CliniCal Guide to MlS laSer therapy · 2013-01-07 · CliniCal Guide to MlS® laSer therapy MLS Laser Therapy is a therapeutic approach to treating pain, inflammation, edema and wounds

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CliniCal Guide to MlS® laSer therapyMLS 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• P2P = 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.

• 3-2-1 = 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, P2P 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 P2P 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


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 P2P 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 main-tained, 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 P2P, 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.

DISCLAIMERIt 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 use-fulness 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.


Small animal

MlS laSer treatMent protoColSIndication MLS Setting P2P/Scan/

Alternating# Treatmentsand Timeline Special Notes

Abscess Incision, Drainage and Flush

Wound h. contamination F/B Acute/Chronic inflammation

P2P SID x 4-5

Abscess with Cellulitis,Incision, Drainage, and Flush

Wound h. contaminationF/B Acute/Chronic inflammation

Scan SID x 5-6

Allergic Pododermatitis Chronic inflammation Scan 2-3x / week or 3-2-1 As needed

Amputation Post surgical 1x, F/B Acute pain 2-3x, F/B Chronic pain (PRN)

P2P ImmediatePost Surg 1x, Acute pain

2-3 days, Chronic pain PRN

Anal Sacculitis / Acute Acute inflammation P2P 2-3x / week or 3-2-1

Anal Sacculitis / Chronic Chronic inflammation P2P 2-3x / week or 3-2-1 Then monthly

Anterior Cruciate LigamentTear - Chronic

Chronic inflammation P2P 2x / week 8-10 treatments, then PRN

Anterior Cruciate LigamentTear, Full - Acute

Acute inflammationP2P 1-2x

Until surgery or bracing

3-2-1 (See special notes)

At three weeks, switch to Chronic inflammation,

then 3-2-1, then monthly

Anterior Cruciate LigamentTear, Partial - Acute

Acute inflammationP2P for 1-2x,

then alt3x / week

1-3x per week for 3 weeks. Exercise restriction


MlS laSer treatMent protoColSSmall animal

Indication MLS Setting P2P/Scan/Alternating

# Treatmentsand Timeline Special Notes

Arthritic Conditions ArthritisP2P, or

Alternate2-3x / week or 3-2-1

P2P if location identified. Scan if not. Follow up

with 1 treatment every 3-4 weeks for maintenance.

Post Aural Hematoma(Surgery)

Post surgical P2P 1Acute inflammation 1x.

Immobilize ear, treat cause

BurnsWound h. contamination

followed by Wound healingP2P

Daily 3-5x then 2-3x / week until healed

Cover probe with plastic wrap or bag. Very light contact or

hold slightly off tissue.

Cauda Equina Syndrome Chronic inflammationAlternate

Start with P2P3-2-1

Maintenance every 3-4 weeks

Cystitis/Interstitial Acute or Chronic inflammation Scan 3-2-1 Maintenance every 2-4 weeks

Cystitis/Urethritis/FelineLower Urinary Tract Disease

Acute or Chronic inflammation Scan 3-2-1 Maintenance as needed

Cystotomy Chronic inflammation Scan During surgery

Decubital UlcersWound h. contamination 1-2x,

then Wound healingP2P

3-5x, then 2-3x / week until healed

Cover probe with plastic wrap or bag. Keep probe off wound.



Indication MLS SettingP2P/Scan/Alternating

# Treatments &Timeline

Special Notes

Degenerative Disc Disease IVDD P2PDaily to every other

day, 5x, then 2-3x / week.

PRN

Degenerative Joint Disease Chronic inflammationP2P, thenAlternate

2-3x / week or 3-2-1Maintenance every

3-4 weeks

Degloving WoundsWound h. contamination P2P

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 P2P Immediately post-op

Dorsolateral Hemilaminectomy

Back injury P2PImmediately post-op,

then 2-3x more

Edema Edema P2P 1-2x

Enterotomy Acute inflammation Scan During surgery

Feline Acne Chronic inflammation Scan 2-3x / week or 3-2-1 Be careful of thyroid

Feline Declaw Post surgical P2P Immediately post-op Also next day if in hospital

Feline Tail Pull Acute inflammation P2P 2-3x / week or 3-2-1

Femoral Head OstectomyPost surgical 1x, then Acute inflammation

P2P Immediately post-op Also next day if in hospital

FLUTD - Blocked Urethra Chronic inflammation Scan1x to relieve

blockage

3-2-1 for cystitis if needed (will not break up crystals but small ones may pass)




# Treatments and Timeline Special Notes

Fractures - After SurgeryPost surgical, then Acute inflammation

P2P 2-3x / week or 3-2-1

GingivitisAcute inflammation

Chronic inflammationP2P

2-3x, based onseverity

Determine acute or chronic (Not a substitute for cleaning)

Hernia RepairPost surgical, then Acute inflammation

P2P or Scan

2-3x / week or 3-2-1 Post-op

Hip Dysplasia Chronic pain P2P for 1-2x, then alt 2-3x / week or 3-2-1 Every 3-4 weeks as needed

Hot Spots Wound h. contamination P2P 3-2-1Treat with other modalities,

pharmaceuticals

Inflammatory Bowel Disease Chronic inflammation P2P 2-3x / week or 3-2-1

Insect Bite/Snake BiteWound h. contamination 1-3x, then Acute inflammation 1-3x

P2P or Scan

1x, may need 3-2-11-3x, depending on bite

severity

Intervertebral Disc Disease IVDD P2P 2-3x / week or 3-2-1 May need follow up treatment

Intra-abdominal Wound healing Scan 1x during SurgeryCover area or probe w/ clear sterile material

Joint Injury - Acute Acute pain P2P for 1-2x, then alt Once - up to 6xFrequently improves after

1 treatment

LesionsWound healing or

Wound h. contaminationP2P 2-3x / week or 3-2-1

Determine if contaminated.Address until resolved.

Lick Granulomas Wound h. contamination P2PDaily or

2-3x / week or 3-2-1Depends on size. Determine S,M,L





Luxating PatellaPost surgical 1x, then Acute inflammation

P2P 3-2-1Treat after surgery, not as a

substitute.

Musculoskeletal Pain Sprain/Strain Scan 1-3x, once daily

Myofascial Pain Acute or Chronic pain Alternate 2-3x / week or 3-2-1

Nerve Regeneration Chronic inflammation Scan 2-3x / week or 3-2-1Scan or P2P, depending on

area size

Neuropathies Acute pain Scan 2-3x / week or 3-2-1

Orchidectomy Canine and Feline

Post surgical P2PImmediately post-op 1x

Otitis - Acute Acute inflammation P2P 2-3x / week or 3-2-1Then every 3-4 weeks,

if chronic

Otitis Externa - w/infection Chronic inflammation P2P 2-3x / week or 3-2-1

Otitis Externa - w/o Infection Acute inflammation P2P 2-3x / week or 3-2-1

Otitis Media / Externa -Chronic

Chronic inflammation P2P 2-3x / week3-2-1, then once every

3-4 weeks

Ovariohysterectomy Canine and Feline

Post surgical P2PImmediately post-op 1x

Perianal Fistulas Chronic inflammation P2PDaily for 3-5 days,then 2-3x / week

Use with pharmaceuticals

Periodontal Diseases Chronic inflammation P2P 2-3x / week or 3-2-1 Determine acute or chronic





Post Performance Soreness Acute inflammation P2PImmediately, thenonce daily for 2-3days, if needed

Post surgical Post surgical Alternate Immediately post-opDo not use after cancer surgery

Puppy Tail DockPost surgical 1x, then

Acute pain 1xP2P

Immediately post-op

Pyotraumatic Dermatitis Chronic inflammation Scan Daily for 3-5 days Lower as healing progresses

Rhinitis/Sinusitis Chronic inflammation P2P 2-3x / week or 3-2-1Stay away from eyes.

Contraindicated if tumor or epistaxis.

Ringworm LesionsWound healing or

Wound h. contaminationP2P

2-3x / week until healed

Determine If contaminated

Routine Dental with Extraction Post surgical 1x, F/B Acute pain 1x P2P Once

Sciatica IVDD P2P 2-3x / week or 3-2-1 Maintenance

Scoliosis Back injury P2P 2-3x / week or 3-2-1 Maintenance

Self Mutilation Wound healing P2P 2-3x / week or 3-2-1 Pharmaceuticals, Barrier

Sprain or Strain - Minor Sprain/Strain P2P Once

Sprain or Strain - Severe Sprain/Strain Scan or P2P 2-3x weekP2P if location identified,

scan if not





Staph Infections -Local Wound h. contamination Scan 2x / weekPut plastic wrap over probe. Use

in conjunction with topical and immuno-boosting medication

Sterile PyogranulomatousSyndrome

Chronic inflammation ScanDaily for 2-3x, then

2-3x / week

Stifle Surgery – TPLO/TTAPost surgical immediately 1x,

then Acute inflammationP2P 3-2-1

Stomatitis Chronic inflammation P2PDaily (Depends how chronic)

Can also use 3-2-1 (6-12treatments, then maintenance)

Tendon & Ligament Injury Acute pain or Sprain/Strain P2P or Scan 2-3x / week or 3-2-1P2P if location identified,

scan if not

Tightrope/ExtracapsularTreat knee joint w/Acute inflam-mation, then Chronic inflamma-

tion. Avoid tightrope area.P2P 3-2-1

Wait 6 weeks for scar to form, then Chronic inflammation

Traumatic & Overuse Injuries Acute/Chronic pain Scan 2-3x / week or 3-2-1

Trigger Point10Hz, 50% intensity4 seconds per point

P2P(See special

notes)Repeat every 2 days until

disappearance of reactivity

Vasculitis - Non-infectious Chronic inflammation P2P 2-3x week or 3-2-1 Be careful of possible thrombosis

Wounds Wound h. contamination/

Wound healingP2P Daily 3-5x

Decrease treatments as healing progresses


MlS laSer treatMent protoColS

aVian



Avian Vesicular Dermatitis Chronic inflammation P2P 3+ Until healed

Egg Peritonitis Acute inflammation P2P 1

Gangrenous Dermatitis Wound h. contamination P2P 3+ Until healed

Self Mutilation Wound h. contamination P2P 3+ Depending on severity


MlS laSer treatMent protoColSIndication MLS Setting P2P/Scan/

Alternating# Treatmentsand Timeline Special Notes

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

Mouth Rot (Stomatitis) Chronic inflammation P2PDaily, depends on

how chronicCan use 3-2-1 (6-12 treat-ments, then maintenance)

Pododermatitis (Bumblefoot) Wound h. contamination

Acute/Chronic inflammation P2PDaily, depends on

how chronicCan use 3-2-1 (6-12 treat-ments, then maintenance)

Wounds - Snakes Wound h. contamination P2P2-3x per week or

3-2-1For best results, wait for

snake to shed skin

EXOTiCS


MlS laSer treatMent protoColSlaRGE animal



Bone Spurs

Phase 1: 73 Hz, 2 J/point, 4 sec/point, 0.64 J/cm2

Phase 2: 10 Hz, 2 J/point, 4 sec/point, 0.64 J/cm2

P2P1-2x/wk for 3 wks, stop for 1 wk, then repeat if needed

Treatment in two phases during the same session.

Bowed Tendons - Acute Acute inflammation P2P 4+

Bowed Tendons - Chronic Chronic inflammation P2P 6+ May have to follow up

Epiphysitis Acute inflammation P2P 6+ May have to follow up

Hoof Abscesses Wound h. contamination P2P 3+ Until healed

Laminitis Acute inflammation P2PTreat every day until

pain is reduced.

Navicular Acute pain P2P 3+ Until healed

Ringbone Chronic pain P2P 6 every other day Once a month

Stifle Disorders Acute or Chronic pain P2P 4+ Depending on how long

Sublux of Sacroiliac joint Acute or Chronic inflammation P2P 3+ Depending on the severity

Suspensory Disorders Acute inflammation P2P 3+ Depending on how long

Tendonitis/Desmitis - Acute Acute inflammation P2P 2+ Until healed

Tendonitis/Desmitis - Chronic

Chronic inflammation P2P 6 every other day Maybe once a month

Tendosynovitis Acute inflammation P2P 2+ Until healed

Documents

CliniCal Guide to MlS laSer therapy · 2013-01-07 · CliniCal Guide to MlS® laSer therapy MLS Laser Therapy is a therapeutic approach to treating pain, inflammation, edema and wounds