The Economics of Laser Therapy: A Personal Look at the Value of Therapeutic Lasers

Therapeutic lasers, or cold lasers, are a big investment, and several questions need to be considered if you are planning to purchase one. Or maybe you already have a laser and the monthly payments are not being covered by the money that is coming in from utilizing it. Perhaps your laser is paid for and gathering dust. No matter what group you are in, this article will address these issues and help inform your decision either to buy a laser (or not) or to dust off the laser you have and give it one more try.

A laser can be used for a large variety of medical issues, but you will find it most useful for pain management.

by Michael C. Petty, DVM, CCRT, CVPP, DAAPM

The acquisition of a new piece of equipment is almost always an angst-inducing venture. Will you see a positive return on investment? Will your staff embrace new technology? Will your clients be open to a new diagnostic or therapeutic procedure? What kind of learning curve will it take to become comfortable with the equipment?

Therapeutic lasers, or cold lasers, are a big investment, and all these questions need to be considered if you are planning to purchase one. Or maybe you already have a laser and the monthly payments are not being covered by the money that is coming in from using it. Perhaps your laser is paid for and gathering dust.

No matter which group you are in, I will address these issues and share my experience to help inform your decision either to buy a laser (or not) or to dust off the laser you have and give it one more try. I have made most of the mistakes new laser owners make and can help you avoid those pitfalls.

The Basics

First of all, what is laser therapy? It is increasingly being called photobiomodulation therapy to differentiate it from surgical lasers and industrial lasers. Photo for light, bio for the living tissues it performs its action on, and modulation for the changes it causes in those tissues. I am not going to go into the exact mechanisms of photobiomodulation, as it is beyond the scope of this article, but I will talk about features you will want to look for if you are considering the purchase of a new laser.

A laser can be used for a large variety of medical issues, but you will find it most useful for pain management. There are other modalities that can be used to treat the same issues, such as acupuncture and rehabilitation therapy, but in general, lasers have the shallowest learning curve, and they have a wide range of applications for your patients.

Even though I am certified in acupuncture and rehabilitation, I often reach for my laser either as an adjunct treatment or as the primary therapy. Lasers are especially useful with certain animals, especially cats, who may be resistant to directed exercises or having needles inserted in them. Finally, it is a low-stress therapy. In my practice, animals get to rest on an ottoman if they desire, and they often fall asleep during treatment.

Here is a list of medical conditions that are commonly treated with lasers.

A golden retriever being treated for elbow osteoarthritis and taking a nap during therapy.

Osteoarthritis (OA). This is by far the main reason I use my laser. I own a pain-management-focused practice and employ other physical modalities as well, but I still find my laser to be a useful tool for treating the pain of OA. In fact, sometimes I need to use my laser for several sessions to reduce the OA pain in order to proceed with modalities that have the potential to cause their own pain, such as rehabilitation and massage. A study in the September 2018 edition of the Canadian Veterinary Journal has an article on treating elbow OA in dogs, one of the hardest joints to treat for pain.

Postoperative pain and wound healing. Treating an incision you made for a surgical procedure not only can reduce the pain in the immediate postoperative period, it can also reduce the healing time of the incision. The same is true for wounds caused by other things, such as lacerations and bite wounds.

Dermatologic issues. My primary dermatology therapeutic is for ear infections, as this is a problem we usually see on a daily basis. This doesn’t mean I don’t send home appropriate medications, but it is a value-added service that can kick-start the healing phase of an ear infection, and by reducing some of the inflammation, it will also reduce the level of pain, making it easier for the owner to medicate that ear at home. Other dermatologic therapies I use it for are lick granulomas, pyogranulomatous dermatitis, and anal gland sacculitis.

Soft tissue injuries. Although not as common, soft tissue injuries can also benefit from a laser. Injured tendons and ligaments come in painful and inflamed, and quickly reducing that inflammation can help prevent the further degradation of that ligament or tendon, possibly avoiding more expensive surgical procedures.

Neurologic issues. Almost any issue can be treated with a laser. Intervertebral disc disease, fibrocartilaginous embolism, wobblers, syringomyelia, and even degenerative myelopathy can benefit. Soon-to-be-published information shows that laser in combination with rehabilitation therapy may also be helpful in slowing the progression of degenerative myelopathy. For many of these diseases, the owners have been told there is only a surgical option or euthanasia. Your clinic can now offer the less expensive and less invasive option of photobiomodulation.

Westie Lung Disease. Although I only see one of these every several years, chronic idiopathic pulmonary fibrosis, commonly known as Westie Lung Disease, responds remarkably well to photobiomodulation. With these cases, you are always a hero: Many of these West Highland white terriers’ owners have been searching for a solution for years, with their dogs enduring the disease and certain medications classically used to treat it, such as oral corticosteroids. (See sidebar for more information.)

Lasers with built-in protocol settings add a layer of convenience and safety.

A laser with a condition selection screen will save you lots of time.

Using the Laser in Your Practice

One of the best things about laser therapy is that, as a veterinarian, I almost never need to laser an animal myself. My technicians and veterinary assistants are perfectly capable of performing the treatments without me, after I have explained the areas to be treated and helped them set up the proper protocol. This frees me up to see other clients or perform procedures that my technicians cannot do themselves. Having their own area of treatment increases job satisfaction and feelings of value in my technicians. Even better, this is such a relaxing therapy that seldom is the case that requires a second person for restraint. Most patients simply relax and enjoy a cat treat or lick peanut butter for the duration of the short therapy.

What about the clients? As long as they are willing to wear the proper eye protection, we allow our clients to be present for all laser sessions. They get to chat with our technicians during the procedure, and they find it comforting to be there instead of their pet being taken to the “back room,” where they might imagine struggles and restraint.

What to Charge?

Of course, everyone wants to know about pricing. Some clinics offer “package” deals where clients prepay for a set number of treatments. In my practice, I have clients pay as they go, primarily because I offer so many hands-on modalities.

For example, sometimes I decide to do physical therapy instead of laser therapy and don’t want to be tied into a set schedule. For one- or two-time treatments like otitis or anal sacculitis, I charge a flat fee. When I am looking at therapy for a chronic issue, I charge one fee for the first region and then a fee per each additional region. For more detailed information on pricing, see The Veterinary Fee Reference, Tenth Edition [AAHA Press, 2018].)

What Kind of Laser Should I Buy?

I cannot recommend one specific brand or type of laser. Although I have used several different brands, I have not used them all, so it would be unfair to make an incomplete recommendation. But I will go through my “list of rules” that I would use myself should I ever have to buy another laser for my practice.

1. Buy a Class IV laser. I own both Class IIIb and Class IV lasers. I was initially attracted to the IIIb for a variety of reasons. The first was cost, as it was a fraction of the price of a stronger laser. The second was the power of the Class IV lasers; at the time when I bought my Class IIIb, the therapy time was only slightly longer than that of the Class IV, but this is no longer true. Class IV lasers are so much more powerful than they were just a decade ago that many treatments just take a few minutes, even when treating deep-tissue conditions. The third reason was a concern for user safety. Although eye damage can occur with both lasers, it only takes a second of retinal contact with a Class IV to cause permanent damage. As we have become more comfortable with both using lasers and the proper use of eye protection, eye damage is something to be considered but no longer worried about. And the fourth and last reason we bought a IIIb is patient safety. Many of the Class IV lasers do not take into account issues like skin and hair color, coat density, and so forth. There was a real potential for patient injury. But with the proper safeguards in place, this also becomes less of an issue, This leads me to my next rule.

2. Buy a laser that has built-in safety and treatment protocols. Especially if you are a first-time laser owner, buy one that provides real-time feedback. “Lower the dose by X% if the animal has dark skin” just isn’t good enough. Not only is it relying on your calculation and opening up the potential for a math error, it increases your time commitment to each and every treatment. No one wants to set a patient’s hair on fire or cause a burn to the skin. Instead, look for a laser that comes with its own protocols: one that optimizes for things like skin and hair type and animal size, and another that can automatically adjust the duration and strength of therapy depending on what area of the body and depth of tissue are being treated.

3. Buy a laser that allows you to tell it what condition you are treating. Maybe it is osteoarthritis for this patient, but it is an ear infection in the next. The time savings are invaluable when you don’t have to look up each condition on a chart and do your own calculations. Make sure it shows you total joules and watts for your medical records.

4. Buy a laser that will allow you to program in protocols for all of the species you expect to treat. Sometimes the odd pet will come in—for example, a bird or a reptile. Or even a large animal like a horse.

5. Ask what kind of customer support you will receive from the vendor. This includes company-sponsored webinars, hands-on courses, and clinical case consultation. These classes should not only be about using their product but also focus on varied topics, including diagnosing different conditions amenable to laser therapy. Also see if the vendor will help you set up a fee schedule for your practice area and for each of the conditions you want to treat. They may not be able to give you list of charges, but they can certainly suggest a range of charges based on the time involved in treating each condition. Some companies even provide you with business tools to jumpstart your laser program.

6. Ask about warranty and repairs. Do they repair their own equipment? I broke my fiber optic cable on my laser three days after I got it. My laser company sent me a new one at no charge. If it is a major repair, will they give you a loaner? Because believe me, once you have that laser as part of your treatment protocol, you will feel like you cannot practice without it.

So is a laser right for your practice, or is it time to dust off the one you have and make it earn its place in your practice? Each practice has to answer the questions I posed at the beginning of this article, but if you can imagine you and your staff making a commitment to use the laser, you see some of the treatable conditions I have talked about, and your clients are like mine and are always asking about nonpharmaceutical options, then the answer is probably yes.

GS_box.jpgLasers for Westie Lung Disease Therapy

Although most terriers are susceptible, chronic idiopathic pulmonary fibrosis is a disease that is most commonly seen in West Highland white terriers (Westies) and is usually referred to as Westie Lung Disease. The disease has a slow progression, often starting with an occasional cough, which progresses with the severity of the disease along with respiratory distress and exercise intolerance. This disease is often mistaken for pneumonia or congestive heart failure.

Treatment using prednisolone and treating comorbidities have been unrewarding. Many of these dogs do not live more than one year after diagnosis.

More recently, laser therapy has proved beneficial, as it did with Emmie Lou, a spayed female 12-year-old Westie who had been treated unsuccessfully with daily corticosteroid therapy for a few years. She presented with the typical end-stage signs of this disease: dyspnea, coughing, and very low exercise tolerance.

Emmie Lou was started with laser therapy, using the laser’s thoracic disorders protocol every other day for a total of five treatments. We treated the lung fields over both sides and at the thoracic inlet. The owners noticed an almost-immediate improvement: She was no longer dyspneic, there was an increase in her ability to exercise, and her coughing episodes went from several times an hour to a few times per day. The interval between treatments was gradually increased to once every two weeks, which seems to be the longest Emmie Lou can go without relapse of continual coughing. She has been receiving therapy for 18 months with no sign of deterioration.

 

Mike Petty, DVM, CCRT, CVPP, DAAPM, is in private practice in Canton, Michigan. He is a frequent national and international lecturer on topics related to pain management. He was also a member of the task force for the 2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats.

 

Photo credits: ©iStock.com/DenGuy, photo courtesy of Mike Petty, ©iStock.com/Sladic, photos courtesy of Companion Animal Health

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