle Disorders Acute

13 Bone Spurs LARGE ANIMAL /Scan/ Phase 1: 73 Hz, 2 J/point, 4 sec/point, 0.64 J/cm 2 Phase 2: 10 Hz, 2 J/point, 4 sec/point, 0.64 J/cm 2 1-2x/wk for 3 wks, stop for 1 wk, then repeat if needed Bowed Tendons - Acute 4+ Treatment in two phases during the same session. Bowed Tendons - Chronic Chronic inflammation 6+ May have to follow up Epiphysitis 6+ May have to follow up Hoof Abscesses 3+ Until healed Laminitis Treat every day until pain is reduced. Navicular Acute pain 3+ Until healed Ringbone Chronic pain 6 every other day Once a month Stifle Disorders Acute or Chronic pain 4+ Depending on how long Sublux of Sacroiliac joint Acute or Chronic inflammation 3+ Depending on the severity Suspensory Disorders 3+ Depending on how long Tendonitis/Desmitis - Acute 2+ Until healed Tendonitis/Desmitis - Chronic Chronic inflammation 6 every other day Maybe once a month Tendosynovitis 2+ Until healed

Reference Guide to Common Conditions. for: CTL-6 CTL-10

Reference Guide to Common Conditions for: Reference Guide to Common Conditions for: This manual of treatment guidelines for Class IV laser therapy is for small animal veterinarians using a Companion and