Thank you, Bruce. And, thank you, everyone who's, found the time to tune in tonight. as Bruce says, I am a consultant on laser therapy, and, my vested interest obviously is the fact that, I do sell a laser.

I sell K laser on the therapy and I sell a CO2 laser on the surgical side. So, I, I hope this will be as unbiased as possible, a lecture for you, because it is meant to be an overview, because, 8 years ago, I, I was relatively clueless about lasers. But having lived and worked in the USA, I saw the rise of laser therapy over there.

And when I came back to the UK, I, was interested, and, set my own business up, VBS Direct, which is where we grew from, and, took on all the different equipment that we sell today. So I hope you find this interesting, and hopefully there'll be questions at the end. But I know this is going to be available on webinarett if you would like to look at it at a later date.

So this is a general overview and I can get this working. The next slide. OK, all right.

So, this is what we will be covering tonight. So hopefully you'll get some core science and understand. Differences and why lasers can treat equine patients from the skin, to do structures and sacroiliacs, backs, tendon injuries.

Also understand why there's differences in laser technology, so that actually the crux of the problem is the fact, the word laser, that it sort of covers all different lasers and therefore, you know, it doesn't really blend itself well for meta-analysis. You need to look at the individual laser and what it's designed for. And then we'll look at a range of applications for equine medicine, and then there'll be a short bit on publications and a, and a couple of, case studies with some, aspects for your own business on trying to make a return on investment, which is an important aspect.

In regards to lasers, there's lots and lots of different terminology, but to try and simplify it, the, the word laser actually stands for light amplification of stimulation of emission of radiation. And so it is an anachronism for how laser light is produced from different mediums. The true word that should be used today for therapy lasers is photo via stimulation.

And it's the ability of lasers to actually use photon light to change biological systems. And this is where it gets very difficult and loosely terminology, because there are products out there that purport to be low-level laser therapies, and now there are ones that call themselves high-level laser therapy, but in general, what they aim to do is photobio stimulation or, or, or laser therapy. So as you go through the course of this lecture, hopefully you'll understand a little bit more about this, but, but these are the terminologies that's used regularly.

And if you look at current use of laser therapy within the UK and globally, you know, it is very widely used in regards to rehabilitation medicine, both from the veterinary point of view, equines, small animals, exotics, but also in the human sphere, where it has been used alongside physiotherapy and other modalities for quite a long period of time. myself and other colleagues will deal with people in pain clinics who are treating sort of fibromyalgia or sciatic pains, but you can also use it acutely, in the sporting arena. And as Bruce, elucidated, you know, I do work, for instance, with, non-healing chronic diabetic wounds.

But also, if you look in the literature, there's a lot of work on therapy lasers used by dentists, in regards to gingivitis, stomatitis, and other areas. Across different hospitals, universities, institutes, they, they're all doing different bits of research and using therapy lasers, for rehabilitation and for wound management. We have to go back to, the 196016 when Einstein, first theorised about what lasers could do.

And like a lot of his theories now in the sort of 21st century, a lot of this has been realised. So, that he coined the ra laser. but it was only in the 1960s that certain scientists started to use lasers medically to accelerate healing and to see the properties of different wavelengths and how they operated in.

My, my, my surname's Hungarian and actually my dad was taught by this guy in Budapest. This guy Andre Master was probably the fore founder of therapeutic photobio stimulation. But, but like a lot of good scientists, he was looking for something totally different.

So he had what's called a ruby red laser. So the diode was a ruby, but it produced a red bean, and he was attempting to kill cancer on mouse models, you know, which he'd gone and created under the skin. But what he noticed in the placebo group was actually the hair was growing back quicker, the wounds were healing quicker, and then he realised actually in this red light, it wasn't.

At all anti-cancer, but it was actually a photo by a stimulator. And so during the 60s and 70s and 80s, he published a lot of work, but a lot of this never got out until after the Cold War. In the US actually, they've been a little bit further behind than the UK and Europe in regards to the use of lasers, and it was only in 2002 that the FDA cleared therapy lasers for use within the human.

Species and also within animals. In Europe, we've been using lasers since the 80s, but also, the first class 4 laser was only licenced from the 1990s. So we have been using them earlier and, and the lasers you see are safe to use and they see irregulated.

In general, the good thing about, and I'm going to predominantly talk about class 4 lasers, but this also goes for class 3B, is that they're non-invasive, deep penetrating, and they stimulate tissue acceleration, but they also, almost as a side effect, have effects on healing and, and reduction in pain. And so they, they could be very useful on a broad range of spectrum that we deal with in veterinary medicine. Well that's equine on small animal.

Here you can just see some of the range of different uses within, clinics, and, and that really does cover a wide range of aspects within the equine clinic, on a day to day basis, whether you're In a hospital or an ambulatory clinic, and you can see it used here musculoskeletically, whether it's, back or sacroilia or, or, or lower tendon injury. But you can also see it used here on, bone stimulation, but also wound healing. And, really a good laser, if it's able to do it on deep tissues, it definitely can go and work superficially.

And the no is, the, the opposite is true though, if it's a weak laser, it may be difficult in the right time frames to achieve good penetration on deep tissues. The common denominator for lasers is that they have low divergence. So unlike a normal light or an LED, they don't dissipate the beam or the energy over a large area.

So you can concentrate a laser beam in a very distinct. Tight area, which allows you to be able to calculate photon energy and, and depth of penetration and all sorts of things. It, it, it, laser beams tend to be monochromatics, although some lasers may have many beams, each of them by their own right, are a monochromatic separate beam, unlike white light, which obviously has a whole range of different lights.

The other aspects about laser light is it's coherent. And it's collimated, and, and this is differs to normal light or LED light, and therefore the ability to penetrate deeper and to go and allow a stimulation of tissues at depth is easier with the laser light as long as you're using the right wavelengths and where this may not be so simple in normal light or especially LED light. And when you look at some of the literature, and this is especially true in, in equine medicine, there are lots and lots of people going on to equine yards purporting to be able to heal, stimulate, do all sorts of things with different modalities that they're using.

And, and, and that can be very confusing as a veterinary surgeon, and especially in where we're taught at vet schools. The truth of the matter, though, A lot of people aren't using lasers, even though they say they're lasers. They're actually using LED heads.

And, and in all the studies that are out there, there has yet to be a study that shows an LED performs better, or, or at least equal to any of the laser studies when they're using the same wavelengths. And that's the difference between, LED light compared to laser light. And that makes it complicated for you to differentiate and for your clients.

True lasers, and especially therapy lasers, tend to have a combination of aluminium arsenide or, or aluminium aluminium arsenide. And and these compounds, when you fire electricity either from a battery or from the mains, produce within this diode structure very specific laser beams, and they tend to be in the red to the infrared spectrum. And when you, when you produce it within a, a, a diode, they, they're able to go and, elevate this electron which produces the radiation within that red or infrared spectrum.

And, and then this is what we have within lasers. The problem for you is the myriad of different lasers out there, and it is very confusing. So when you look on the left there, you can see a pen.

So actually that's a relatively weak laser. It may only be up to about 100 milliwatts, but it is forming a little tiny acupuncture point. So it's treating a very specific, very localised area.

Other lasers, which you can see on the 3 on the right, are, are what's called Class 4 lasers. And they can come in again in a myriad of different shapes and sizes. And, and so what, what is a challenging for the equine clinician and for the clients is the fact of understanding that sometimes, a small laser may not be as powerful, but also size doesn't mean everything.

and the technology, a bit like your mobile phones, has moved on light years. And in doing that, you can actually produce a lot of power from a relatively small machine. You just need to know that it, it, it, it, it's legally doing that, and it's doing it within the remit of what the European Union has said.

Similarly, lasers themselves, you know, if they are a big laser, often, especially in the human sector, they're put in huge great big boxes, and that justifies the cost of the machine. It doesn't mean the technology is very good inside. It just means you've got a very big laser.

and really there is, the technology now to produce small diodes. Which are powerful, has moved on a lot in the 21st century and therefore you are able to have a relatively small Class 4 or Class 3B laser that could, in, in the case of Class 4, produce a lot of power, but actually be a very small machine rather than a great big box. For, for laser light itself, .

It depends massively on the wavelengths you're using. Having said that, every single wavelength out there will have to some degree reflection on the skin. It'll have scatter, and only part of it will be transmitted.

It will vary in depth of penetration, depending on the wavelengths, and depending on the tissues you're, you're actually firing into. But the aim of a good laser. Is to go and penetrate deep enough to the target tissue to stimulate a biological change, and you'll always have some reflection and some scatter.

So, for a good laser, wavelengths is the key component. So when I have certain clients saying, oh, but my laser has an 800 beam, and it can penetrate just as far as a class 4 laser, they're absolutely correct, that, that, that, that wavelength will penetrate deep, and a 660 will only Go skin deep. So whether it's a class 4 or class 3B, it will only go skin deep with the 660 worse an 800 or an 810 beam will penetrate very deep.

The difference is, does it produce enough energy at depth to make a difference? And that's the difference. It's not how deep can it penetrate.

So there are lots of biological molecules in the body called chromophores, and this is really what we're trying to go and target with these specific ways to be laser beams, so that they can make a photochemical effects, and penetrate to whatever depths we're wanting them to, to achieve an effect. What's important from both a safety effect, but also from an ability to be able to ensure that you are targeting and delivering the laser as best as possible, is, is taking into consideration aspects of the laser. So reflection is a problem.

If you have lots of shiny surfaces, you will reflect off those surfaces. But even if you look on the right hand side, if you have skin, if you angle the beam rather than act perpendicular, you will scatter the beam and not not penetrate as deep as if you were going perpendicular. Also, .

Water molecules and debris and dirt will also scatter that, and therefore, it's important when using a laser, you are as perpendicular to the target tissue as possible. Because if you are not targeting that perpendicular, you will create all this lack of ability to go and penetrate deep through the scatter and reflection phenomenons. For lasers themselves, the key aspect in regards of energy is joules and watts, and there are certain classifications to go and type different powered lasers, which is called the anti classification, which is a North American classification which is now taken globally.

So fundamental aspects about photon energy, and this is the energy that a photon of light will produce, whether that's white light, whether that's a 660 red light, or whether that's an infrared in the 800 or 970 beam, is the joule. And, and that, that creates enough energy to create a photochemical, or in the case of a, a surgical laser, a photothermal effect. And power is the amount of energy that's produced per second, so that's joules per second.

And, and, and the, the major differences in laser is safely, now in therapeutic lasers, more powerful C class 4 lasers can treat the same tissue in a shorter time. Or a larger area within a, with a, a bigger quantity of energy. So it allows you to do things a little bit more efficiently.

A Class 3B or a class 2 even could treat the same tissues. It would just take a lot longer to be able to achieve the same amount of energy. When we look at power density, and this is again a confusing aspect about lasers, it's the amount of joules per second delivered to a centimetre squared.

And so if you look at that, you could have the same laser, and a lot of people in the equine world will know about diodes, lasers, which they're treating sarcoids with, and that diode laser, when it's treating a very small spot with a high level of power, can produce a photothermal effect, which is a cutting effect. Having said that, that same laser, if you opened up that beam into a much wider effect, that same 800 nanometer beam could then become a photochemical effect, which is a healing bio stimulatory effect rather than a cutting. So you can see here a articulated surgical CO2 laser that is cutting that tissue, where on this case here, It could be the same wavelength, but in this case here, it is now going in photochemically stimulating healing rather than causing any cutting effects.

And this gets very confusing when talking about lasers, and you really need to understand the wavelengths and the power density to understand what it's fit for purpose. This, this again shows that if you look at any sort of equine general reading magazine, they'll talk about hot or cold or soft lasers. This is totally immaterial, and, and, and it doesn't make any real sense in regards to how lasers operate.

The true definition is, is really about the amount of radiance, which is the power density, the, the watts per centimetre squared, compared to the amount of time and exposure the tissue is happening. And you can see on this graph here, if you have a large time frame exposure with a lowish power, you will have a phototherapy effect. But then if you cut down the, you know, if you increase, oh sorry, cut down the power, you know, increase the power and decrease the time that that is doing it.

You can then actually have a surgical and then if you go even higher up that scale, you can get to industrial lasers where they're actually able to have a photo ablative or, or a photomechanical effect on the actual tissues themselves. So it will change according to spot size and the amount of exposure that the actual tissues happening. When we look at the ANC classification, there are 4 different classifications, although one of them, the 3 classification is split into 2, A and B.

And you can see there are different power settings there which allow you to go and classify these within that spectrum. So, when I first started in this country, there were really no therapeutic class for lasers. But, but now there are multiple different Class 4 lasers available, which, assist in regards of equine and small animal, medicine.

Here you can see a class one laser, like the computer I'm using. You don't have to wear goggles. It's a safe.

It's very low powered. Similarly, you're not going to go blind going to Tesco's to go and have your sandwiches or your groceries. Having said that, if you even look at a pen torch for longer than 0.2 of a second, you could cause damage.

So even a class 2, although you're not legally meant to wear goggles, could cause damage. Class 3B are often used industrially for measuring distances on roads or or chem or switches within different mechanisms. And on this one, you should start to wear beams.

And especially now, once you start talking about the therapeutic Class 3 B lasers, and those can be the haws, the omegas, and a whole range of different aspects, you, you must wear goggles. Having said that, the power is still very low. In regards of being less than 500 milliwatts for each laser light.

Conversely, you can have some machines like that that have thousands of different class 3B lasers, and therefore the overall exposure is quite high, but most of the Class 3B lasers only have one or two laser beams and they're all under 500 milliwatts. Class 4 lasers This is where the issue, and they probably will break this category into even smaller categories, but anything over 500 milliwatts, which is 0.5 watts, becomes a class 4, and that could be a therapy laser, it could be a surgical laser, or it could be an industrial laser.

So, so there really is a, a, a, a big melange of different types of lasers within this. Like a Class 3 B laser, you must wear goggles, but, and, and they can be damaging to skin and eyes depending on how they're used. Lasers themselves come in different boxes and sizes, so some of the lasers have fibre optics, and there is a number of UK lasers, both human and veterinary, which offer this aspect.

And what you have is a diode produced in the actual machine itself, and then it, it, the beam is projected for a fibre optic to the actual delivery head. And the head then allows you to deliver that and there is very minimal loss of energy as it passes through the fibre optic. You may have a fan in the machine, and often that makes quite a big noise because it's dissipating the energy actually within the, the main bulk of the laser as it generates this laser beam.

That there are other non-fiber lasers, and these tend to be class 3 B lasers, and they tend to be lower power. It may not mean that they are a small box, but they are lower power. So when you see this coiled lead there, it, it tends to mean it's an electrical beam rather than a fibre optic beam, and therefore it's delivering a much lower power.

It is confused. Though, because there are other machines out there which when you get a big box like this, you're thinking you're gonna go and have, fibre optic, but actually, the actual main beam is in the head here and not in this box. This is just an LCD, battery operator, and the main beam is in here, not actually created within here.

. Other, other ones have fibre optics, and you can see a range of different machines out here which the actual machine has done within it. You can see here the FP4, and again, the beam is created there and then there's a fibre optic that goes and delivers it and allows you to go and project that beam into the tissues, and there are other machines out there. But interestingly, it's difficult sometimes because you can see this machine here.

Actually, that is a Class 3B, but, but it looks like. It's delivering it via fibre optic. Well really that's actually just an electrical cable and much less power.

And in conclusion about some of that, then you've got the surgical lasers, which tend to be very high power density. You tend to do it under anaesthetic or sedation. They cut, they ablate.

They call it a photothermal or photoablative effect. And then you have the therapy lasers, which are still class 4 lasers or Class 3B, but they produce a photobio stimulator and a photochemical effect, and their power density is much less. So the crux of laser therapy is this word photobiostimulation, and we're all used to biologically that the chlorophyll in plants, when it absorbs light energy, creates sugars, which then help plants and green plants grow and algae grow across the globe.

Well, similarly in our bodies we have Chromophores, which absorb light energy. Now we're all aware of melanin because when we go into the sunlight, our bodies turn brown, and in turning brown, it's because the melanin is absorbed light energy and that light energy then changes the skin to produce more melanin, which is actually a protective mechanism for, for our bodies to prevent UV damage and cancer. In therapy lasers, they work in this area which is called the therapy zones.

So we're not an ionising laser, so we're not creating cancer. We're not a gamma X-ray or UV light, so we're not creating cancer cells, and we're also not in this long wave radio waves. We're in this section which is both red and infrared, and we're a non-ionizing safe zone to use, which allows us to stimulate specific chromophors in the body.

And in summary there, you can see the wavelengths, it's the colour of the light, and that creates a depth of penetration in the cell targets. But the power also helps because it allows us to produce a dosage at depth and different depths and allows us to produce enough energy. So if you are using the wrong wavelength, you may not be able to use it for what you want it to be, and you may not be able to penetrate deeper than superficial tissues or may not target.

Get the right type of molecules. So, you know, it's, it can be confusing because a 20 watt laser, which is in the 970 to the 1064 range, targets water. And this may be less penetrating than a 20 watt laser that's in the 780 to 830s, which is targeting other molecules and may penetrate at least 30 centimetres deep within a short time frame.

So, you, you have to know what the laser is doing to be able to understand, whether it's fit for purpose. Most therapy lasers to date are targeting these molecules, and these are the chromoors, the body, absorbs photon lighting. So we're targeting melanin in the skin.

Cytochrome seam in the skin in the skin and deep tissues and especially the copper in cytochrome C. The iron and haemoglobin targets is targeting and allowing you to superoxidate tissues, and the water is an important one because that creates thermocouples and allows you to open up capillary beds within the body system. So if you're looking at lasers per se, therapy lasers tend to be in the red to the 1000 nanometer zone, maybe up to 1,0064.

They're not in the radio waves, where you can see metre long wavelengths, and they're not in this very high power, so they're not vaporising water. So they tend to be from about 650 to about 680 nanometers, and they're targeting in the skin, chromopho, melanin, and, and they tend to be class 3B lasers, because if you have a powerful Class 4, you could actually burn skin. So most therapy lasers are class 3B in regards to their red beam.

And then depending on the lasers, or either a class 3B or a class 4 targeting something in the region of 780 to 830, and this is the peak absorption here of cytochrome C. This line here is the peak absorption of haemoglobin. So you can say it's quite a broad absorption level, and they can be all the way from 780 all the way to 1000 and affect haemoglobin, but they tend to be around the 9910 nanometers if they're trying to get peak absorption of haemoglobin.

And then in the therapy zone, we're targeting anywhere from about the 900 all the way through to the 1000. nanometer, 10,0064 targeting that to go and increase microcirculation. In the CO2 and NDA lasers, they tend to be cutting lasers and they tend to have much higher power, but also their wavelength is much greater and therefore they're able to vaporise and cause a photothermal effect.

If you look at this video here, this gives you a little bit of understanding about how it works within the body system. So if you're looking within the circulatory system first of all, and looking at the red blood cells specifically, it's the haemoglobin in the iron that we're targeting. But in the water content within it, first of all, if we're using that 970 or 1000 nanometers by Targeting water, you create a thermocouple, change in temperature, and so you can open capillary beds and therefore you will improve perfusion in different tissues, whether that's superficial or deep tissue structures.

And with the oxyhemoglobin, obviously if a tissue is an animal's osteoarthritic or if it's a post-surgery, it may not be using and utilising that tissue much. You are not producing a lot of lactic acid. But if you fire the photon energy within the 800 to 810 region, you'll increase oxyhemoglobin.

sorry, the 905, sorry, the 905, 905,900 region. But the 800 and the 660 region, you're targeting both cytochrome C in the skin, but also, in the 800, 810, 820 region, also cytochrome C at depth, and it's a copper, which is particularly absorbent in the cytochrome C to photon energy. And when you do this, within the mitochondrial structure, you can speed up the enzymatic action.

So it's not heating it, it's creating a change in the, in the biological aspect of cytochrome C and especially ATPAs, and therefore you can increase the actual levels of cell metabolism by improving the the amount of ATP at cellular level. So these are the target molecules that good therapy lasers are targeting. The targeting water through the blood medium to increase perfusion by microcirculation.

They're targeting iron and haemoglobin to improve oxygenation, and they're targeting copper and cytochrome C to enhance cell metabolism. And in the skin, it's both cytochrome C, but also melanin that can increase skin metabolism and accelerate healing. And most of the work, as you can see, is by this woman called Tina Crew in Russia, who has analysed what different wavelengths do and what different depths and tissues they're trying to target.

So it's not one thing or the other. It's a combination of wavelength and power that allows you to do photobiomodulation from very superficial tissues, and you can see there on the bottom right a photon energy going through a hand of a human, but you could also penetrate with the right beam's deep tissues down into the sacroiliac area of the body itself. You also need to ask the right questions about, you know, lasers.

Is your laser really penetrating deep enough to have a biological effect within a short time frame? Any good laser within the 80,780,810 will penetrate deep, but it is doing it sufficiently quick enough to make it worth your while and it's economic within your practise. You can see here the study, which was done at Oregon State University, targeted an 800 beam into water.

And as it went, it got scattered, as I said that right at the beginning, all laser beams were scatter and you can see you're actually targeting a much bigger area, but by the time you're down to about 6 centimetres here, you've lost. 71% of the energy that you started with on the surface. And this was tested using what's called an MRI Monte Carlo simulation at Oregon State.

So, so Oregon State used this and the clinical oncologist who was doing the study, did radiation therapy, killing cancer usually using this model. Instead he flipped it on its head and looked at how much energy is created at depth. To create a healing effect through these photobiomodulatory wavelengths.

And so they use cadavers and buried little photons at depth in the tissues and then they measured the amount of photon energy achieved with different coat colours, sizes, and depth. In order to make sure that this laser was able to penetrate to that depth, then they did it in vivo and looked up to 10 to up to 20 centimetre depth with different bone, skin, colour, different technologies to make sure it was able in vivo to be able to do that. And then it was published.

And, and what's amazing actually, since 2011, when this was published, there still is yet to be another commercial machine that has any data showing that they're able to achieve depth of penetration. So I think you need to ask the questions, is the laser, has it got clinical proof to show that it can do more than just superficial penetration? The beauty about Class 4 lasers is the fact that when they're using the right wavelengths, they should be able to at different depths produce a therapeutic dose.

That is in a larger volume of tissue to deeper targets in a shorter time frame. So it becomes economic in veterinary medicine, especially equine medicine, to make it worthwhile and actually fit on. So hopefully you're getting a quicker response with better results over and therefore your clients are happier with the end results, and it's working well with your medicines and surgical techniques.

It's not that Class 3B lasers are bad, they're not bad. Used well, they can work. It's just the fact that technology has moved on and the ability now of safely delivering a larger amount of energy at depth is easier.

And similarly, when you're looking at technologies, both technologies get you from A to B, but this is not as quick as this, and therefore you can deliver more to a larger, greater volume in a shorter time frame and therefore it's a better efficient use of your time. In going out there into the practise. In clinics.

This gives you another example. So Class 3 B lasers target very specific points and you have to use different points across an area, which sometimes can take up to 45 minutes to go and treat an area which in 5 minutes a class 4 laser should be able to treat a larger area within that time frame. So it's about timing as long as you're looking at the same wavelengths and pulse frequencies.

This gives you an example here. So on all the studies looking globally, when you look at studies where a good laser has worked, it tends to be in this range, so superficial wounds, the energy level per centimetre square, the power density, the radiance that effectively treats a wound. With the right wavelengths is that with more superficial deeper tissues.

With deeper tissues, you can see there's a trend for going and going for higher and higher amounts of energy. And so these two gurus of the laser industry who have written many more papers, talk about that there is a range of things. There's not, we're not specific, but we know that the more least superficial you are, the, the, the less the energy is.

The deeper you are, the more painful. Of the condition, the, the, the, the, the more energy you require. So if you're treating wounds and superficial things in less than 2 centimetres, a Class 4 laser may not be necessary.

You may not need something. A Class 3B should be more than adequate. But if you want to do wounds, MSK, deeper painful tissues, what a Class 4 laser allows you is to do it more efficiently and quicker than a Class 3B would be in the same time frame.

The other component about lasers is a delivery systems. So you can see here that lasers can deliver light in continuous form. They can do it in pulsing, and that tends to be on a 50% duty cycle, whether it's going 4 times a second or 20,000 times a second.

And some lasers produce what's called an intense super pulse, so they can peak at a much higher level, but the average is lower, where, where this may be a 50%. On average, this is usually lower than the actual peak absorption. Why does pulsing happen?

Well, wavelengths, power are important factors, but when scientists have looked at different data, they've shown that when you have low pulsing lasers, maybe in the 800 range, you have better pain and control of neuralgia. When you start to stimulate tissues, the pulse frequency goes up, and when you look at swelling or inflammation or infection, you get a much higher pulse frequency. So there seems to be a a symmetry between certain tissues but also certain Aspects of how the laser works on biological systems, which is governed by pulsing as well as the, the, the ability to get there with the, different frequencies.

We, we, in, in regards to K laser, they have done a lot of work in Maelbek University. In Trieste University, where they looked at cell cultures in this case. And when they used different beams, they were able to show pulsing had a dramatic effect on which tissues were stimulated.

So if you're looking at continuous beams, interestingly, you actually get more leukocytic. These are looking at different cell lines, smooth muscle leukocytes, endothelial osteoblasts. When you look at low frequency, you get much greater osteoblast chondrocyte.

growth. When you look at higher frequency, you get more endothelial cells, and when you're looking at the highest frequencies, you tend to get smooth muscle and keratinocytes and other, soft tissue structures, tendons, muscles, and seem to be more stimulated. So if you are only doing Wounds, actually a combination of maybe the leukocytic and the superficial, the high frequencies is useful.

But if you're doing joints, actually you may need a combination of all the different wavelengths in order to optimise what you're able to go and do within that joint structure. This gives you an example of it because it is confusing this, and there is a lot of mismarketing and misselling of lasers based on power, but also on pulsing. So if the laser is a standard pulse frequency at 50%, if it was 8 watts, it would give 4 watts.

If it was 15 watts, it would give 7.5. So it's, regardless of how many times it pulses a second, it would give you the 50% average on that.

But for a laser that purports to be an intense super pulsing, what happens is you get a much higher peak. Of laser, and that affects the ability, oops, sorry, it affects the ability to go and do it. So, some of the lasers out there may not be pulsing at quite the level that you are expecting.

So I call it the not so intense super pulsing, because if the laser, instead of it being on for a period of time, now is only on for a billionth of a second. That average power now shoots down because regardless of whether it's 25, 50, 100 watts, if it's only on for a billionth of a second, that dramatically drives down the amount of power and the average power, which is the important thing when trying to go and treat tissues at different depths with the correct amount of energy. So when you look at this, it doesn't matter how many times it's pulsing, if it's only on for a billionth second and the overall average power is reduced, that means that the duty cycle and the average power is much lower.

So you need to ask these questions just because it's PR pulsing at 100 watts, 25, 5 watts, it doesn't matter what is the average power it's able to do it and is it delivering enough energy at the target tissue. So in summary of all this, science, dosage and wavelength and frequency are the three modalities that allow you to treat from skin all the way down to a sacroiliac joint. And it's a combination of using the right wavelengths, the right power, and the right pulsing that can determine the really big range of biological effects that lasers can do.

So you need to make sure that what you're wanting it to do. And what it's able to do makes it fit for purpose. So these are the three parameters that give this broad spectrum of use.

Clinically, also, the actual person delivering it is also important and your compliance. You would not go and give an antibiotic or a painkiller femalebutazone, if you were not giving it sufficiently at the right dose, but also regularly enough to have a biological effect. And that's the same with lasers.

There is a little more art in it, because you need to be more aware of what's changing and happening in front of you and not being too prescriptive. But there are rules of thumbs that you should follow. So whether it's pain levels, healing or antimicrobial, this, this effect is is the same.

So a laser should accelerate the healing. And as you're going through it, it should continue to accelerate it. And increase and increase and increase.

So you're driving that, what normal healing is away from what you could create and speeding that process up. If it's a chronic problem, again, you need to be using it, maybe not quite as regularly, maybe not daily as you might use an acute wound, but you'd be doing it every 48 to 72 hours to try and drive that down to as close a perfect healing, whether this is a tendon or wound or muscular. Skeletal injury.

And with osteoarthritis, which is less of a problem in the equine patient as the small animal control, what you are trying to do is not get the perfect patient, but you're trying with all your multimodal use of different drugs and other aspects in physiotherapy and surgery to go and drive that down to a better quality of life so that the animal itself is in a better condition and the owners are happy in regards to the outcome for where fit for purpose that horse may be. In regards of, return on investment, you need to do all your own calculations. You need to look at how many vets you are, you need to look at the type of cases you're seeing per day or per week, work out the total amount that might be suitable for laser therapy.

You need to work out are you treating it sufficiently a number of times and what you're going to be able to charge, obviously with time and travel and everything else. But it's surprising how well customers like laser, and it's surprisingly how much you can, even with 10% of your clients taking it per week, end up actually earning per annum. So it, it really can pay for it.

Self and make it a very, very viable option in regards of equine, whether it's working in a hospital or ambulatory. It, it allows you a new option, to be able to earn new income which is vets specific. A lot of you will be using ultrasound, and there is compatibility.

There are some studies showing the compatibility between laser and ultrasound. But there are limitations. You cannot use ultrasound over metal, which you could with laser.

You can't use it over skin. Which, which you could with a laser, and you can't use it over any cavity. So you can only use ultrasound over the appendages whilst you could use laser over the abdomen or over the actual area of the ribs or any other contra sternal damage that might be happening.

Clinically, there are some good studies out there. And this study from, which was published at the ECBS in Edinburgh, was a study done by Bristol University looking at antibacterial effects of lasers. And, Christian, to Tristan and Kogan and Dawn showed that you can on a log scale of bacteria actually get down to zero.

With the optimal laser energy and the right combination of of frequency and wavelengths. They showed in this case, in laparoscopic space, that they were able to halve the amount of asepsis score, which is a combination of pain, inflammation. And infection compared to the standard laparoscopic space without, laser therapy.

Then they took up further and they showed with the log scale on cadaver skin from, cattle, when they were infected with Eococcus, if you took away a 660 beam, the infection went up, which was the same in the 800 beam. Which was the same in the 905 beam, but interestingly in the cadaver skin, when you took away the one targeting water, it had no effect whatsoever. So there are certain interesting research that is going on at the moment.

From a tendon point of view, there are studies in the equine, but I'm showing you this because I think it's an interesting study to show you on a histological level. This study was done in rats crushing the the calcaneian tendon. There was a control group, there was a controlled crush group.

And then there were 3 groups that were crushed and then lasered either 35, or 7 days. All of them were stained for their, tendons and looked under by fringes with histology. The group that was crushed and non-lasered was completely disrupted on day 8.

The day 5 lasered group was as close to the non-damaged lasered as it possibly could be, you know, statistic. So there was a definite improvement, not only in alignment, but reduction in inflammation and quality of the healing of that tendon, and both with type one aspects. There are some studies we, we sponsored a a PhD in vet school, which was looking at back pain in, in, racing and jump horses.

And, when it was stubbored on a double blind because you could do a placebo laser. There was a significant difference on day 42 between the dynamic tests, and the static tests studied by the, veterinarians, and also the jockeys who are riding these, they could see a difference in the horses that were lasered versus the non-lasered horses. Recently, the, Andy Bi and Carly Briggs from from, Ross have put forward something at VOT as an abstract, which looked at 61 horses, and they looked at a range of horses which were having laser, non-laser, or a combination of it.

And when they looked at these horses, they used a class 4 laser using 4 frequencies between 6:30 and a 1064. They were treated twice a day, for up to 14 days, and they followed them up a year later. of the 64, they were looking at superficial digital flexors and suspensary injuries.

And they, over this study, they showed that conventional treatments when they're using platelets, stem cells, hyaluronic acid, therapeutic ultrasound, shock wave surgery, all of these were used in combination. On the conventional ones, 52%, showed a full return to, function. The laser group showed 63% and the laser and the combination showed a 92% return to full functionality and a very significant improvement overall on using that despite the low numbers.

From a case study point of view, there are some good case studies out there. Just to show you examples. Although lasers in general, you should not use over cancer.

This one was on a non-healing cancer, which was of, which had been removed by a diode laser, surgical laser, and it was non-healing for up to a year. So after a of using all different medications and types of things to go and heal it, they then used K laser in this case at 3 watts. So not a powerful dose, still more powerful than a class 3B, but not that powerful over the whole area, 150 square centimetres.

And in this case, they repeated it for the daily for the 1st 10 days, and then they started going up for twice a week for the next 2 months. Over that time frame, that wound completely healed, and, and there was no scar tissue, which was evident. So good epithelialization and good healing.

A lot of people use lasers for tendons, but in this case, it's a splint bone study, and this was a national hunt, horse, where it had palpable, splint bone and inflammation and pain on palpation, and it was underperforming in the weeks leading up to the vets being called in. On the 6th of February when they first saw it, they decided to go and use the laser twice weekly for 3 weeks, and they used it on a dark setting and the knee setting. So they were giving several 1000 joules into that area.

By 3 weeks later, the halt was rottling sound and it was unreactive. It was still a bit reactive to palpation on that. But by the 22nd and by the 26th, this horse was sound.

It was cold and firm, and there was no pain elicited. And that was 3 weeks after the diagnosis of a splint bone injury. .

They continued to laze intermittently once a week on this horse, and by the March of that and the, April of that time, that went to go and race in Cheltenham, and this horse was full, fully back to racing condition and actually competed and came 3rd in the race at Cheltenham. There are certain testimonials there to, show how useful lasers can be in, general practise and in referral basis, of a range of things from both superficial and to deep tissues. And the portability of the lasers is also good because you can actually take it out into the yard and actually deliver it on site rather than having the clients actually come to you.

So whatever works with your scenario, you have the ability to be able to take it out and, and deliver it at an efficacious dosage within the condition that you're treating. In conclusion, lasers versus LEDs, there there is a huge difference, which is why there is scepticism. Out there, there's huge differences in regards of the type and the quantity of the laser.

And, you just need to be aware of a lot of things before you go and, endeavour in, in, in even purchasing one of these because there is a large differences compared to pharmaceuticals, due to the lack of regulation. I hope that was interesting. I know I've gone quite a long time, so I, I, I'm cutting myself short at that point.

Steven, don't worry about that. It was absolutely insightful and I'm sure all the folks listening that haven't worked on lasers before are a bit like me sitting thinking, hell, I need to look at more and get more information on this. They're very, very interesting and insightful.

But it's it's amazing that there is so much clinical presentation and and now actual studies that have been done to to back up what's what people who've used lasers for many years have been saying. Yeah, I, I, I, I would love to have done a whole the whole presentation just on the scientific clinical papers out there. but I needed to put some background just for this lecture, so we may have another one in the future, just looking at clinical papers from wounds to tendons, to muscles to pain management.

But, but, but I thought for the state of this, I wanted to keep it relatively, omnicompetent in regards to what lasers are. And, and you promised us you would touch on all the different types of lasers and you'd never let us down. So that's really, really great.

We've got a couple of questions and comments coming through, lots of comments coming in saying nice presentation. Thank you very much. This has been hugely interesting.

Are there specific treatment protocols for horses? Absolutely, you know, the, the, the, the, it's not just about, the, as I hope people have understood, the wavelengths, the pulse, the power. It, it, it, the, the, the actual protocol needs to be, fit for purpose.

You know, if I had a high frequency, laser, which was just a 660 beam, and it only went up to 3 watts, it would be very good for wounds. But it would be next to near useless in going and doing tendons or anything deeper than that. So, so, so it's incredibly important that, that it, it, it has the right protocol, the right, wavelengths in order to do that.

and, and that should either be trained on the clinician using it to understand the differences, of laser technology, or it's clever enough that it's built into the protocol to make it easy for the end user, so they don't need to go and, be, an astrophysicist to go and work out what they're trying to do. Yeah, I, I must say parts of this makes me feel like I'm, I'm not an astrophysicist. I have to be honest.

You know, it, it shouldn't, it shouldn't be our job, you know, that should be the job of the manufacturers and the, and the companies to prove that their laser does that at depth and does it to whatever they purport it to do. Yeah. I, I think you've answered the next question that comes from Christopher.

He says, and I'm gonna read it as it's written. Does this mean a good therapy laser will have a range of wavelength lasers that work together to help with healing? If they want if they want to optimise it, you know, if they really want to get the best, then it does require a range of different wavelengths.

You, you could still have a laser which is one wavelength, and if you're using the right wavelength, it would have a benefit, but it may not be the optimal. And, and, and this is confusing not just from the user point of view, but it's confusing from the literature. So when you look at clinical papers, it is very, very difficult, even from someone who understands lasers, to ascertain exactly what happened in that study, and to understand why it worked or why it didn't work, because it, it, it, it's both the wavelengths, pulsing and power that, that, that, that can be the benefit or, or the failure of a study.

Excellent. I'm going to paraphrase a couple of questions together here Steven because they will all come down to the question over or regarding overheating and burns and especially with continuous wave lasers. Yeah.

And, you know, there is a, you know, all Class 3, Class 4 lasers, you need to wear goggles. There is a danger that you could burn, with a laser. As I tried to illustrate through the surgical versus therapy, you could have the same beam, and one could be a therapy, and one could be a, a, a, a, a, a, a surgical laser.

So it does depend on how you deliver it. It, it, spot size is very important. The amount of energy delivered can be important, but also pulsing is important.

So on a continuous beam, they're exactly right. You're giving the most amount of energy, to that tissue, and it, whether it's a 500 milliwatt, or 200 milliwatt or a 15 watt laser. so, so you do need to be careful in regards of how it's delivered.

and again, I, I, I can't, you know, you need to be trained properly on that laser by that manufacturer or, or distributor, because they really do vary. they're all, any laser out there which is used for therapy, whether it's a class 23, or B or 4, will have passed CE regulations and some of them will have had FDA regulations, which means they're safe for use. But they're only safe to use if you've been trained in how to use it.

Story of life, isn't it? Yeah. Charlotte's got an interesting question.

She says she's an equine vet with an interest in rehabilitation. She's been trained as a veterinary acupuncturist and she wants to know if you can use lasers to stimulate recognised acupuncture points and trigger points. Yeah, yeah, there, there, I mean, again, there's, there's so many clinical papers I'd love to have spoken about tonight, but there, there, there are some really good papers showing the use of needleless laser acupuncture.

To stimulate the same high points that a actual acupuncture needle would stimulate. So, so there is a lot of overlap and similarity, on how they can operate, not just on a photobiochemical level, which is what I was trying to show that they can penetrate deep and affect cytochrome C. But, but, but if you are truly trained in acupuncture, you Can use therapy lasers to stimulate those same high points.

And, and I know, on the small animal side, people do use them a lot on cats where they have difficulty in needling cats, and, and they find it, it's more easy in, in some of the cat species to go and be able to do that. But you can do that on equine as well. Excellent.

Again, I'm gonna paraphrase a couple of questions coming in together. It's all about, finding reliable research and rather than manufacture a hype or, you know, sales gimmick and that sort of thing. What can you advise for people to go and research as far as what is a reliable source or where can they find some information that's not advertising bias.

I mean, you know, inevitably there's always bias. I mean, I've just put this slide up here, you know, I mean, we, we, we, you know, the, the person buying it should have a healthy scepticism, but not a scepticism to, to think, oh, it's just not gonna work. In this, in this area, unlike doing a meta-analysis of, non-steroidals, it, it, it is much more complicated than that because, it does depend on what the, you know, all the different parameters, and, and therefore it doesn't blend itself well for meta-analysis looking across the whole of the area.

You need to, whoever is selling you or whatever research you're doing, I would look for clinical proof on that specific laser. To make sure that it is actually able to clinically prove it, it it it's very easy to extrapolate data. And, and to use a paper that's published in Sao Paulo to verify why your laser should work.

It, it, that doesn't mean that your laser's fit for purpose. So, so you do need to look at the individual laser. You do need to really query the manufacturer or the distributor or the salesman walking in your door to make sure that they have clinical papers to justify what they're saying in their glossy brochure.

It's all well and good to tell me how good your product is, but show me the proof. Exactly. No, no, I, I look, and I, I hope, you know, I would hope anyone watching this still has a very, very healthy scepticism because, you know, there is a reason why it's taken a while for therapy lasers to come on and especially in the equine world.

In the equine world where there are a lot of people coming onto yards purporting to be able to heal animals. and there is a little conflict with the veterinary surgeon there. I think vets for a while have been very sceptical in the equine world about therapy lasers, because basically a lot of those may not have been fit for purpose or not in the time scale that they were being used.

And, and therefore, it, it probably the equine world has been the slowest to catch on to this in any of the areas. OK. Just going back a couple of steps there about the acupuncture we were talking about.

Hillary has gone on to say, does the therapy laser have to be left in place as long as the needle would? It, it's, the, the, I mean, different lasers, I, I can't purport to all the protocols that are on different lasers. to give you an example, if we're treating a sacroiliac joint, we're giving close to 4000 joules in one of our lasers, OK?

If we were treating an acupuncture point, we would give 15 joules. That's a huge difference, OK. So someone using a, our laser accurately and knowing how to use it on an acupuncture point, will put it exactly over the right point, and that will only require 15 to 30 joules of energy.

Depending on the colour of the skin. Again, it's about training by the manufacturer for that specific instrument. Indeed, it has to be calibrated for what it's, what you're trying to use it for.

Now, now using 4000 joules will stimulate a high point, but really the aim of that is to biologically stimulate deep tissue. Yeah, yeah. Hmm.

It gets more and more interesting and more and more fascinating as we talk. We've got a whole lot of questions coming through about different conditions. So there's questions about, healing ulcers and navicular disease and, and various others.

Are there, specific guidelines, for example, with your K lasers for treating specific diseases. So you would get a, let's call it an idiot's guide to go when treating navicular disease, this is the depth, this is the strength, this is the position and timing. Yeah, we, we try.

And be as educated as possible. So we have online videos, and we, although it's not a legal requirement, in the veterinary industry, we, we do what we do in the NHS, which is called the core of Knowledge. So they sit 3 modular exams, or 3 modular core.

And sit an exam at the end of it, so they have a good understanding of, of what is required. So that even though that whatever machine they're using is calibrated, they can still question, is this the right? And if I'm not getting the results, do I need to slightly manipulate the protocol?

Because our, our protocols are set at an ideal, but nothing's ideal. And, and therefore, you know, there is a certain self no in understanding whether you're using it appropriately. So I'll give you an example of your two questions there.

For a wound. if it's a chronic wound, you need to treat a much bigger area than the wound itself. Because if you're not stimulating good circulation to that tissue, that static wound may not do as well as just treating the actual size of the wound itself.

OK. OK. With the navicular aspect, and this is again work done over, in Nantes vet school, because they saw such good effects on the, on the sacroiliac joint, they started treating navicular disease, which is a big nemesis obviously for any equine vet out there.

And, and the reason that it can reduce inflammation, but also stimulating circulation and stimulate healing, obviously, you're like, wow, that's fantastic for a navicular disease. But the truth of the matter is, the hoof is the worst material to penetrate. So you don't put a laser through a hoof.

You fire through the coronet around the top of it into the hoof. And when you fire it into the coronet around the top of the hoof at the doses we thought were good for navicular disease, it was too powerful. So we were causing too much analgesia initially, and the horse was running around happy as Larry because it didn't feel the pain.

And then obviously the pedal bone started dropping even further, so we were actually having a detrimental effect. So we had to rein in the power of navicular disease. So that it had an anti-inflammatory effect but not an analgesic effect, so that it was working in unison with trying to improve all the, you know, the other drugs, that they were using or the, the box rest or and or the chewing, and to make sure that the animal didn't overexercise.

OK. Folks, I, I need to apologise. There are a lot of questions about specific conditions and that sort of thing.

Tonight's forum is, is really not the right place to be discussing those. So forgive me if I skip over more specific questions. One, Last question because we are running over time here, Steven.

Where would you advise people to go and research lasers, papers, the acupuncture laser combination, all these sorts of things. Do, do you just do a Google search or are there specific sites that you would recommend? I, I, I've spent 8 years looking.

And so, so, and, and, and the Google is a great medium, but you also get all the crap as well as the good stuff, and it takes a huge amount of time to sit through stuff. There are thousands of articles, some good, some bad, some excellent, some awful. So, I, I would put the onus on whoever you're dealing with to come up with papers that hopefully are around their own laser or, or, or using the right way.

Lengths and frequencies. So, so I, I, I, I think trying to go and do all the research yourself is difficult, especially if you're in practise and you're busy and everything else. I, I, I would put the onus on the company that you, who purport that they are able to solve all your problems, and, and get them to produce papers to, clarify and give, clinical proof of their efficacy.

I think that's a brilliant plan. Again, don't tell me, show me what you've done. Yeah, I, in regards to all these questions, I mean, I don't know what webinar that does, but if they write them down, I'm, I mean, I, I'm more than happy to answer them.

My email is Steven with a PH at BBsect.co.uk and, and I'll try and answer them as honestly and as you know, objectively as possible.

Dawn has popped your email address into the chat box. So for those of you that want to write it down, for those of you that don't have a pen handy, if you send the, questions in to office at the webinar vet.com, in other words, our webinar vet email, we can always forward those on to Steven and he can help you.

Stephen, we've got loads of comments coming through about absolutely brilliant, thank you, very insightful. I can't believe how much this has helped and so they go on. Anthony always likes to say, if we were in an auditorium, there would be thunderous applause happening at this stage.

Oh, that's very kind. So thank you very much for this hugely insightful talk and we look forward to hearing more about lasers. Other species maybe or more clinical ones.

Folks, as I started by saying this is your channel, if you want to hear more about lasers, Give us some feedback on tonight's webinar. Ask for more stuff on lasers. We really do take your feedback very, very seriously.

And if there is enough interest, obviously we will put more webinars on. And I'm pretty sure we can twist Steven's arm to come back on and share his knowledge with us in the future. I mean, I could definitely do one which is only about clinical papers, .

And, and rather than giving the ABC of what lasers do, look, look into, is this gonna work and how does it work and why does it work? Excellent. Well, there you go.

So if that's something you'd be interested in, surveyMonkey, feed it back to us and let's get this all organised. Stephen, it's just left up to me to say thank you very much for your time tonight. It was hugely insightful.

I know I've learned a lot and it certainly has stimulated me to want to go and research lasers more. Yeah, thank you very much for taking out Tuesday night. Thank you to Dawn and Catherine in the work and we look forward to seeing you again on another webinar there.

So that's good night from all of us.