Hello, Anthony Chadwick from the webinar vet. Very fortunate today to have Stephen Barravas going speaking to us all about veterinary lasers. He is the man in certainly in the UK for talking about lasers.

So we're gonna be looking at some clinical publications and applications. I, I'm sure you're aware of who Stephen is, but he is the director of VBS Direct Limited, which has a very substantial part of its business. You know, looking at lasers as well, I'm sure Stephen will, will talk a little bit about that, during the presentation, but of course Stephen is also that.

Has worked in practise, but also, within corporate with companies like Sherry plough. If you're old enough, you'll know who they are. If not, I think they're now part of MSD.

And plus as well, so, . I'm really looking forward to the presentation. I think it's, it's interesting.

Laser is probably becoming more mainstream, but certainly 3 or 4 years, 5 years ago when we first did the webinar, it was very much, you know, cutting edge, everybody was, wanting to know more about it. Stephen's done a great job at bringing it into the mainstream, but I'm sure, Stephen, there's lots of things that we still don't know. You know, how to use it to its best, to its best way possible.

So I'm looking forward to listening to your words of wisdom and of course the clinical publications that you're gonna share with us as well. So over to you, Stephen. Thanks, Antony.

And thanks everyone for tuning in at 8 o'clock tonight or whatever time it is in your country. about 2 years ago, a Webinarbet asked me to go and do a generalist lecture. About laser therapy, and it was fairly rudimentary at that stage.

It was, it was relatively new to the veterinary industry, and at the end of it, there was a lot of requests for . A much more clinical orientated, rather than a generalist one with more about marketing and other aspects about it. So, so that's why sort of 18 months later, we've come back again and this time it's going to be a much more clinical, validated, and also some of the applications which potentially even if you have laser therapy, you may be missing a trick in regards of your practise, so.

I, I do work in the NHS as well within the the UK, so I, I'm an honorary, laser consultant at Guy and Thomas's. And, and as Anthony says, I have a company, so there is a vested interest, but at the same time, hopefully, I did my research and due diligence around everything. So this is, this will give you an overview of all laser science.

We're only gonna talk about therapy lasers, we're not talking about surgical lasers in this, just to make the differential. There is a lot, because of the lack of regulation really in lasers, there is a lot of, misinformation. people talk about low levels, they talk about high levels, they just talk about laser therapy in general, and it's quite difficult to understand exactly what constitutes one and where the other one begins.

So in, in regards to laser therapy, there's only two real words. That make any sense. One is the word laser itself, and that's the way that we actually produce this and differentiate it from normal light or LED light that we might know in our day to day lives.

And laser stands for something it called stands for light amplification, stimulation of emission of radiation, and it was Einstein and who identified this way of being able to produce radiation through the use of electricity and different chemicals. And the other word is photo biostimulation. And basically what we're using is photons of specific light to cause a photochemical effect, and in doing that, it changes things within the body system, whether that's blood flow, cell metabolism, or a whole range of different things that could happen.

And so these two words, laser and photobio stimulation, are really the key words when we're talking laser therapy. Currently, medical lasers now, and these are therapy lasers, not surgical lasers, therapy lasers are very broadly used, so you can see a whole range of areas with veterinary, but out with veterinary as well, where they're used in rehabilitation, in specific pain management clinics, for wound healing, especially some of the more chronic ulcers, but also just general surgical post wounds. It's used by elite sports, and, Premiership and, European, and international sporting teams.

In the UK alone, we've got, lasers in the UK hospitals, private healthcare, but internationally also, there are some major, clinics using it, therapeutically and, for pain management. The dental world in the UK has adopted it much more so. So if you are in a dentist clinic, there will be an increasing amount of dentists now who use lasers, not just for doing cutting, but also for healing and for helping regeneration of some of the tooth roots that they are doing.

An interesting area we'll talk about later is about cancer healing, post-treatment, which would be an area even two years ago I'd have just not gone near, and things have changed quite dramatically in that. From our own things, there are certain universities that are using, therapy lasers, and, it is very beneficial both from the neurological and, post, orthopaedic surgery cases for rehabilitation, but also for pain management. And then there are institutions around the world that are doing specific studies looking at what each wavelengths does and how they operate, and, and what they can do to enhance the, use of them in medical science.

There's just a generalist picture, just to show you from an old age person to podiatrist, to dentist, to sports therapist, to, just general public, treatments. So, it really is widely used. But it is also used in elite sports.

But the beauty about good therapy lasers, and you need to To the right there, it literally can be used from a baby, or in our case, it could be used from a, a mouse or a, a, a small, vertebrate or a bird, right up to an octogenarian or in our case, an older animal, whether that's a horse, a dog, a cat, or anything else. It, it, from my own experience, I've enjoyed working on both sides in the human and the veterinary side. And, and, and, you know, we work with people like, Rafa Nadal, and, you know, he has chronic patella tendinopathy.

Now he's still #1 in the world, but his physio and in the case of his laser here, which he takes all over the world, that they help him stay in one piece, and allow him to go and maintain that level of, sporting prowess even in his 30s. From a veterinary point of view, the beauty about a good therapy laser is how broad spectrum it is. When people ask me about a good laser, I say it's as close to a a steroid or a steroid injection without the side effects.

So you. Really can have a fundamental effect on the general metabolism of a tissue, both from that pug at the top left where you're doing a superficial, you know, hotspot to, that horse on the top right where you're doing a deep stifle osteoarthritic joint. And all the other pictures there show just quite how comfortable it is, and whether you're using it on a cat, for osteoarthritis or a little guinea pig there with back problems.

But you can also do some tricky things which are, like nasty wounds like a cup pad or a chronic wound, a dog bite wound or an infected wound, and that allows you lots of opportunities to be able to use it, in practise. Not many of you, I would say today would be exotic specialists, but for those who are using it, the ability of laser light to travel distances, means you can treat things at a distance with a known amount of, energy, and that is very useful in animals, which are really quite tricky, or, or, or there may be no licenced drug for its use or the condition that you're trying to do. And so anything that can accelerate some of those damages and the injuries or or or even things like bumble fit and that.

penguin are of benefits for us in, everyday veterinary science, but especially in some of the exotic world. OK, so I'm gonna start really just in a general overview and then I'm gonna go into the actual papers to back this. But this is not gonna be looking at core science, per se, more clinical science, but to understand how a laser works, you need to understand that there are certain wavelengths that target molecules which we call chromophors.

And in doing that, it can improve the overall environment of the tissue that you're trying to target, whether that's improved oxygenation, general metabolic ATP levels in mitochondria, but also we can go and improve skin and all other aspects of the body system and help it regenerate a little bit quicker, but hopefully with less scarring. The. Action of some of the wavelengths on water means that we can create what we call thermocouples, and we can actually increase blood flow to tissues and improve the perfusion.

But over a protracted period of time, you can actually increase the growth factors there that help angiogenesis, and you can actually improve some of the blood flow. So I, I, and some of the diabetic wards I work on, we can improve blood flow to certain parts of the feet. The anti-inflammatory effect is twofold.

Yes, there are changes in some of the anti-inflammatory, but most of it is down to the fact that you're improving perfusion to that tissue and therefore you can reduce the swelling, but you can also get away some of the cytokines and some of the inflammatory cytokines that are causing inflammation, but also bring white blood cells and bring other good tissue substances there to go and help that inflammatory process. The, the, the challenge with any good therapy laser is to get deep enough and get beyond the skin, and trying to get down to the nerves is a challenge. And there are only certain lasers within a short time frame that are able to do that, and, and have a desired effect in regards of healing that tissue.

If you can stimulate the nerves in the central nervous system and the DNA and the RNA, then you can have a more profound effect on maybe the radial analgesics and some of the actual healing process if you have a peripheral neuropathy. So it's more of a secondary effect of of affecting the nerves that can then can have an analgesic effect on a more broad level. But it's a very useful thing.

Overall, you can accelerate some of the tissue repair and, and cell growth, within it because you're improving perfusion, because you're improving the cell metabolism. But the beauty of it is you can actually produce more type one collagens. So when you're healing and you're using a laser in as part of the rehabilitation process, you will produce more type one, and that's very good in regards to the end results, whether it's surgical or non-surgical in what you're trying to achieve.

Fibrosis is, is more of a problem I find in the human than the animal, the sector. The animals tend to heal a lot better, but, you know, if you are, if you've got nasty scars, a good therapy laser will help that because it will improve perfusion to it, and it will bring white blood cells there as well and stimulate those to go and break down some of that fibrous tissue, but it will take a bit longer, so that level of immuno regulation doesn't happen overnight. It does take a longer period of time.

Especially with chronic scars. But with faster wounds and smaller wounds and, post-surgical wounds, you can have a really good effect. The earlier you use a good therapy laser, the better the end results will be.

So, so my, take home is really try and use them as quickly and as early as possible, with or without surgery. Some of you may use acupuncture. And you can use laser, and you can use a needleless laser for doing that.

But most of the lasers I'm talking about here in this lecture are about doing a more radial effect on the tissues rather than actually picking out specific Western or eastern trained acupuncture points. But that is possible with lasers, and you can have the same desired effect as a needle. OK, so just to understand some fundamentals, key to a laser is the wavelengths, and key to the wavelengths is what they're trying to target, which is these chromophors, and these are molecules in the body that absorb specific wavelengths of light.

And for a therapy laser, we tend to work in the red and the infrared, and those wavelengths target. Things like water, melanin in the skin, cytochrome C, the copper in it within mitochondria and the iron in haemoglobin. And those are the four key molecules to help perfusion and general metabolism and oxygenation within the tissues that we're trying to do.

So, so this gives you an overview. So what you're seeing here is beams of light, and we're looking at nanometers on the bottom, and they're very small, so you, this is the distance between wavelengths. So on the left hand side we're down to about 600 nanometers.

The way on the right we're down to about 1000 nanometers, which is over 1 metre width between each wavelength. And when we start on the left hand side here, that green line is melanin, and that's the absorption curve, and the red line is cytochrome C. So in using a 660, and these tend to be either a class 2 or a class 3 because you do not need a lot of power, it, it tends to go and stimulate melanin and it tends to stimulate cytochrome cinem in the skin.

Now some of the more whether it's a Class 3 B or a Class 4, they all use the wavelengths around the 800, the 820 range to go and target cytokine at depth. And then around, you can see that pink line is quite broad and hemoglobin's got a broad range of absorption. But around 9:05 to 9:10, you've got peak absorption of haemoglobin, the iron in it, and then you can increase the amount of oxygenation of tissues there.

From a water point of view, around the 950 to 1000 nanometers, you've got a wavelength there that can do peak absorption. Now you're not vaporising pets, but you are going and causing changes in temperature, which open up capillary beds and improve perfusion to and from the tissue. On the Right hand side there, this is a CO2 laser.

So these are lasers that are not diode lasers, which is what we're talking on the therapy ones. These are lasers that using CO2, we can stimulate a radiation that allows you in this spectrum to vaporise water, and we can actually very accurately do cutting with a scal without the scalpel, and it seals as it cuts as well. So that's a totally different type of laser.

OK. Why is laser power important? Well, we've known about, lasers for a long time, and as we know more about them, we know we, we produce more and more powerful lasers, some of which are military, industry, surgical, but, but there are also therapy lasers, and, and if you look at the bottom right, it says the AC.

This is the, North American standard index for classification. Of lasers, and it goes from class one, which is a very, very low power, and you can see in microwatts, up to a class 4 which is anything over 500 milliwatts. And, and in between there, you've got the different classes.

So back in the 80s and 90s, they started using therapy lasers in medicine, class 3B, and they were generally quite weak, but they were able to go and stimulate tissues, especially superficially. And, and, and acupuncture points. And as we got more and more familiar with the safety and the, benefits of medical lasers, we started introducing class 4 medical lasers, so they were classed as safe under the World Health regulations, but they they allowed you in a shorter time frame to achieve more from using therapy lasers, in that treatment time.

Why do we need more power? Well, none of us have got a lot of time on our hands, especially in general practise, or referral practise. And, and in having a laser and making it benefit your practise, you need to have something that produces something in a short time frame.

And the reason being is any wavelengths, whether we're looking at 800s, 920s, 905s, whatever wavelength you're looking at. A certain percentage will get reflected, some will get scattered, and a, and a certain amount will get transmitted. The best penetrating beam is the 800, but the other beams will also have a similar sort of spectrum.

The problem is though, if you want to be able to go and target that molecule, that chromopho, you need enough energy in a short time frame to be able to do that, and that's why sometimes the Class 4 lasers are more beneficial to practise in being able to deliver that in a short time frame. This gives you an indication of it. So, you know, if you were only doing superficial wounds, then a Class 4 laser would be too much because you only need a small amount of energy over that that tissue, surface.

But the deeper you go and the more painful the condition, the higher the energy levels need and in. Producing at depth enough energy, you need a lot of energy starting at the skin surface. So at the bottom you can see we measure photon energy in joules.

That's recorded in watts, which is the energy per second. You can measure the energy you deliver to a certain area of tissue in in power density. But the dosage is really important because you need to make sure you've got enough dosage at depth to have a biological effect, and that's where doing 10 joules per centimetre squared maybe for a a hip joint is the least amount you'd need in order to make anything change at that level.

But in order to get that, you need a lot of energy on the skin surface to get down to that level. Fluence is an, is a calculation of how much energy you get at that depth. Class 4, I, I, I mean, I sat on lots of courses in my life, and, I, I, I came to the realisation that if I was going to do something in, in, medicine or in veterinary using therapeutic lasers, I really had to use a Class 4 laser because I needed enough energy in a short treatment time, one to keep me happy, but also to actually feel like I was benefiting the tissues at depth and superficially within a short treatment time.

So it fitted in with everything else I was trying to do medically and surgically. So, you know, a class or laser delivers a therapeutic dose to a larger volume of tissue with sufficient photon energy to do those deep targets in a short treatment time. And it's not that a Class 3B can't do this, it's just a time frame to do it means that you are not achieving it at depth in the time frame that you're providing that laser, and therefore it may not provide the level of results that you're looking for.

I got also involved because, I saw some of this research. So this is some of the research, this is some work that Kay Laser did initially, and which convinced me about the beneficial effects and also the depth of penetration. So, so we're interested not just in how the surface level, but we want to make sure that the laser we're using actually can penetrate deep enough and with enough energy to actually have a biological effect at depth.

So that picture on the right shows a high intensity laser 12 watt. Fired into water and you can see there's a scattering effect which I showed you on the previous slides. And so even by the time with the best penetrating beam, by 6 centimetres, you've only got about 29% of what you start on the surface.

So you need a lot of energy on the surface in order to get enough at depth. What, on the right is what radiation specialists would use. It's called an MRI Monte Carlo simulation to work out how much radiation to kill a tumour.

We, we did it on the opposite way. We worked out how much energy you needed to go and penetrate a tissue with enough energy to have a biological effect at depth. And what you're looking at here is those things.

So you can use this Monte Carlo MRI simulation, not for working out how much to kill a cancer, but to work out how much energy you need to heal that. Shoulder damage in that left hand picture there. And and so initially it's a guesstimation when you use this to work out how much energy you need.

And then we tested it using photon detectors in the cadavers of dogs. This is actually Oregon State vet school work, and they buried photons at different depths in the tissues and made sure that there was enough fluence and dosage of energy at depth to actually have a biological effect. And then they tested it in vivo in the living animal.

So did the similar process, put a photo detectors at depth under the spine, in the hip, on the stifle joints, and were able to work out that we were able to achieve that depth of penetration. And and then they published it in a journal called the North Americans. Association of laser therapy.

And this is the first journal that actually published data showing that a commercial laser is able to do that. And to date, interestingly, it's the only medical or or or veterinary publication I've seen of a laser being able to penetrate that depth in the times that they say on your dial. One thing, also with lasers, you've got the wavelengths, you've got the power, and then you need the pulsing, and the pulsing is the actually the on off cycle of actually the laser going on, off, on, off, and how many times it does it a second.

And that's measured in hertz. And what you can see from this picture is if we were using an 800 beam, which is a good stimulating mitochondrial beam, and we shine that at different cell cultures. You can see that top line there, continuous, we can stimulate a lot more leukocytic action, but actually you've got hardly any effect on endothelial cells, osteoblasts, and a little effect on smooth muscle.

If we have a low frequency, you're talking under 50 times a second, it's turning on and off. Actually you can see, yes, a little effect on the leukocytes, but actually a really profound effect on bone cells. And they helps them grow and multiply more quickly and it stimulates them better.

At higher frequency at around like 500 hertz, you actually stimulate a lot more endothelial, so you can actually cause a lot more end angiogenesis. You can do a lot of other things within the body system. And at the highest frequency you've got more smooth muscle, caratinnocytes, epithelial cells, and that's very good for both soft tissue and also for superficial wounds as well.

So fine tuning it can actually improve your clinical outcomes as well. In order to go and bypass some of the usual effects that you get with lasers of the scatter and the reflection. Some of the, lasers will have what we call a intense super pulse, and that means that instead of just having them on continuous and getting a lot of warm superficial dermis and, and subdermis area, by doing high intensity, photons deep into the tissue, it actually goes a bit deeper and allows you not to cause so much superficial heating, but actually get down to the joints that you're trying to go and target or or the internal organs.

From a physiological point of view, pain and, anti-inflammatory management is often what lasers and therapy lasers use. There's a lot of clinics now set up on the human, but also on the veterinary side, where they're using it for rehabilitation for OA cases in conjunction with, obviously weight loss and pain management. And so what you're looking at here is that.

They have shown that you're able to go and get, similar to like the changes in the mitochondrial cytochrome C or the, haemoglobin. The photon energy can be absorbed by the transmembrane proteins and neurons, and that can change the action potentials flowing along it. So you can reduce some of the action potentials if you are trying to reduce some of the pain.

From a peripheral joint damage. But, but one of the most profound effects is, is, is the acute effect where because you're improving perfusion, and you're, and you're improving blood flow too, but also away from that damaged tissue, you can reduce the edoema and swelling and obviously, in, in reducing that, you can reduce some of the the firing of the receptors that cause pain and inflammation. If in the human sector and increasingly in the veterinary.

When you've got really chronic pain and neuropathic pain, just treating the local area is not sufficient. And the beauty about nerve cells is they're very plastic. So if you start treating the appropriate nerves that supply that appendage on that joint, then you can have quite a long term effect in regards of changing.

The the chronic pain pathway and improving the overall outcomes and reducing the pain that that dog or human or animal would go and perceive. So there's three ways of being able to manage it. OK, so that 1st 20 minutes was a brief overview of the background science about what makes up good therapy lasers.

The rest of this I'm gonna start superficially and then work deeper into the animal, and it's a combination of animal and human studies to go and validate, stuff that you are doing on a general basis in practise. OK, so the articles are down there in the bottom and I've just summarised three articles here. One of them was looking at fibroblast proliferation and migration, one was looking at fibroblast growth factors in the skin, and the other one's looking at creating sites mobility and viability.

Overall, using good therapy lasers, these studies showed that you got about a 30% acceleration in healing. And overall quicker contraction, better epithelialization, but faster tensile strength, and better overall tensile strength that tissue. So if you're using a good therapy laser in practise, you should expect to see about a 30% wound acceleration.

Overall, when you go back at that tissue six months later, compared to a group that you hadn't, there should be less scarring. I'll show you some data in regards to the reduction in infection, but because you're improving perfusion to and from it, you get less pain and inflammation. And, and you'll definitely see a faster regrowth of hair in that tissue.

And if you go to certain clinics in London now, you'll see the amount of lasers used to try and regrow men's hair in their heads. OK, this is a general picture of a group of physiotherapists at university who used an 800 beam wet laser. And they used quite a high level, 8 joules, and just using one phase, 700 hertz, they were using, and about, not, not a high level of energy, 157, OK, joules.

Then what you're looking at here on the left hand side is the pixel, so the size of the wound that was created in the forearm of these physiotherapists. And they split them into 4 groups. There was the silver standard wound dressing with laser.

There was no dressing with laser. There was dressing. No laser, no dressing, no laser.

By day 20, they're 21 year olds, they all healed very well, they've got no biological problems with them. But what you can see, even with standard wounds, you could see a 30% acceleration with the black and white, which was the laser groups compared to the non laser. And at day 20, there was a very significant difference in the pain in the arms of the individuals who had not had laser compared to the ones who did have laser.

For the more challenging cases, the more infected, non-healing chronic wounds, what you can see there is some really nasty diabetic wounds and other, non-healing wounds in individuals. And, below are some of the challenges we have to deal with in life when the owner not understanding that a cup pool is really a big challenge for us and it will take a lot of bandage changes. And then some really nasty secondary effects of, some sort of MRSA cases and other things like that.

So these these are the sort of the worst cases. But again, there are papers and good information showing the effects on granulation, minimal scarring, but more importantly, we can stimulate the white blood cells to clean up and debridede some of that tissue, but also help in some of the reduction in some of the infectivity there as well. And definitely within some of the diabetic wards I work with, you know, the reduction in infection, but also the reduction in the MRSA biofilm, it is a big benefit in accelerating that wound healing and providing better oxygenation and flu perfusion to it.

You can see there a really challenging case of having created a trephin to go and get rid of the fungal infection, it then doesn't heal and and trying to go and heal that obviously with healing bone as well as soft tissue structures, but, you know, anything to accelerate that is a benefit. I, I often get approached to go and set up trials, and, this was a, a fantastic girl, called Dawn Billing, who is a veterinary nurse, and for her diploma, she approached us to see if she could do a study at Bristol University. And under Tristan Kogan and their antimicrobial department, they went and took on the study where they looked at laparoscopic spray wounds, so really tiny wounds, and the effect of the laser, in this case it was K laser that they used on the wound to see, does it have an antimicrobial effect.

So what you can see on the left hand side is the log scale of inbacteria. And you can see at the lower. Dosages of power, no effect whatsoever, but once you got up to 100 joules, which is similar to that physiotherapy study, we got down to zero infectivity on the skin level.

And then when they put that over with that 100 joules and all the frequencies and the pulsing and everything else and the wavelengths to a laparoscopic group, they split them, half lasered, half non lasered. And you can see the difference in the asepsis score was about 5%, even despite of all the aseptic conditions that the non laser group was using. When they saw that, that intrigued them further, and so they started looking at the effects of wavelengths.

So in the left hand side you can see they've taken away one wavelengths there and when they've taken away one of the four wavelengths, the infection has gone up. Similarly, when you look at the right hand side, when they took away the 660, which is really only going skin deep, again, the infectivity went. So there seemed to be not just a an effect of the wavelengths and the power and the frequencies, but also a direct effect from the wavelengths themselves.

And they're doing another big study there at this point in time to look in depth. Looking at some meta-analysis of wound, and general wound healing, this is a study by, and weaker, based in, America, and she did a meta-analysis of, 34 studies. So we looked at about 200 different studies, but went down to ones which are really good double blind placebo controlled studies.

Because of the variability, she had to use what was called the Cohen's D. stats, so the bigger, the more positive the number, the better the laser was versus placebo. But the more negative the number, the, the better the placebo was versus the laser.

And what you can see on the right hand side is two of those studies looked at flap survival. 14 looked at rate of healing, 7 looked at tensile strength. It's a whole range of things.

But those numbers, when 0. + 8 is a very good effect, you can see the massive effect that the laser has. In regards of improved rate of healing.

What is interesting is when you get down to the second bottom one, we did increase the amount of my cells in the wounds, but what we didn't do is increase the degranulation. So for some reason, although we were stimulating good healing, good overall effects on, on getting the, the minimal scarring, we did not cause more histamine release or other chemicals which would have been detrimental to that healing effect. Understanding your anatomy is really important, which is why good therapy lasers should only be sold into the veterinary, physio, or, or medical field, because you really need to understand your anatomy in order to get the best results.

So what this study was showing was there were 4 groups of rats, and they cut a flap off the belly and then re-sutured. And then one of the group was a control group. One of the groups, they just did the main ila lumbar blood vessel, and the other two, they either did the proximal or the distal part of the wound.

And if you look to the right, you can see that white, which was the placebo group and the flap survival in millimetre squared, compared to the two grey ones, which was the proximal and the distal, which was significantly better. But more interestingly, just doing the major blood flow to that flap was as. Good as doing the proximal the distal area, so it just shows the importance of rerascalization and and and preventing tissue necrosis by getting good blood flow and perfusion to that area.

Similarly, can we do that on deep tissue? And this study was looking at the effects of, blood flow deep within one's arm, forearm. This is a human study again, based on physiotherapists, and they use what's called lismography, so they're measuring the blood flow at depth in the arms of these individuals and comparing it to their non-lasered other forearm.

And then it was a crossover double blind placebo controlled study. And, and obviously they were looking at the improvements in, in, in how that happened, but the, the repercussions on that is how it can affect people in regards of ischemia, hypoxia, or edoema and preventing tissue damage. So although these were healthy, that was what we were looking at in the future.

. From the study, as I quote there, it says, Class 4 lasers can emit greater phonic energy in shorter time frame than Class 3 B. So it's not that they do anything different, it's just they do it better and quicker without an appreciable tissue rise. So most people say, oh, a laser just rises temperature.

That's not what it's doing there, doing a lot more than just causing temperature changes. And this higher power becomes important when treating injuries in deeper tissues such as ligaments, muscles, tendons. And, and I definitely agree with the second quote that improved circulation is considered one of the most laser's greatest contributions to soft tissue healing.

So in the clinics I work in, it is not, it's a, it's a, an opt out if they don't want to use laser post-surgery, because the clinics I work in have seen the differences, and, and it becomes a standard of core standard of what they're doing as part of the whole, improvement in the wound healing post-surgery. Similarly, a higher dose made a difference. So the higher the dose, the better the blood flow, the longer term that blood flow continued.

I take you to, wounds that luckily we don't see often in, in the human in the veterinary world. This is a human diabetic study. And what you're looking on the left is the normal rate of healing, and what you're looking at the, right is the granulation tissue.

And the, bottom line is the, placebo group and the top lines are the, laser group. And automatically you can see that the laser group accelerated better and quicker. They didn't get to 100% in this group, but they got better.

And what you can see from the placebo group is the patients, despite the same podiatrists, got worse, the wounds got bigger, and the variance amongst that population was much greater than when you use laser. There was a normalisation from using laser therapy. A colleague and myself were involved in this study where we set up a trial at Guy and Thomas's, which is part of King's College in London.

We had about 250 patients that we recruited, but the end result was a much, much lower because trying to find a group of patients that could get into the publication with the same wound, the same position on the foot, the same amount of pseudomonas, the same drugs, the same haemoglobin was challenging. And so, although we got straight line into the paper, it was a much smaller number than the 250 we started with. The recruitment was 3 year old wounds on the feet.

Compared to just standard podiatry without the laser in this case. And we were treating them twice a week, for up to 12 weeks. And during that time, 80% of these non-healing wounds healed, in 4.6 weeks compared to 0% in the placebo group.

And that's just one of the pictures from it. So you can see the overall healing and that's just 3 sessions that it took to go and get to that level of a really chronic wound and you can see the chronicity of the toes and everything else on this poor individual. Showing you an animal one.

This is one I was involved with the RSPCA. It was a cruelty case. I mean this poor little chihuahua was, burnt, and, and had a full thickness thermal burn.

and I saw it on the 27th, where it was about 12 centimetres by about 6 to 7 centimetres. And it was nice and fresh at that point. And so they were considering doing skin grafts and all sorts of other things to it.

So we started lasering, and we were lasering twice a day initially and then once a day thereafter. But you can see on day 4, the wound compare it was on, on day one. And there's contraction of the wound, but it's healthy in the, in the skin and there's no breakdown and there's no infectivity there.

And then you can see it on day 11. So you've got not only hair now regrowing in some of the areas, but you can see the contraction of that wound, but nice wound healing without any scarring. Obviously it was on antibiotic cover and pain relief as well.

But that animal did not require, some fairly serious, wound grafts and, went back and got rehomed nicely. I use this, one from the USA, this was, a dog who was owned by the vet's father. And therefore the vet felt a certain degree of responsibility for this dog.

You can see the drugs at the top that were used. This was a snake bite on the underbelly of an Airedale terrier, and you can see the necrotic underbelly on day 3. On day 5 they went under heroic debridement, but on day 6 you can see it's all gone and become necrotic and it's, it's dying back and the tissue looks really very poor, and the animal's in a really bad state and it's not in a good health.

So on day 6 they decided to do a trial on this dog. So they debrided 15th again, but they then in this case used the K laser on 4/5 of it. And you can see on day 8, having had two laser sessions on day 6 and day 7, and now we're looking at day 8, you can see how healthy and granulated that tissue is in the one little corner, they didn't laser, how necrotic and infected it is.

So they gave up the trial, lasered that for the 3rd time, and now you can see on day 12 after 3 sessions, how that looks. And then on day 15 they started putting the dog together again, and, continued using 2 to 3 times weekly, in this case, the OK laser. And what's interesting is you can see how well that came together.

So in 6 weeks, there's only a tiny little wound and how incredible the amount of hair now cover is of the whole of that underbelly area. So the dog is not dehistsed, and healed very well and it it was back to full health. Again, what we do today is important what we do in the future.

This is a human study on inguinal hernias, and, and, and half the group of 28 had just standard surgery, standard rehab. Half the group had 4 laser sessions post-surgery within the first week. What we're looking at here is 7 is 6 months after surgery, 6 months after lasering.

And on the left hand side, in the groyne region, there was 72% less scarring in the groyne of the patients who were lasered compared to the control and then on the right hand side you can see 82% stronger tissue healing. So although there was less scarring, the tissue that was healing was better, and overall they used what's called a Vancouver scar scale score, and that was 11,266% different at 6 months, which is what we all want to do and achieve. I said that there's been some interesting results coming out.

So, these are results looking at tumours. And, we've been doing quite a lot of work on this area, because definitely when I started, I wouldn't have gone near a tumour. Now this study looking at rats and mice used melanoma and carcinoma models, and we found that we were able to increase cell metabolism but not increase tumour size.

And in fact, when we looked at the histology, we'd actually increased and recruited more T helper. Cells, dendritic cells and type one. And yet we hadn't stimulated the angiogenic macrophages that caused the growth of the actual tumour itself.

And as you can see, it says a striking and unexpected result and an emerging strategy. And so I couldn't get the licence for this, but in the US, in, in, not the USA in, in Italy, they managed to get a, a, a whole load of dentistry, univ is to come together and start doing work on children, because after a squamous cell carcinoma in the mouth, one of the side effects they get from all the chemotherapy and radiotherapy is massive mucusitis of the mouth, which causes speech impediments, glutician problems, and a lot of nasty scarring. And, and what this is showing is that the reduction in the scarring, from the use of the laser.

And, these are the, mucositis scars that they got within their mouth structure, which was, really quite painful and nasty and and long lasting. And then they did a much bigger study, so they did 101 children in about 8 different sites. And what you can see is the acceleration of the healing process and the reduction in the actual pain that these patients had without any side effects.

So we didn't cause any recruitment of any more cancer cells, but they healed much quicker, and on that basis, we have got now nice approval from the NHS in the UK. For the use of this, on, mucositis and other, post, oncology treatments, causing damage. Healing and, repairing tendons, again, there are some good studies out there looking at the effects.

But again, what's interesting is when you use a good laser, you produce much more type one collagen when the healing happens rather than what we associate. With a scar, which is a more type 3 scar and, and therefore, if you have tendon or ligaments or even muscle damage, it will heal much better overall. The study shows that clearly, what we've got here is a rat study, and, and, there were 54 rats in the study.

All had, well, 6 of the control, the Achilles tendon damaged. And then apart from the control group, the 42 study rats that had their control, their Achilles tendons damaged, were either split and lasered 35, or 7 days. All 54 were then sacrificed and looked at under the microscope.

And on the top right, what you can see is the control damaged versus the day 5 lasered below that. And there was a very significant difference histologically. And in fact, when you look at the results, the second line down, the non-damage control versus the damage group were almost identical histologically.

There was no inflammation, no good alignment, and, and clinically they, they would do well. From the carpal tunnel, point of view, this is a study looking at the effects, ongoing for patients with carpal tunnel, which is, an inflammation within their, wrist joint, from their extensor, from their flexor tendons. And, this is a slightly, low powered laser, but, they were using 10 sessions.

10 minute 5 times a week for 2 weeks. And in this case they were looking at the effects on nerve conduction and grip strength, and how they were perceived during that time. So after 2 weeks of treatment, so 10 sessions.

There was actually no significant difference, although there was a a a a numerical difference between the laser and the placebo. But when they stopped the laser and then looked at it two weeks after finishing laser, now we're looking on the right hand side, there was a significant difference now. So the, the laser group, despite non-lasering for 2 weeks, continued to get better.

And the placebo group continued to get worse. And when you looked at the vast score of these patients, now when you're using 100 score, actually those patients did show a statistical distance after two weeks, which, like the grip strength and nerve strengths, actually continued to improve despite not using the laser. So using a laser and using it well, you should start to kickstart the general metabolism to improve overall.

Again, there are some studies here looking at both ultrasound, but also laser in the human world, showing that you get a much higher level of type one collagen if you can use a good therapy laser over that tendon or, or, or ligament tissue. I use this a lot in the human side, but it's less interesting, although we do use shock wave in the, veterinary world, there is less, therapy ultrasounds used. But when you compare a good therapy laser versus the ultrasound, there is a much broader spectrum overall use, but more importantly, you can use a good therapy laser straight away over broken skin.

You can use it over irregular parts, you can use it over the thoracic and the abdominal area. And you can use it where there's been metal implants to go and accelerate the healing post surgery. So there are lots of big benefits there.

The, the muscle repair, there are less studies on this, but there again, there are studies showing the improvements in muscle fibres, reduction in inflammation, and overall improvements in angiogenesis to that damaged tissues. There are studies also looking at bones, looking at the effect, versus control pre and post non laser versus the right hand side, laser pre and post, where there were significant improvements, not only in the in the amount of osteoclasts and osteoblasts in that tissue, but in the tensile. Strength of it when they actually unfortunately had to break it later on to go and measure the tensile strength.

So it definitely can heal. One of the benefits obviously is you reduce pain and inflammation, so they start walking on the leg earlier as well, but obviously you need to go and do a proper structure in rehab to make sure they don't overexercise. We did some work over in Oregon State, using K laser on, on, cranial cruciate surgery.

And the reason we did this is the dogs obviously have the set surgery, set procedure, set pre and post-op aftercare, and the only thing we did different was add in, in this case. The laser at the point of surgery, and not afterwards. Usually we do a whole rehab thing afterwards with the standard laser therapy.

And what you're looking at here is the peak for vertical force as a percentage of your body weight, using the preoperative versus, the red is the laser group and the green is a non laser. So preoperative, pre-laser. And then 8 weeks, so the group had laser, both went for surgery and then 8 weeks later they looked at the two, and you can see a significant difference between the two groups of 26, 51%, which was statistically significant.

And when the radiologist who didn't know what X-rays they were looking at, looked at that. The left hand group is the laser versus the two right hand ones, which is the non laser. And there was much better overall healing in the bone, muscle and integration with the implant compared to the ones that weren't lasered.

So it did cause an acceleration of it. From a human study, there are less good OA studies in the veterinary side, but on the human side, you can see a placebo versus a laser here, and there were 48 joules, so we're getting a much higher now than we were using in the skin. 2 times a week for 4 weeks, and you can see the pre, the post, and 2 weeks you can see that, although there is a placebo effect in the humans, there was a significant improvement with the laser group.

And even after finishing the laser at 2 months, with a month off, you can see that it still hasn't really increased dramatically. And the same goes with the range of the motion. There's a slight reduction in the range of motion after a month of not using it, but overall there was a significant improvement and an improvement over time.

Final area I'm going to talk about is nerves. And so now we really are very deep and, and not all lasers are able to penetrate this deep, or at least within the time frame that you have within your clinic. And there are studies looking at the effects on no sea reception, that's the point of where the nerves are.

But more importantly, at the central nervous system, the effect of enhanced neurogenesis and improvement in dendritic interactions, the reduction in apoptosis and the death of nerve cells, and there are some really interesting studies looking at the effect and penetration deep into the cranium. and there are studies, obviously at the moment looking at the effects of football injuries and, American football and the effect on the cranium and, and, and they're using lasers there to try and see if that can help in rehabilitation. This rat study looked at the placebo versus a laser group, using an 800 beam, and they showed, that there was a very significant increase in the size of the neurons, but also the amount of sprouting and interconnectivity between the neurons when you use laser in this case.

And similarly on this study, here now, if you look at the bottom left, there is 185 joules, so we are using a lot of energy now. But when we, the study was looking at crushing the sciatic nerve, but instead of lasering where the sciatic nerve was it was, it was damaged, they actually only lasered the area of the lumbar sacral nerve roots that were supplying the scatic nerve. You look on the left hand side, it says action potentials running along that nerve.

There are days on the bottom after the damage. The bottom line is the crushed non-lasered group. The top line is the control group, which slides to drops off after day 50 because it's of allodynia when you start trying to stimulate it.

But the black dots are the crushed laser group, and you can see right from day 0 all the way through to 180 days, it consistently stayed high and improved the overall outcomes. But that was lasering the nerve cells in the back, not over the actual damaged tissue. I'm gonna show you this one, which is the, the last study really.

This is a study looking at, again, damage to the lower spine because of, the chemotherapy, radiotherapy of ovarian hysterectomies, all sorts of problems that these ladies had. and, they lasered the lower back, but they also lasered where they were getting the peripheral neuropathies, the fibromyalgia pain in their lower limbs as well. So in this case here, they were using a big dose, about 10,000 joules, and they were using a high power of on average 10 joules per centimetre squared to all those different tissues.

The end result was no observed complications, which is really important, and no recurrence of any cancer. But also they showed a very significant effect on low toxicity treatment for the chemotherapy induced neuropathies, and they surmised that this must have been down to changes in the plasticity of the nerves and the prevention of further cell death within that area. From a clinician point of view, I haven't spent much time on this today.

I just wanted to show the science, but compliance, like a drug, is really important. If you do not treat sufficiently frequently depending on what you're trying to achieve, you will not get the results you're wanting. So in our case, we recommend that a client should.

Come at least twice a week for 3 weeks for the really chronic or the rehab cases. But for the acute or the wounds, they could come daily if that's necessary for an RTA or a really nasty contaminated wound. But for a simple wound you may only need to.

Treat it once at the time of surgery and once at the post-op check, and that should be sufficient. You shouldn't really need to do it more frequently than that, but depending on the severity of the wound or the injury, you may need to treat multiple times a week, if possible, in order to get that knock-on effect and benefits. In summary, I think, there's a lot more we need to know.

There's a lot of more science each day, but like regenerative medicine, there's a lot of science happening at the moment, a lot of good research, but you do need to do your own due diligence. Unlike drugs, lasers are not regulated. The only thing they're regulated is safety.

They're not regulated for whether they work or not, or whether they're fit for purpose. So you do need to make sure you're getting the right thing that is gonna work for you. I think in time we've shown that there are lasers now, Class 4 lasers that are proven them, they're fast, they're powerful, and they produce the rapid results.

And it's a combination of many things, not just one power, one wavelength, it's wavelengths, power, frequency, all of those things combine to allow you to do the array of different things. But, hopefully today you'll have seen that there are good studies now on wounds, even chronic wounds. There's some soft tissue studies, there's some bone cartilage studies, and also neurological and pain management studies.

And also there are some, the first studies now that have allowed NHS to go and approve some of these lasers within its, NICE approval system. I've gone very quickly through that, but I know I had to go through a lot. I thank you very much, and there might be some questions now.

Hello. Thank you, Steve, and that was splendid, really interesting and you know, it's just fascinating some of the case studies you showed there with, you know, the healing of wounds which are obviously very surface, so we can see it, but if it's having that effect at the surface, obviously some of the deeper stuff I think is also very interesting as well. Thank you.

We've had a few questions, so I think I'll go forward. Yeah. And Ashton Peter said it's hard to think how light penetrates more than a millimetre, but clearly it does because we've seen some of the results.

Yeah, I, I, I, I mean it it an 800 beam will eventually go the whole way through your body. So, it, it is dependent on wavelengths, but it's also dependent on time and power, so, and, and the way it's delivered, so. You know, initially, yes, most of the lasers that we were using were great for doing acupuncture points.

And doing wounds, but they were not powerful enough or we were not giving them enough time to actually penetrate deep enough. Yeah, yeah, just while we're, we're sort of having things coming in, we've got Omar there said great presentation, greetings from the K Laser team in Mexico. So, 11 user, tired cos I think it'll probably be a bit earlier in.

Yeah, I think they're they're they're they're just waking up. You're, you're, it's, it's probably about 4 o'clock, so it's definitely hard as I think I've got that right. Sam's saying were all of the tests that you were mentioning there, were they all using a K laser?

No, some of the ones weren't. The, the, the meta-analysis looked at a range of different lasers. the physiotherapy one where they were, .

Looking at the pixel size of the wound on the arm, that was not a a a laser study. I, I, I, I, but I, I, I tried to pick studies that were true double blind studies and had really good validation. One of the difficulties anyone has is when you read a paper, sometimes they don't talk about the amount of energy, they don't talk about the wavelengths, they don't talk about the power density.

So it's really difficult to understand how you can replicate that in practise. And, and, and hopefully now there are some actual journals that are only doing laser therapy and hopefully that's trying to bring up the standard of the actual reporting so that we can learn from stuff maybe in Mexico or Buenos Aires or in Sao Paulo or whatever else, and learn from their research and, and, and actually add that into protocols that we're already using. That's great.

While we've got everybody on, of course, we've got Mexico. If you're listening in from somewhere exotic like Birmingham or wherever, please put that in, you know, whatever place or country you are, then it, it's always interesting to hear where the the several 100 we've got on today are, are listening in from, . Natalie said, are there any causes for veterinary nurses on the key laser?

It, we do, regular courses where we, well, I mean, we actually go out to practises and we go and, and lecture, over the UK, so, so yes, we, we, we, depending on what someone would like, we, we will adapt something for them or for their clinic they're working in, absolutely. It's almost, you know, if you're gonna do a course, Natalie, it's probably because you're gonna get a laser, so I think. You know, and correct me if I'm wrong, Stephen, you, you're happy to go out and.

Yeah, yeah absolutely a practise and you know, then they can make their mind of whether they want to purchase one. Yeah, and and it's very much a case, I mean it, you know, there will always be sceptics within a practise and therefore sometimes you actually need to do a trial within the practise for a period of time just to be able to go and understand, you know, how or what it's able to do, . I, I can see there's a question there about is laser absolutely contraindicated if neoplasia is.

I, would not treat directly over cancer. But where I was 10 years ago to where I am now, if I was, inadvertently treating an, what I thought was an OA case and it turned out to be neoplasia, I would not be so worried now. I, I, I think the way things are going and the research that's been done in the last two years is, changing the way we look at what laser potentially can do and will do in the future.

Mm. Just, just a word of warning there, Stephen, you could get the unions onto you because the chairman's Union, the chairman asks the questions just so you're clear. Sorry.

Sorry, I'm teasing, but otherwise I'm redundant and I haven't got a job, so. Let me have at least a bit of fun. You've had an hour of presenting.

I need a little bit. Yeah, I'm quiet. OK, that's good.

Emma said, please could you help me understand the difference between IR laser, red laser, and blue laser for wounds. At uni we were told not to use red on infected wounds, but blue was safe. And help reduce bacteria, is this correct?

And what about laser on wounds. And when, when we, we did the study on Bristol University, I was not expecting the results we got because like you, I had been told that UV and blue was actually directly antimicrobial, and since slaughterhouses that, you know, chickens to try and reduce Campylobacter will go through UV light. And, and so that was a surprising piece of research, but now there has been other bits of research that show that red and infrared are useful on infected wounds.

And they do not seem to stimulate the bacteria, but they will stimulate the body's own, immune system and propensity to heal a little bit better. We're not sure, that's why we're doing further research, whether there is a direct antimicrobial effect. Whether it's er because it just improves the environment.

We've got another question here, can you use them around the eye trying to heal eyelid damage? The eye is one of the few areas that you're contraindicated to use it. I, I, I wouldn't use it on a conscious animal, because if you go through the retina, you go through the cornea and the lens, it will concentrate, especially infrared on the back of the retina, and it could cause damage.

It's, it's a difficult area. I have treated bulldogs with, indolent ulcers, but I've treated them from behind and shown that, you know, from the sort of quadrilateral going, cranial medial direction, and, and that is possible, and that will stimulate angiogenesis and it won't go into the eye itself, but, you've got to be a little bit careful around eyes. It's almost a sort of specialist area if you're only starting on laser eye it's probably not the first thing, is it?

Exactly, yeah, yeah, it wouldn't, it wouldn't be high on my list of things I would. There are lots, many other things hopefully today showed where you can use them. Just, Peter will put a little link in.

We've obviously got the virtual congress coming up next Friday, Saturday, I'm particularly interested, and Mexico's, reminded me that, one of our focuses is going to be on rabies, and Mexico has just been recently declared clear of rabies, which is a massive, achievement, and we've got a, A vet from, now I'm, I think it's Peru, Sergio Requeenko, who's been really famous at helping to reduce rabies in Central and South America. We've also got Sarah Cleveland, who is well known, I'm sure, to a lot of the British audience for doing amazing things on rabies in Africa. And the reason we're, we're shining a light on this as part of our virtual congress, which is obviously usually a lot more clinically based on, on, on stuff that you would see.

You know, not infectious but routine kind of, clinical cases, is because, you know, rabies kills. 50,000 plus people a year and I think we as vets should all be part of the. Lobbying, if you like, to get governments to make more of an effort in this area.

So it would be great to see a lot of you there. It is free to attend. Obviously the virtual congress itself, if you wanted to go to all the congress, you'd have to pay for, if you're a BVA member or a certain, of the other associations, you get some of the bits free.

And in fact, there's a bit from the Royal College about mentoring and perfectionism. So if you are interested in that, obviously just get get in contact with us and we can send you relevant links, but I'd love to see you at the, at the rabies talk, . Margaret has said, when you mention, and I think Peter has put that into the chat link if, if people want to register, if they haven't already, over 7000 people already registered for the whole congress, so it'd be lovely if you haven't registered to see you there.

Margaret said, when you mentioned a 130 nanometers being used for bone repair, was this just the dose that happened to be used or should we switch off the other wavelengths on a K laser when treating a fracture? Thanks for a great webinar. It's Margaret.

Yeah, hi, Margaret. I use that piece of research because, it, it that was the best one I could find in regards of bones per se, and and at least they recorded exactly what wavelengths and they showed what power and they showed what you know. Frequency they were using it at.

So I, I, I use that for an example, but I mean there are other studies that equally show good, you know, bone effects, so I, I wouldn't switch off a 970 or something around the, the 905 area if you have that, because they will all help and they'll have additive effects in regards to that. I mean the study I showed you in regards to cranial cruciate surgery, you know, there was just one treatment had significant improvement in the bone metal integration. And that and that was a variety of different wavelengths there.

That's great. We've had Ivan saying he's listening in from Serbia, which is fantastic. Do not be shy of your listening in from, sort of we, we all had North Wales, Rosie said listening in from North Wales, which is also great.

I, I spent about 2 or 3 years very early in my veterinary career being in North Wales and what a lovely part of the world it is to come from. . Does, laser therapy.

Indications on patients who are taking any photo photosensitive drugs. Again, you, you, you know when you look in a, a non-steroidal, data sheet and you're like, oh my God, I'll never take one again, you know, there is a, there, you look at, you look at lasers, and if you go to what's called the core of knowledge training, they will tell you that, you know, if you're taking like tetracycline. Which is supposedly a, a, a phototherapy drug, you can cause problems.

I, I, you know, in all my experience, especially knowing the, the wide variety of drugs that we use both in the human and the veterinary, I have never seen a reaction which I could attribute to that. So I think it's something that's put down in the annals because someone felt there might be a problem. But I, I've yet to see any clinical studies that show that, and I have yet to see a case study that has caused that.

And and and then of course it stays in the annals for years and years because it's been, cos it's been in one, you know, yeah, if it's, if it's a weighted to, it stays in, doesn't it? Yeah. Somebody said the presentation you reported Class 4 laser a lot, you know, obviously K laser, that's your experience it was class 4 in general, yeah, yeah, yeah.

From what you have said discussing time in your opinion, would a 3B give the same results if time is not a constraint. I mean, it's, you know, all the initial work was done in the like 80s and 90s on Class 3B lasers, and there, you know, the, the wavelengths, what I tried to show at the beginning was the critical things are wavelengths. the power helps because it reduces the time frame that you need to do it.

And, and it, it, it, it's all very well shining a light there with the right wavelengths, but if it isn't got enough energy to do it in the time that you're using it for, then it's a place, . And the other thing is the, the frequency, you know, so there's things you can improve and optimise with the pulsing. But those critical two things is the wavelengths and the power.

And, and, and if you are, I mean, I, I, I work with a, a surgeon or a medicine guy on in London, and he uses a Class 3B, but he leaves it there for an hour on the patient, and I totally respect him because he understands the limitations, but also the benefits of it. And he leaves it there long enough to have that biological effect, so you know, he he he he he does it properly. I think a very important question again, somebody's not said who they are, so I can't say the name, but I'm told that high power can be dangerous and can give burn wounds.

What is the highest power you can use safely in, you know, in an animal? There was a slide I, I didn't bring into this lecture which, shows, you know, that there is, although, Class 4 therapy lasers have got C, FDA, maybe Mexican, . You know, ability to go and be used safely in practise.

There there isn't a knowledge to say what, how high you can go. When I, when I showed that study on the sciatic thing, we were using 185 joules per centimetre squared. That that is way higher than I would ever dream of using one of my lasers, and yet that had a beneficial effect on the nerves within the spine of those rats.

So I, I, I, I actually don't have an answer for that. I, I, if you use, I mean we only sell our laser into the medical and the veterinary and people who are medically trained physios, sometimes even hydros, and, and they need to understand an anatomy. And, and I think there's an onus on the manufacturers, but also the distributors to train people about safety and how to use them properly.

Any la, I mean, you know, you can cause damage with a Class 3B laser, but you can also definitely cause damage with a Class 4 laser. So it has to be used appropriately and well, by the right people to get the right results. I think we're coming towards the end of the questions.

We've got another question here. If you are treating an arthritic joint on an animal, horse or dog, how many joules per point would you recommend and what is happening at a cellular level? I what is being achieved in terms of anti-inflammatory results.

OK, I, I, I tried to explain it in one of the slides that I, I can't tell you the different, I mean, you know, if I was treating a large breed dog, in the time frames of what I use in the laser I'm familiar with, you'd be doing around 2500, 3000 joules. And it would be done in about 5 minutes' time. OK.

So, so, but, and, and, and similarly on a horse, if I was trying to do a, a sacroiliac, I might even go up to 4, 4.5 1000 joules in the same sort of time frame. But obviously if I'm doing a little chihuahua, that may be down to, I don't know, 600 joules or something like that.

So it will vary according to the size of the individual animal and how deep you're trying to get, and it will be different for each joint and each depth of joint. The, the, the anti-inflammatory aspects about it, what we're trying to do is, stimulate better blood flow to that area, improve the lymphatics to that area. So that's, you know, it has both effects in regards to reducing some of the edoema and swelling.

We know that the, lasers can stabilise some of the cell membranes, so they may not leak so much as well, if there's been tissue damage. and, and then if you're looking on a more, not, not, not so much an anti-inflammatory, but if you're looking at a more global effect of a laser, you can do acupuncture points with them. And you can also obviously do the spinal nerves, but that takes a much longer term to go and change some of the pain relief.

No, that's great. . Jane has said, following on from the photosensitive drugs, have you ever seen any photosensitization using laser in dogs with liver disease?

Not myself, no. The only thing I would say I've ever seen is sometimes where there's been a very big scar, the hairs may not grow back the same colour as what was there previously. Yeah, but I have never seen a side effect caused by any drugs or any anything like that.

I've only seen it because of, you know, whatever the body's done, it's not regrown with this exactly the same colour skirt pattern. We've got, some people who want to, contact you, and I think at the end of this, there should be a survey whereby, you know, if you want to receive more information, you can actually, you know, let us know a webinar that and we will obviously pass on your details to Stephen and he can follow up on those. Obviously, there's already one person who obviously I won't mention, but they want to, to have a look at that.

Sarah said, where can we find guidelines as to dose rates of laser treatments, presumably from the manufacturers. Yeah, I, I, I think you have to look at each individual machine because it it it isn't, it, it's a combination of the wavelengths, but it's also the pulsing as well, and it's the power. So, you know, you have to look at each individual machine on its own merits and what research has been done and what they.

Regard as a safe protocol for for what they're delivering. I, I'm not trying to pop out there, but it's the same as when you're looking at a drug, you know, you wanna make sure that if you're using a, a different form of meloxicam, you wanna make sure that, you know, it is exactly the same dosage across all of it. And then when you swap to, you know, Carprofen, that it it it you you you'd use the appropriate dose accordingly, it, it, it is gonna be different, you know, all non-steroidals are great, but, you need to make sure you've got the right dose of the right drug.

Presumably, you know, with your laser, you know, part of, as you've said before, is if you're. You know, letting somebody take one of those on, then the educational side is, is very important because of course we don't want to do any harm, so we've got to make sure that we're trained, you know, how to use car and meloxicam, you know, or one of your lasers. Yeah, I, I can't speak for anyone else, but we decided right from day one that we would do take the same level of training that we do in the NHS and private healthcare.

There is no rule or legislation or law to say that. One should do that in the veterinary industry, but we think that's a fault of the laws and the rules because, you know, you've still got people in the room, you've still got staff, you've still got customers, and then you've got the animal itself that you're trying to go and treat and get better. So, we do what's called the core of knowledge for ourselves, .

And that allows them to do a 3 modular course online on safety, on efficacy, on what photon energy is. And then we make sure that before they actually use the laser, even for a trial that we train them properly with cases on how to use it. Well it's things like, you know, the spectacles and everything, there's a lot.

It's a dangerous product if you don't know how to use it, isn't it? And also you're not gonna get the results if you don't use it well. So you know, if you don't understand anything about it, you're not gonna get the results.

It, it, it, you know, you can inject, you know, meloxicam under the skin and you know roughly what's gonna happen with a certain percentage of the animals you treat, but with the laser, if you're dangling it in the wrong direction with the wrong power and the wrong wavelengths, then you're not gonna get any results. That's great. I think Peter has put in the associations, but he's not putting in the rabies, components, he's put in the general congress, which you can, you know, if you go in, you can see exactly what's going on, and there is a, a rabies element, you know, which you can sign up for.

I think also if you put it into Google Rabbies VC 2020, you'd also find it. So, you know, I'd love to see some of you at the, at the rabies to cos I think it's such an important. Area.

I think that is everything Jars saying thank you for the presentation, Zoe. I'm sure I've said this to you to you before, Stephen, you know, you just can't hear the tumultuous applause on, on webinars, so it can be a bit of a letdown from that perspective, but, . Otherwise, I think people have really enjoyed it.

We've had a lot of people staying on, you know, for the questions as well. Yeah, thank you. I've really enjoyed it and, somebody's just asked the question, will it be available to, oh there's one that I've missed out, laser pens.

Do you have laser pens at Klaser? And we, we don't because, by the very virtue of a laser pen would be like a class 2 laser. Yeah.

So it, it, it, you know, if they, if you were if you were only gonna do acupuncture settings, fine, use a laser pen, and, and there's nothing wrong with that. But if you're wanting to do a much bigger area or deeper tissues, you need to go bigger, stronger, you need something else, yeah. The laser pen won't be good.

Great. Somebody else asked, you know, will this be available? It should be on the site within 48 hours.

If you have registered, you should get an email, you'll get a certificate as well. So, you know, do feel free to look over it again, and of course, do feel free to let other colleagues know because this was a, a free webinar thanks to the very kind sponsorship of Steve and I, you know, I, I think this is a fascinating area. You know, for ourselves, you know, as humans as well as for the pets that we treat, I, I may be having a quiet word with you about some of my aches and I look, I, I, I genuinely think it's an area that will continue to grow and that we'll learn more and more.

And I think whether it's human or veterinary health, I think it will become a kind of a mainstay of what we add into it. So I think it's here to stay. Stephen, thank you once again.

Thanks everyone for attending, and I look forward to seeing you on our rabies talk, if not before on another webinar. Take care, bye bye. Thanks a lot.

Bye, bye.