Thank you, Paul. And, thank you, everyone, for joining us tonight. This is meant to be an overview for you, so that, I mean, there is a lot of interest now these days in, both the human and the veterinary side in regards to the benefits, that laser therapy could.

Provide, to your clients and, to the general income of the practise as well, but also utilisation of stuff. So this gives you an overview of, where laser therapy is now, and hopefully, from the sort of fact and fiction aspect, you, you, you can be a little bit more, ascerning about what works and what doesn't work. And what proof there is.

There is a little bit of clinical, stuff at the end of this, but we may do as a separate lecturer in the future, something purely just on, on the clinical papers and the supporting data. So on this picture, you can just see a dog very comfortably being treated with laser therapy. But the critical aspects are power.

Wavelengths, which is on the top right, and pulse frequency, which is the amount of times the laser turns on and off per second. So, we'll go through this. That's really the area that I'm gonna be talking about.

You're welcome to ask any questions at the end, but I, I know Paul will, also take questions which I can return on emails if there is any, but those are the topics we'll cover today. There is a lot of, different terminology that's, talked about. Lasers just stand for something.

It stands for light amplification of stimulation of emission of radiation. So it, it, it's an anachronism for what it's meant to be doing. But really, the only true way of defining lasers is what we call photobiostimulation.

So it's the fact of using the energy from photons of light to stimulate chemical changes in biological tissues. We're all aware of photosynthesis. Well, this is using light energy, especially laser energy to go and stimulate biological tissues in, in a, in a human or a, a mammalian species.

There are other terminologies, low-level lasers, high-intensity lasers, laser therapy, but, but they, are very bland and, and aren't really well defined in exactly what that means. Laser is used really very widely. From, of course, tonight, we're talking about veterinary, but in the physiotherapy, chiropractor, osteopathy, sports therapy, podiatry, it's used on a broad section of, treatments, and it can be used both in pain clinics as well.

I, I work on diabetic wards, and, we, we treat non-healing ulcers, but also, post-surgical treatments for acute tendons and also from post-surgical incisions. It's used in sporting worlds, NHS hospitals, and also in a number of different vet schools around the UK as well as other institutes around the world where they use this technology to, understand, and, and improve our knowledge. It all goes back to Einstein, and Einstein theorised lasers.

In his lifetime, he did see lasers being manufactured and produced, and in the 1960s it was the first real medical lasers starting to be used in practise, but it really, it's come a huge distance since then to what were the technologies that we're using now in the 21st century. But the originator really of medical lasers, and, and a lot of the scientific papers that were done was back in the 1960s by this Hungarian professor of medicine who was trying to use what's called a ruby red laser to kill cancer cells on the skin of, of mice. What he very quickly found out that the laser was not, a killing laser.

It was actually stimulatory, so it's placebo mice, their hair and their skin and the wounds and everything regrew very quickly. And that's what was the four founder of photobiostimulation. And, and you can see back in the 1990s there were in the 1960s really, there were Class 3 and Class 2 lasers, and then in about the 1990s they started to be Class 4 lasers in the European field, but it took until 2002 until they got FDA clearance as a safe laser to be used on both humans and animals.

Class 4 laser is different in the sense that it is a little bit more powerful. But in regards to other lasers, depending on the wavelengths, it will still penetrate this deep tissues, it just does it a little bit quicker, class 4 laser, and with a higher level of energy, able to do things on a faster ability and therefore the responses and the regeneration should happen a little bit quicker than you would do with other laser technology. There is a very wide range of use of lasers, and that's one of the reasons why it's so successful in veterinary medicine.

Because when you understand how it's used and you're using it appropriately, it's not just about using it on superficial tissues, where it can be very beneficial in accelerating, tissue wound healing or post dental surgery, but it, it, it, it can, on a good laser, it can penetrate deep tissues. And therefore, it can have quite a profound effect on, post-surgical rehabilitation, but also can work on arthritic joints and, spondylosis and, and neurological conditions. So it, it ends up being the most widely used piece of equipment within a vet clinic.

Lasers differ and so it's important to understand what you're trying to do with the laser and why lasers are different. So, so lasers allow you to go and have parallel beams which an LED or a normal light source wouldn't, and therefore you can concentrate a beam on a very small area and, and provide sufficient amount of energy to make a biological change. And they tend to be single wavelengths, although, more modern lasers may have multiple single different wavelengths.

They also have some other, capabilities. They, they're they're, they're coherent and collimated, which if you use a normal torch, it will very quickly die out a certain distance. Lasers can travel a much greater distance in air, and this is because they're coherent.

And collimated and therefore they are not interacting the beams. They aren't dissipating energy as they're going along there and therefore, as you might have heard recently, and someone was using a laser light to go and target a plane flying over the northwest of England recently, so they really can travel long distances. When you look at lasers, though, the word is very loosely terminal, there's very loose terminology, and therefore often people will talk about lasers where actually what they have is an LED machine.

And LEDs have the same propensity light emitting diodes as normal light, except they will be very specific light beams that have gone and been chosen. And when you look at studies, there are no LED studies that outcompete laser studies. So lasers always using the same wavelengths, same power settings will always outcompete an LED.

And so there is significant benefits in using lasers appropriately in veterinary medicine. All therapy lasers are what we call diode lasers, and they tend to have a combination of gallium arsenide, gallium arsenide, and, and this chemical, and what you're looking at at the top left here, you can see an arrow there. This chemical goes and interacts with, electricity.

And in this diode, when that chemical interacts with it, it produces a change in radiation. And that radiation will be dependent on what chemical you have in it. In the case of your unusual vet clinics, helium within an X-ray, the, the electricity interaction with helium produces X-rays, and if you have surgical lasers, they tend to be CO2 lasers, and when CO2 interacts with electricity, it produces radio waves which have a cutting capacity.

Therapy lasers are gallium in our side, and they tend to be producing, red and infrared laser beams. But there is a huge array of different lasers out there, so it can be extremely confusing to people what is working, and there was a good reason why the veterinary industry for a long, long time shied away from lasers, and because in general they, they, they were not used appropriately and they were not powerful enough to go and have a truly biological effect. If you look at the top left there, that is a class 3 laser which is treating an acupuncture point.

So it's being held for a long period of time at that point, similar to what that lower one on the bottom left is is used on a, on a cat head. We really, when you look centrally and on the bottom right, you might be having what's called Class 4 lasers, and they may be a little bit more powerful and able to produce a lot more energy to a wider air in a short time frame. Having said that, size isn't everything.

So if you look to the top right one, that large box is still a Class 3B, and the head is an LED head and that pen generates the laser light. So it, it, it, you know, don't be fooled by size, size doesn't mean everything. Similarly, when you look inside lasers, there are huge differences.

On our laser on the right, you know, the K laser, you can see that the diode is a really small piece of technology that's developed in both Russia, Italy, and also in Switzerland, and it's a composite product that allows you to go and produce this intense laser beams. The, the, the left picture is also a class 4 laser, but you can see that's a much, much bigger, older technology, and you need about 5 or 6 different, diodes there just to produce the same amount of energy. And so there are differences out there, and, and definitely in lasers, a bit like your mobile phone, size doesn't mean everything.

The technology can get smaller and smaller, and yet it's much more efficient at what it's able to go and produce. One of the important aspects about understanding any laser, whether it's a Class 2, Class 3, or Class 4, is if it has the wavelength, that is the most important thing because wavelengths allow you to penetrate deep into tissue and therefore, the beams that you're using have a huge influence on what you're able to do using different lasers. The power aspect allows you to go and do it in a shorter time frame, but, but the beams is what's important in regards to penetrating deep into the tissue.

And then so, so this slide kind of talks about that where generally, whatever wavelength you have will determine on how deep that laser beam will go. And what we're trying to target is biological molecules in the body, which are called chromophores. And in targeting those, there is an exchange of energy that, that creates a photochemical energy change within the actual cell structures that you're trying to go and target.

The way you use a laser is also important because when we set up a laser in a clinic, we make sure that people are understanding about the safety because there's a lot of shiny surfaces and mirrors in vet practises and you need to make sure that you're not shining it around, because those surfaces will reflect. But also when you're actually trying to go and do it onto an animal, you need to be as perpendicular to the skin as possible. Otherwise you're also going to get reflection and hardly any of that will actually get to the target tissue.

So you need the laser as perpendicular tissue, otherwise it's going to cause a lot of scattering due to the redirection from the skin surface as it bounces off it. Though you can see a picture of someone, even though they're treating a back, the actual laser is projecting directly onto the back as perpendicular and it's moving its way and pushing out the hair to try and get as close to the skin. It treating humans is a lot easier than treating animals because of the hair component.

I, I've yet to meet an owner that's allowed me to shave their pets when we're treating osteoarthritis, but, the truth of the matter is you do need to go and push that hair away in order to get as close to the skin. In order to be able to go and maximise the penetration and depth that can do it. Energy is the form that we measure, and that's what the word, that's the classification of how we judge different types of lasers and the amount of energy delivered per second is in watts.

So that's usually the power of the laser, and that's really what this anti-classification is based around. So the fundamental energy photon is a joule. And that the amount of joules you have will alter the amount of either becoming a photochemical or very, very high power on a high density, it may become photothermal and actually have a cutting of capacity.

And then so therefore, you do have lasers which are surgical and lasers which are therapeutic. The power is the amount of energy delivered, and that's usually called in joules per second or in watts, and therefore in therapy lasers, generally the more power you have, The shorter the time frame or the larger the amount of energy you can deliver over a bigger area. So they tend to be a little bit more efficient in being able to do that, and therefore you can do shorter treatment times which fits into a busy vet clinic very easily.

Power density is important, because that determines the amount of energy delivered to a certain area. Most of the calibrations we have are delivered over a certain set area, whether that's a wound or a musculoskeletal. But if you are using a surgical laser, you may be using a very, very small spot size, and that spot size in the case of a, CO2 laser, will have a photothermal effect and it will actually cut tissues as you go through it.

In the case of therapy lasers, they will have a much greater, surface area, and they'll be able to dissipate the energy over a larger area, and therefore this becomes a photochemical effect and not a photothermal effect. Again, this sort of shows that this, especially in human medicine, they talk about hot and cold lasers, which is a, is a silly words to talk about it because you could have the same laser, maybe say an 800 beam, and if you, do a lot of power per centimetre squared and you do it over a very short time, you could actually ablate tissue or, or you could actually cut tissue. But really what we're talking in, in, the therapy lasers is we're giving a relatively, low power amount of energy over, that, that's a low amount of power over a longer time frame, and therefore, this has a photochemical or a photo bio stimulatory effect on the tissues we're dealing with.

This is the classification which people use, and it determines not only the safety but also the power that's delivered. And so we have Class 1, which are low powers, with Class 2, Class 3, which is often used in industry, and Class 3B were the first therapy lasers. And they're also used in all different other areas as well.

But Class 4 is a much bigger group, and anything over 500 milliwatts or 0.5 watts could be an industrial, NASA type one, a surgical laser or a or a therapy laser. So there's a whole range of different lasers within this class.

But in order to get safety and in order to get a licence, a therapy laser has got to prove itself to be safe in use and therefore that there are certain other stringent tests it has to go through both in the EU and the FDA to get that licence. Class class one, as I said, aren'ts are very safe. You don't need goggles.

They may be interactions between a computer to go and make it work. You might have class 2 lasers going and, doing, you know, barcode counts and, you know, in shops for going and, allowing you to go and pay for your goods. Class 3 are the first ones really which you need to start wearing goggles, and they are more powerful, but they tend to be used for measuring devices, or, or they might be used, within a, a sort of electronic basis for, for, doing certain targeted tissues.

Plus 3 B are the ones which really are used, initially in the sort of the 1960s up to the 1990s, and these were therapy lasers, but it, it, it can be confusing because the laser here actually has a majority of them are LE. And there are only 4 laser lights in that. But you can also get a class 3B laser, which is made up of thousands and thousands of class 3B laser lights, and those also still a class of class 3, but that might have a power of maybe 50 watts.

So it may be a very powerful laser, but, it's still a Class 3B, and they come in all different shapes and sizes. Class 4 lasers, as I said, again, you have to wear goggles, but, in this case here, you, you can have industrial lasers, you can have surgical lasers, and you can also have therapy lasers. So it's a whole range, and, and, and you definitely need to wear glasses in this case.

Most of the therapy lasers either are produced in the head and therefore they have electrical wires passing from them, or they're produced in the main body of the laser and then they are projected to the animal or to the human by what we call a fibre optic, and the fibre optic will project that beam along along. Lead from the actual laser to the actual source of where you're trying to direct it, whether it's a wound or a deep musculoskeletal tissue. It, it is confusing though.

And so, you know, if you look at this laser here, you would think just on size alone, there should be a class 3, a class 4 laser, but when you look at the lead, this is a, a copper wire all wrapped up. It's not a fibre optic and therefore, the actual laser is in here. And so this is a quite a low powered laser.

Similarly, this large one being used here on acupuncture points on the horse, again, that's a, a, a, a copper lead and not working as a a laser beam conducive, it's mainly a battery within that structure. It is confusing though in Class 4 lasers, because you can have lasers like this, where actually the laser itself is in the head and therefore within this, it's just a battery and an LCD and you could tell that because the the lead itself is a copper lead. Other therapy lasers out there will have a fibre optic that leads itself and within the actual laser.

So there is even within this area, you have to be a little bit more astute to work out what is true Class 4 laser and producing it within a high powered system or what's producing it within a head. In summary to that, you can see the differences here. From the surgical, you're talking photothermal or ablative, and you are thousands of watts per centimetre squared you're delivering.

So a really high intensity beam in a very small area, and that literally cuts or ablates tissues, usually water is a molecule, and it can cut very aseptically. So it's a good tool to be able to use. Therapy lays as though they're bio stimulatory or photochemical, and the power tends to be 10 or lower watts per centimetre squared.

You tend to feel a warm sensation, or maybe feel nothing at low power, and, and it enhances the whole range of metabolisms and tissues within the structures. So if we start to concentrate really on what for therapy lasers and photobi stimulation is, we're all aware of photosynthesis and the sunlight going and affecting. Plants and in doing that they produce sugars, which produces the plant ability to go and photosynthesize, and it's the energy of the sun that's doing that and targeting these chromophores, which is chlorophyll in the plant.

In our bodies it may be cytochrome C, it could be oxyhemoglobin, it could be water. There's a whole range of different things that red and infrared laser beams are targeting. And, and it's important to know this from yourself, but also the client.

We are, we're not using ionising radiation. So, you know, there's no risk to you or your patients or anyone else in the building in regards to using therapy lasers. So we're not like gamma X-rays or UV light.

Within our structure, we're non-ionizing radiation, and, and therefore, we're able to go and be safely used within, the building, with, with minimal risk to any persons in the vicinity. Wavelengths, as I said, is an important factor, and that determines the chromophore you're targeting, but also the depth of penetration within the, the tissues. The power is an important factor because it works out how much dose you need.

Obviously, not much if you, you're doing a superficial tissue, but you, you, you, a lot of energy if you're doing deep tissues. If you get the wrong wavelengths though, it doesn't matter how powerful the wave the laser is, it will not penetrate deep enough or it may not reach the superficial tissues. So you need to be sure that you've got the right wavelengths for your laser.

And an example of this is we could have a 20 watt therapy laser using a 970 up to a 1064 beam, but it has less penetration than a 20 watt, infrared of a lower level around the 800s. And this will penetrate at least up to 30 centimetres. So you do need to be aware what wavelengths you are using.

These are the main chromophors that laser light is targeting. So you target melanin, you target cytochrome C, haemoglobin, and water. And in doing that, we can not only stimulate skin healing and accelerated skin healing, but in deeper tissues we can target and improve the general circulation and metabolism.

So if you look here, these are the range of wavelengths that people are using in lasers. They tend to use an aiming beam on a lot of the lasers, but in the case of our laser, we do use a class 3B laser because this is the absorption of cytochrome C in the skin. And this is the absorption curve of melanin.

So we don't want the laser to be too powerful, otherwise we're just going to get very hot skin. But we want it powerful enough that it, it's not just an aiming beam, but it's able to penetrate, and there are a lot of lasers which just have aiming beams, but not therapy beams. Deeper tissues though use the infrared, and the infrared will be using a range of wavelengths around that to target cytochrome C.

They'll be targeting and in quite a broad range of oxyhemoglobins, you can see all of these beams will have some effect on, on haemoglobin and oxygenation, and they'll not be vaporising, but they will be creating thermocouples which will open up capillary beds around the 970, 980, 1000 nanometers. So we're not in this area of surgical lasers where they're like metre long wavelengths and lots of power where we could actually vaporise water. This is a summary of that.

So you can see the chromopho is water, the target biological tissue is blood, and in doing that, we can open up capillary beds and improve perfusion and microcirculation. Iron is the next chromophore targeting haemoglobin, and we can decouple haemoglobin in those tissues, not only improving fusion, but also dumping more oxygen there to help the metabolism. Copper is the main constituent of cytochrome C, and we can increase cell metabolism, and then melanin in the skin will is present in the Kearachnocytes, and then it improve skin healing and the general metabolism on, on the basal cells.

You can see there the range of wavelengths that we're talking about. So if you have a laser which is using those wavelengths, that's really what it's targeting within that range, and therefore you can be more or less specific in how you're operating a laser depending on the wavelengths that you're using. OK, so the combination is power and wavelengths which allow you to do this photo by modulation.

You can see we can penetrate deep down to a horse, or we can do wounds or post-surgery on a cat. In this case, that's a human hand, and you can see with an infrared camera, you can penetrate deep down and actually look at all the different structures of the hand itself as it penetrates through. I got involved in lasers back in 2011, and I was kind of fascinated with them before then I was working in America, and I saw the rise of lasers, but I started sitting on a lot of courses between 2008 and 2011.

And some of these courses started to show me whether or not They were therapy lasers that I would trust. So, I, I, as, as Paul said, I've been involved with Klaser and one of the reasons I chose K laser was they back in 2011 had published data showing the penetration. So what this is is looking at water and you're using an 800 beam penetrating into it, and you can see the laser beam scatters and spreads.

So, you know, even if you're not very specific in what you're trying to do, you can actually treat a larger area. But by the time you're down to 6 centimetres, you've only got 29% of what you're on the surface, so you need quite a lot of energy if you're trying to do deeper tissues. The clinical director of the company at the time was a radiation oncologist.

So when he was treating cancer, he would use what's called an MRI, Monte Carlo simulation to treat and work out that it wasn't causing collateral damage, but just treating the tissue with the cancer. He flipped it on the head and said, OK, how much energy am I using to actually treat that damaged tissue? And he used the same simulations.

He then tested it in Oregon State vet school. Bearing little photon detectors at different depths of tissue to work out, are we able to go and produce sufficient amount of energy within that time frame and we looked at all the different wavelengths to work out the depth of penetration. And then tested it in the living animal at different depths and different tissues and different bones and soft tissue structures, and then it was published.

What I found amazing is this was published in 2011, and to date no medical and no veterinary laser has ever produced any other data like this. So to date, this is still the only laser that has data to show that it can do depth of penetration. OK.

So why Class 4? Well, Class 4, if, if you have the same wavelengths as a Class 2 or Class 3, you know, you will be able to penetrate deep. But what a class 4 laser does is it can deliver a larger volume or a bigger amount of energy to a deeper tissue in a shorter time frame.

So you get a quicker response, more consistent results, and therefore more happy clients by the end of the day. And it's a general progression. So, you know, there used to be Class 3 B lasers, but really like all technology, they've moved on and we're able to do more sophistication, better things.

And similarly, the, the speed and the precision we're able to do it is a lot better, using this as an analogy of modes of transportation. An example of that is when you use a Class 3B, you'd be using this on that area for about 45 seconds, then another 45 seconds, then another 40, and you'd work your way across and then work your way around that. So that, in reality would take you about 45 minutes or half an hour to do that area.

With a decent Class 4 laser, you should be able to do all of that area in about 5 minutes, which is a, it gives you a lot better use of your time and, and from the client's point of view, much more likely to go and see a significant improvement in a relatively short period. If you are only doing superficial wounds or or or or or any superficial tissues, then you may not need a lot of power and then maybe a class 4 is not so necessary. But if you're trying to do any deeper tissues or any painful deep tissues or any chronic injuries, you need a lot more energy and doing a lot more energy, you need to be able to go and deliver a sufficient dosage to actually have a biological effect.

OK, and that just explains, you know, you're just able to do it a lot quicker and a lot faster. OK, the final aspect about lasers and the way they deliver it is their pulse frequency, and, and good lasers should be able to produce a whole range of pulse frequency. What I mean by that, it's the amount of times the laser will turn on and off per second, so, you know.

We can have lasers that, you know, will be just on continuous, but other lasers may have the ability to go and do pulsing, and it tends to be what we call a 50% duty cycle on, off, on off. So if you have 8%, 8 watts, you might have 4 watts average, and they may be doing that 20,000 times a second or 10 times a second. But you can also have what you might have heard about super intense, and this may be peaking at a higher level, but averaging a lower level and therefore they they often use this to bypass the skin absorption and allow you to go to much deeper tissues without causing superficial heating.

Pulsing has also been shown to be beneficial in trying to get different biological effects happening. So if you are purely interested in an old osteoarthritic animal, you may be producing more lower frequency laser energy to the tissues that have a more profound pain control or neuralgic effect, where really if you're stimulating soft tissues, especially, you might be having a higher frequency, and also if you're trying to do more. Anti-inflammatory aspects again, you'd be using higher frequency and you can see there's certain work being done on infections as well using high frequency, infrared laser light.

The laser we work with, was tested both in Maelbeek University in Germany and also in Tries Medical School. And, and this is looking at cell cultures, but out of this work, they showed that on continuous wavelength, you actually stimulate a lot more leukocytic action. So we often on wounds will start and end with a continuous waveform, not just for improved perfusion, but also for helping in regards of some of the white blood cell activation.

At lower frequency we might be working more on the osteoblasts. Higher frequency, more endothelial blood vessels, and highest frequency, whether it's skin, smooth muscle or tendons, it'll be pulsing at a much higher level. So the soft tissue structures.

So if you're treating a joint, you will go from continuous all the way through and back to continuous in treating all the different cell lines. Whilst if you're treating really just soft tissues or wounds, you'll be predominantly using higher frequencies. And, and that will optimise what you're already able to do with the wound.

With the wavelengths and the power settings. So this gives you an example. So we're looking at a standard pulsing, it may be on and off 50% of the cycle, and therefore you're 10 watts power but averaging 5 watts, and you could be treating, you know, maybe a stifle injury.

But if you're using intense super pulse, and this is trying to bypass the dark pigmentation in the skin, you may be peaking at a much higher level, but you can see this isn't half the the the power, it's about 1/3 here, so you may be peaking at 20 watts, but you're actually down to 6 watts. And the actual time frame is bigger, and that allows the tissues to recover a little bit quicker and therefore you are able to penetrate deeper but not causing superficial heating of the tissues. The problem for you as the end consumer is there's a lot of misselling and poor marketing by companies within this area.

So I call this the not so intense super pulse, and you might have lasers out there that say we're pulsing 100 watts or we're pulsing 50 watts, and you're like, Wow, that is a powerful laser. But the point is they're on for only a tiny, tiny fraction of time. And in doing that, the average power drops all the way down to a class 2 level or maybe a class 3 level.

And, and even though they might be peaking at a high level, the amount of power delivered is very small and therefore the results are, are, are, are fairly slow, and, and, and the time frames may be very long in using these machinery. And so the key factor in regards of using these lasers is to understand what the average power is, not what the peak power is. You need to find that you're safely delivering enough energy at depth in order to be able to go and and get the desired effects that you're looking for.

So in summary, there's a combination of things. There's a dosage, which allows you to go and change and vary according to the colour of the skin, the amount of power and the pain levels, and the depth that you are, and the amount of energy at depth you're wanting to provide. Therefore, it has a factor on how long the laser's being used for.

But the wavelengths targets the different molecules and it targets different depths of tissues. And the frequency is a sort of fine tuning, allowing you to go and make sure that you're optimising the laser on whatever tissues or, or disorder that you're trying to go and treat within that system. From a practitioner point of view, this is the more the art side of things.

So, when you're using it, whether it's a veterinary nurse, a physio or a vet in practise, Whether you're treating acute or chronic, you need to know what's happening biologically, whether it's pain, inflammation, or just general healing, but you also need to use the laser appropriately enough that you actually get the desired effect. So, here you can see on the acute standard pain level, if you use a laser, it starts to reduce the pain and there's a different. But if I don't repeat the laser, it will start to go back to normal levels and therefore you do need to repeat, especially in acute injuries, fairly frequently and often in order to get that as close to perfect healing or reduce pain as quickly and as rapidly as possible.

For more chronic scenarios, there is a more oscillating effect. So yes, it will go down, but it will seesaw up and down again. So you'll get this change over a period of time, and it will gradually go up and down and up and down and hopefully get to as near perfect a healing.

So this could be, for an example, doing a cruciate surgery or elbow surgery and trying to go and ensure that you get as close to perfect healing as possible. But, but for things like osteoarthritis, at least we're improving the quality of life and the pain levels are coming down. You're never going to be perfect.

And as a multimodal choice, you can use this alongside maybe omega 3 fatty acids, joint supplements, nonsteroidals, rehabilitation, hydrotherapy, all those sort of things will help, and it will lower and lower and improve the quality of life. And therefore, it is part of a multimodal treatment that you can use in your pain clinics. The beauty about it is every case is going to be different.

So you, you know, you've got to use your brain, you've got to look at what's happening, and sometimes you might need to increase the frequency. Other times you may need to decrease the frequency, but there is an optimal for every single scenario that you're using in order to go and work out what's happening. OK.

Financially, the laser is very profitable. When you're using it and you're using a good class 4 laser, the time frames are short and you can fit it into very good nursing clinics. You can fit it into the operation clinic.

You can do a whole range of different aspects. If you have hydrotherapy, you could use it alongside hydrotherapy. But the beauty about this is that a short, sharp treatments which fit in within the busy schedule within every practise in the UK.

The point is within a busy practise, they may be having 4 simple surgicals, you might be having 1 major op, you may be doing 6 dentals, you might have 10 chronic cases that week, you might have 20 acute cases, all of which could have had laser. They all have a certain amount of treatments that we recommend. There is a range of different treatments and costs that you may go and charge, and overall that will vary dramatically in regards to what you're able to do.

Obviously no one's going to get 100% in regards of their weekly amount. But even if over the course of a year you're doing it, you may get a whole range. This is looking at an equine example.

Small animals tend to not be charging quite so much. They tend to be charging more like 20 to maybe 15 or 10 pounds for the surgical wounds. But again, there there is a, is a profitable route or practises if you're charging appropriately and you're using it regularly each day.

And some people may be using therapeutic. It tends to be more human side, but therapy lasers, there is an overlap in regards to what, what things it's doing. Having said that, a laser is more effective at being able to stimulate a much greater range of biological things, all of which have got clinical papers to show that.

What a laser is also very good at is you can also do it over the thoracic and abdominal cavity, but it also can be used straight away after surgery over broken wounds and over plates. And circulage wire and metal work, but you can also use it acutely, which means that if you are trying to rehab animals post surgery, you can get them back up very quickly and then help them with all the other good advice you're giving clients or all the physiotherapy or hydrotherapy that you may be using on that animal to get it back to an optimal healing. OK.

The last part of this, thing is I was going to go through some clinical data just to show you some of the papers to give you the idea of proof to show that it is working well. We, we recently published the data in 2011 from work that we're doing with Bristol University. It worked within the, antimicrobial department using a veterinary nurse called Dawn Billings, and she looked in practise and in the veterinary school at the effect of, in our case, K laser and how it would work on wounds.

She tested the laser and thankfully at our wound setting for spay wounds at 100 joules, we were able with the four wavelengths and the 10 phases of pulsing, we got down the infection down to zero. So we were glad that it did replicate what we were hoping it was going to do. She then looked at laparoscopic spaces, so these were really quite small 1 inch to 2.5 centimetre long wounds in the size of the dog.

And then she measured using a human APs to score, the level of healing, the inflammation, and the infection rate on the skin. And using K laser once compared to not using it on these laparoscopic sprays, we halved the AEsa score, which was a very positive proactive move in regards to, and in general, most clinics who use Klaser are using it on wounds every single day. She then did something different, which we were not expecting.

She then looked at the she, she got some slaughterhouse cadaver skin from a bovine source. And using the optimal power and wavelengths and frequencies, she looked at what it did in regards of a known dose of enterococcus on the skin. And then took away wavelengths and what you can see is the infection went up when she took away the red infrared lighting.

Then when she took away the 800, the infection went up. And similarly, when she took the 905 beam, the infection went up. But when she used the 970, which is targeting microcirculation, there was no effect.

And obviously there's a cadaver skin, so there may not be a synergistic effect on using that, but it may be beneficial in vitro, in vivo, sorry, compared to the in vitro study. Anywhere. In studies done on tendons in rats, this is quite a nasty study.

This has crushed the Achilles tendon of these rats. There was a controlled non-damaged versus a controlled damaged, and then 3 groups of rats had their their Achilles crushed, and then they were lasered 35, or 7 days consecutively. And then on day 8, they were sacrificed.

What this is doing is they then stained those tendons and the crushed, damaged. Tendons of the non-lasered were really disrupted histologically very badly. But when you look at the day 5 laser group, there was a very significant ability to, stimulate that tissue, and you can see it very clearly here.

And in fact, when the histologist looked under the slides, not knowing what they were looking at, the non-damaged and the laser day 5 group were identical. They could not tell the difference between the two groups. Similarly, we've done work with Nantes vet school, and we were able to show that we could penetrate an equine up to 30 centimetres and do sacroiliac and back joint injuries.

And over that period of time in the vet school as a PhD thesis, it was a good double blind study, and they looked on day 0, 21, day 42. There was a vet validation looking at the static and the dynamic thing, and then there was a a rider analysis as well on each of the days. And by day 42, there was a very significant difference between the groups that were treated and the groups that weren't in regards of lameness and in regards of their ability to perform on the racecourse and at a high level.

We've also done work in regards of using it around surgery. So, this was a study looking at the preoperative use of K laser on TPLOs. And we did TPLOs because this was done at Oregon State Vet School.

And that's where they devised the TPLO surgery, but also it's a known surgery with a set amount of very standardised surgery to the joint with a generalised level of pain and inflammation pre and post-surgery, which will be similar amongst all the dogs. The dogs were treated by the same surgeons. They had the same post-op therapy.

The only difference was half the group were lasered once and half the group were not lasered prior to surgery. And then afterwards they were analysed, prior to surgery and after on force plate and radiography, to see how they performed. This is a picture of the force plate analysis looking as a percentage of body weight, and you can see the ability of the dogs which were non-laser prior to surgery, and the dogs, sorry, this is a group here, they were split into two groups.

This one's going for laser, non-laser prior to surgery, both of them. This group then had laser, and then 8 weeks later, both of them were looked at. And you can see a 26% on the non-laser versus a 51% on the laser group, which was significant.

And when the radiographers did analysis of the integration of bone, metal, soft tissue healing, lack of inflammation, there was much better. Healing and lack of inflammation in the dogs that were lasered compared to the non-lasered. So that was modelled in the fact that they were they were able to walk and do things much better.

Most of the time, obviously with laser are more than just one treatment, but it does show the benefits that can be done. Similarly, we've done some really big, multi-centered double blind studies in, in, in humans with, peripheral neuropathies. And these, unfortunate women, had, peripheral neuropathy induced due to the chemotherapy and radiotherapy that they underwent.

As you can see here, we use fairly large doses of energy over a quite large area of the body system, and using quite significant levels of power. The study at the conclusion showed no overall complications, despite the amount of energy used, and the data indicated that the photobio stimulation had an effective low toxicity treatment for chemotherapy you can use peripheral neuropathies, and it may improve neuropathic symptoms through a number of plausible mechanisms, including prevention of apoptosis and enhancements of the neuro outgrowth. So we run a number of pain clinics around the country and, and, and we successfully treat both sciatic and fibromyalgia pain.

OK. I, I'm gonna, I have about 10 minutes spare, so, and Paul hasn't interrupted me, so I'm gonna go and do some case studies, and then hopefully there'll be some questions at the end. This is one case study here, showing superficially how lasers can work.

Not many of us in the UK have snake bites on our dogs, but this was a vet whose father's Airedale got bitten on the underbelly, and you can see a huge mass necrocious. And you can see the vet did fairly heroic debridement and gave claviamoxciprofloxin, tramadol, and Denimarin to this dog to try and ensure a good survival. But by day 6 you can see how necrotic this is, even despite this intensive treatment.

So not advised for all of us, but this guy decided to do a trial on the dog. So he lasered 4/5 and debrided 1/5. And after two sessions, you can see the necrotic section, which was non-lasered versus the lasered section and the nice healthy granulation beds and edges of the wound there.

They continued to laser, so they lasered now once there and for the 3rd time here. And again, you can see very healthy tissue and good granulation bed and a much, much different picture to the what you saw previously to that. And then on day 15, they started to do suture the dog together.

So using transposition flaps, they started to bring it together. Continuing to laser a really wide area to ensure perfusion and making sure there was not too much necrosis at the end of the tissues. And after 6 weeks, you can see the lack of size of the wound and also the, the healthy hair growth that's gone over the whole of the body system there.

Similarly, on osteoarthritis, you can see this, large, very large German Shepherd, which was referred from a vet clinic down in Epsom to Mosley. In true German Shepherd file, it had skin, gastrointestinal, and OA problems and had very significant OA in its elbows and also was lame on its hind limbs. And as the dog became more and more lame, it became more and more aggressive, so the woman wasn't allowed to take this dog out really into the neighbouring area and wasn't allowed to take it to the stables.

It was about to be put to sleep. This was a very good woman though. She did, weekly hydrotherapy, she did, Seroquin, tramadol, meticam steroids, but the dog was failing.

So they tried at Molesley with the, the laser. They did a right tip, the lumbar sacral in both elbows, and after two sessions, this dog started jumping in and out of the car, which he hadn't done for years. And by the end of the initial 6 sessions course, it was running around pain free.

If you X-rayed, the dog would still look awful. But the dog's quality of life and its ability to exercise and its demeanour and the reduction in aggression meant that the dog lived for another 18 months, with a good quality of life, and the owner continues to go and write thankful letters in regards of how it helped and improved what they were able to go and do. Finally, the last one I was going to do was a cat, and so this is one from Alevets up in Northamptonshire.

And Smudge was a 7 year old neutered cat who, like a lot of cats, got hit by a car. And you can see the level of damage to the surrounding areas and the, amount of avulsion. And at that point, there was a, a, a big worry in regards to the lack of ability to, defecate and urinate as well.

After 6 days though, they started, they, they started to respond a little bit better. But there was a breakdown in the wound, and the wound became necrotic. And so they started going and treating intensely, not just with the antibiotic cover, but also with Klasers to save as much tissue and improve the viability of the actual underlying tissue so that they could proceed and amputate at a future date.

So he had 6 treatments and you could see the change in the soft tissue, so we used what's called an edoema congestion. To go and target the soft tissue structures. And after 6 to 5 sessions, there was a marked improvement and a lack of necrosis of the area, which allowed them to proceed and do the tail amputation.

Continued to go and have every 3 days OK laser therapy and you can see 10 days after the surgery, the improvements and the lack of swelling and the ability to be able to defecate and urinate properly. This is a final point from one of the practises, talking about how it affects the practise and, also, the benefits that the staff see as well as the clients coming through the door. And, especially from a nursing point of view, it can be a really quite empowering tool.

It allows your nurses to become much more front of house and allows them to get very involved in the rehab. The lasers themselves don't take up a lot of space, so that can be very useful in a consult room. But it does allow you to go and do the complete aspect of rehabilitation within even a, a small inner city, practise.

Conclusions wise, make sure your laser is a true laser and not an LED. Not all lasers are the same, so there's very poor regulation. To licence the laser, you just have to show it's safe.

And Class 4 lasers allow you faster, more rapid treatments, even like to like with the wavelengths of a Class 3B. So they allow you to do a lot more in a shorter time frame. But be aware that it's not just one thing, wavelengths, pulse frequency, and power combined in order to optimise what you're able to do.

And therefore you should really make sure your purchase is validated not just with the ease of use, but also with the clinical publications and the amount of, use that you can have it. And when doing one of these processes, you should make a really good business case and, and do a good business model in order to do that. At that point I think I'm finished.

Is that OK, Paul? Excellent, thank you very much, Stephen. Yes, very informative, very thorough, lots and lots of information for everyone to digest.

We do have some questions coming in, out to everyone who's still listening, if you do have any questions, please feel free to submit them into the Q&A box now and we'll get through as many as we can. We will, host the recording of this webinar on the website as well. So if you have missed any of tonight's talk or you want to go back through anything, it should be up within the next couple of days.

Yeah, or any, any members of staff who haven't been able to join this, you know, if, if they're interested in doing rehab medicine or, or enhancing what they could do for wounds, you know, they could learn something. Yeah, perfect. Excellent.

We will send out a an email within the next few days when the recordings available. We have a couple of questions, so we'll get started on these. Jenny did miss the start of the webinar.

She's saying due to technical issues her end, so, she's just asking, you may have covered this, but can the laser be used to treat perianal phunculosis? There is no clinical papers, that I know of in treating it, but on case studies, I, I, I have seen good results with it. But some of the studies I haven't shown is the fact that we don't know why a good therapy laser can stimulate healthy tissue but doesn't overstimulate white blood cell.

In fact, it might have the counter, it might actually reduce. Over exuberant white blood cell production. So in the case of something like phylosis, which is intimately involved with the immune system, it does have an effect because it can dampen down that the immune system, but also stimulate better healing of all those deep fissures you get with phylosis.

You do need to use high frequency though, because it's soft tissue, so you need a laser that one is penetrating deep but also is producing high level frequencies to treat that soft tissue structures. Perfect. Thank you very much, Steven.

Katherine is, an orthopaedic RVN. She's currently writing a paper for advanced diploma on therapeutic modalities for optimal recovery of the canine undergoing cruciate surgery. And she's asking whether, you have the links to the research papers that you've used in tonight's presentation.

I mean, she's welcome to email me and I can send her as many papers as she possibly wants. Excellent. Do you have, what we do then, if we, if we put that in the, email, that goes out with the recording and any other questions?

No, no problems with that at all. I, I, I can happily send as many papers as necessary. Oh, fantastic.

Thank you, Steven. Roberto's saying he's a veterinary surgeon specialist in small animal surgery, saying, does, the laser therapy sometimes burn the skin and why is that? right at the beginning I showed the, the same wavelengths, you know, if I had a, a powerful 660 red beam and I used it as a class 4 laser, I could burn skin.

So in our laser we only use it as a Class 3B. Because the absorption of melon is so intense with a 660 beam that you won't penetrate deep, it'll just heat up the skin. So, it, it, it is, it depends on the wavelength and it depends on the spot size, the density of energy that you deliver in a certain area.

It's those combinations that do that. So we only sell into the medical market in the veterinary and it's for that reason that you need to be able to use a laser well to get the best out of it, but also to use it safely. Yeah, that's great.

Thank you. Question here from Philippa, she's asking, where can we find the data on the canine laser trials? She's got a lot of non-believer vets that she needs to help convince.

It first of all, get them to sit on the webinar and listen to it rather than not do that. And that would be a good step. And then they can do that over a glass of wine any evening.

The second one is that, like the previous person, I, I'm more than happy if some, if you want to send my email, that they, they can, I, I'll send them whatever papers they need. Yeah, that's great. Thank you.

I appreciate that, Steven. Interesting question here from Anne. She's asking, can laser treatments sometimes stimulate growth of cancer cells?

I didn't go into this and this, this thing, if you'd asked me in 2011, I'd have said don't go near cancer, because it's a photobio stimulator, so logically, you'd think that would be not a good thing for cancer. Interestingly, in the last 3 years, we've published 2 papers, no, 5 papers, but 4 of them are all related. But one of the papers looked at the mouse model with carcinoma and melanoma, and not only did, did the size of the tumour reduce, but when we did histology on it, we would stimulated T helper cells and dendritic cells to attack the cancer.

So there is some really interesting research, and now we've gone and done a study on 101 children with mouth cancer, carcinoma of the mouth, and they were given K laser in this case, and half 50 and 51 was split, non-laser laser, and the reduction in mucusitis was very significant and the ability to speak and to get back the mastication was very significant, but we never caused cancer in any of those patients who had delivered Klaser. Very interesting and as you say, a lot of research going on in this area, a lot going on in this area, yeah, and that, and that, to be honest, if we were talking in 5 years' time, there will be machines where you get into after having breast cancer, where you try and get rid of the rest of the seeded cells, there will be things moving in this direction. Brilliant, thank you, Stephen.

I have a question here from Philippa, who's online from Portugal, and she's a vet specialising in rehab. And Doctor Milli from Tennessee recommends using around 25 joules per centimetre squared when treating deep neurologic conditions like IVDD. On dark fur, it becomes difficult because it causes a lot of skin heat with that dose.

What do you recommend to minimise this? the, the only way you can minimise, I mean, he's right, so, so, is it Philippa you said? Philippa, yes, yeah, Philippa's exactly right.

The, the, the, the way that some, I mean, although I said 10 joules per centimetre squared tends to be. We expect actually some of the data is showing that you can go up to 185 joules per centimetre squared, which is obviously significantly more power per centimetre squared. The only way you can deliver that safely is through hand movement.

So you've got a constant movement over the tissues. And you're not spending too long on any one place because the science shows that it's very beneficial, but the downside would be that you'd, if you'd stayed and produced that amount on one spot over a period of time, it would be too hot. So you need to keep the movement going and over a certain time frame that amount of energy will then have that effect over it.

Perfect, I hope that helps. Yeah, absolutely. Some very positive feedback coming in, superb talk, very interesting talk, Stephen, thank you.

A couple of questions here in regards to, actual processes and things like that. So Catherine's asking, is it recommended for the animals to wear, goggles when, therapy. I mean, we do have goggles and goggles, but they very rarely used.

Pure and, and I do do a lot of dentistry work, so, you know, it it it it, unless you're literally pointing the laser directly into the eye. Through the cornea and the, lens, you aren't gonna concentrate it on the back of the the, the, the eye. In fact, I, I treat horses with uveitis laterally from the head.

And it has no damage to the eye. It's only concentrating it when you go through the lens and the thing, which is actually quite hard to do. But in this day of health and safety, we, we, you know, we try and do it as much as possible for the human point of view that we're keeping things very safe, and you must by law wear those.

But, for the animal's point of view, it looks very cool on Facebook, but it's not as a necessity. Some animals do quite like it though, and they chill out with the goggles on, but, but it's, you know, I think it's good marketing rather than, you know, a necessity to have. Yeah, absolutely, that's a good point.

Couple more questions coming in here. Steve's, asking, have you any data on the efficacy in treating chronic gingivitis in cats? They're, they're interestingly, on this area, we're way behind the humans.

The humans use lasers now a lot for treating post-surgery dental work and gingivectomies and, you know, stomatitis and, you know, bad inflammation of the gums. So we don't, to my knowledge, have a lot of clinical papers in the animal, but we do have it in the human. But, it, it is useful from a, you know, and I know from our own, you know, work, it is very good on gingivitis and dermatitis, and you can treat externally without even opening the mouth of the animal and therefore cause a lot less stress for the animal, which may be quite painful.

And, and if I was, you know, back regularly in general practise, I would be treating animals. Before surgery if they had really bad gingivitis dermatitis, because there'll be a degree of analgesia and it will stimulate better healing as well. Mm, it, it's interesting, isn't it?

We've got normally there's more research on animals and then it comes over to the human side, but it seems to be the other way around on the dental side it is, yeah, the dental is definitely the, the, the humans are, are, sorry, light years ahead of us. Perfect. So, I've got a question from Kevin here.

He's asking by saying, I was under the impression that class 4 lasers would come under, IRR 17 regulations and would need, you'd need to appoint a radiation protection advisor. It doesn't sound like you've said that during the talk, it's the, the, the, the rules and regulations in the, in the UK are, every country is different. And in the human sector, you, must have, and also we advise, in the veterinary sector, you must have a laser safety officer.

So that's someone in the practise who's been trained by the manufacturer at a high level on the safety and the efficacy and how to use the laser, and they become like the point of call, similar like you have an X-ray supervisor within the, in the practise. And, and they can write certain documents and all the rest of it, which, which should be displayed. There is no law to get a laser safety advisor in veterinary practises, but it is not a bad thing to do.

But there, there, there is no law to go and say that you should do that. The only law in the UK, ironically, is in London and Nottingham, where you must have a laser safety advisor if you are doing it for humans and using it on humans. But in the veterinary, there is no law for that as yet.

But we advise them definitely to go and have an appointed laser safety officer or officers within the practise. Interesting, thank you. We are, I'm conscious we are slightly running over, but we've just got a few more questions that we'll go through and then as, as we mentioned, any other questions that people do have, if you email into office at the webinar vet, we can pass on to Stephen, try and get these, answered for you.

So Steve's asking, are there any double blind studies on osteoarthritis in dogs with lasers? Ironically, there are less studies on this, and, and I think the problem comes down to, the difficulty we have in veterinary medicine to measure arthritis well. And I think, it, the, you know, I've showed you a fibromyalgia study, on pain, but in the animal species, there are much better ones just on general lays and lameness post-surgery.

Than there are on, on osteoarthritis. There are some, but, but they're not as many as you would think. OK, thank you very much.

We will call it to close there. If you do have any further questions or anything that you really pressingly want answered, Steven's very kindly agreed, as we mentioned, to answer those. If you send the questions into office at the webinar vets.com.

We'll be able to get that done for you. The recording, as I mentioned, will be available soon. If you could take just a minute or two to fill in the post webinar survey, that really helps, that feedback so that we can improve continuously for you.

Thanks once again, Stephen, for an excellent talk. It's been a pleasure. Thanks for joining us tonight.

I hope that was useful.