Author Archives: Fred Kahn, M.D, FRCS(C)




This patient demonstrates the benefits of Laser Therapy in the treatment of the neurological problems that typically present at our clinic. It cannot always be accurately determined how much benefit is obtained secondary to Laser Therapy, but in this case, prior to February 2017, the patient’s status had plateaued completely. Subsequent to the initiation of Laser Therapy in February 2017, his ability to speak and the improvement in his visual fields, in view of the absence of other factors, must therefore be attributed to Laser Therapy.


  • Chiari Malformation-Left Temporal Lobe with spontaneous intracranial bleeding episode. (December 31, 2015)
  • Emergency Craniotomy. (January 1, 2016)


The patient is a 22-year-old male, who had been diagnosed with an intracranial arteriovenous malformation in the left temporo-parietal area, diagnosed two years prior to treatment at our facility.

At that time, he had sustained an intracranial hemorrhage with a subsequent rise in intracranial pressure. The situation required an emergency craniotomy in order to evacuate the hematoma in the left posterior temporo-parietal lobe.

An MRI post-surgery revealed a discrete area of encephalomalacia involving the parietal operculum and the posterior temporal lobe extending to the left side of the brain.
As a result of the surgery, the patient continued to have significant visual disturbances, memory loss, cognitive issues and aphasia. His ability to speak was markedly reduced, along with comprehension at many levels. An automated visual field perimetry study performed post-craniotomy revealed a total inferior right homonymous quadrantanopsia, consistent with the cortical damage that had occurred.


Aside from the visual impairment and aphasia, there was a modicum of findings with regard to other abnormalities.
There was a loss of normal curvature of the cervical spine and moderate tenderness over this area.


  • Chiari Malformation-Left Temporal Lobe with spontaneous intracranial bleeding episode.
  • Emergency Craniotomy.
  • Visual Field Impairment/Aphasia, along with Moderate Cognitive Impediments

    The patient received a total of four Laser Therapy sessions involving the cervical spine, brainstem and cerebellum at the Meditech Rehabilitation Clinic beginning February 21, 2017. As he lived at a distance from the clinic, his caregivers were trained on the utilization of the Home System and continued the treatment subsequently at regular intervals. The areas treated included the cerebral hemispheres and the cervical spine.

    After several weeks of treatment, the patient’s attendance at university was resumed.

    Six months post-initiation of Laser Therapy, the patient had a follow-up appointment with his ophthalmologist. An automated visual field perimetry study was performed and revealed a 10% decrease in scotoma. The quadrantanopsia did not cross the vertical midline.

    Enclosed in this communication are his visual fields prior to starting Laser Therapy and six months after continuing treatment. His ophthalmologist was impressed with the improvement noted considering that the trauma had occurred almost two years prior to initiating Laser Therapy. His initial quadrantanopsia had been considered to be permanent.

    As his improvement in speech and vision are continuing to move forward, the patient was advised to continue with both the cranial and cervical Laser Therapy under our supervision.


    For over 30 years, Laser Therapy has been effectively used in the treatment of many medical conditions, including musculoskeletal, dermatological problems, wound healing and more recently, the treatment of neurological conditions.

    The technology has been utilized for over 40 years and over the past two decades, has made significant progress. Laser Therapy is a non-invasive, light-based therapy that applies a combination of red and infrared light sourced from red and infrared LED’s and laser diodes.

    Photon particles are absorbed by the mitochondria through cytochrome c oxidase, causing a photodissociation of nitric oxide from cytochrome c oxidase resulting in increased cellular ATP levels. The dissociated nitric oxide levels also promote vasodilation and improve arterial perfusion.

    Transcranial Laser Therapy has been demonstrated to significantly improve outcomes in patients of all types. Lampl et al wrote that “Although the mechanism of action of infrared laser therapy for stroke may not be completely understood, infrared laser therapy is a physical process that can produce biochemical changes at the tissue level. The putative mechanism involves stimulation of ATP formation by mitochondria and may also involve prevention of apoptosis in the ischemic penumbra and enhancement of neurorecovery mechanisms.”1

    Apart from ischemic heart disease, stroke (CVA) is the leading cause of death worldwide. The current approved treatment is to apply tissue plasminogen activator within 3 hours of onset of a CVA. Although this method is effective in clearing blood clots, the narrow time window that exists for effective treatment limits treatment options for the majority of stroke victims.
    Laser Therapy has been investigated as an alternative treatment for CVA and has been shown to have a neuromodulatory and neuroprotective effect, while regulating many biological processes.


    Photon particles are absorbed by the cerebrospinal fluid and distributed throughout the cranium, including the ventricles. These confer a significant neuromodulation effect. The particles of energy are also absorbed by the arterial, venous and lymphatic systems and are thereby transported to the fluid surrounding the central nervous system and the spinal cord. Additional benefit is transmitted by direct irradiation of the soft tissues and the skeletal system of the area involved.

    1Lampl Y. Zivin J.A. Fisher M. Lew R. Welin L. Dahlof B. Borenstein P. Andersson B. Perez J. Caparo C. Ilic S. Oron U. Infrared laser therapy for ischemic stroke: a new treatment strategy: results of the NeuroThera Effectiveness and Safety Trial-1 (NEST-1) Stroke. 2007; 38:1843–1849

    Automated Goldmann Visual Fields (December 23, 2016)

    • Right Homonymous Inferior Quadrantanopsia
    • This is a typical “pie on the floor” appearance in a visual field that conveys involvement of the optic radiation as it traverses the left temporo-parietal lobe. Note complete scotoma of the left lower quarter visual field.

    Automated Goldmann Visual Fields (August 18, 2018)

    • Right inferior quadrantanopsia
    • Scotoma is not homonymous in this visual field. Note 10% improvement in both visual fields with sparing of the central visual field

Beware Before Swallowing!


The article below is a typical example of the inappropriate dispensing of medications simply for the easy relief of symptoms. The latter may not even be a significant problem and it would be more appropriate for the physician to deal with these matters by assessing the patient more extensively prior to resorting to prescribing. A few minutes of discussion can most often avoid the “instant gratification” provided by writing a prescription.

According to current trends, cannabis may soon be over prescribed and in many situations, unnecessarily so, yet the downside of that approach is less hazardous than the many toxic chemicals so casually dispensed.

Before you swallow beware! Instant gratification in the form of a pill is seldom a permanent solution and in some cases may be a deadly one.

Fred Kahn, MD, FRCS(C)

Antipsychotics, not anti-insomnia

National Post (Latest Edition)16 Jun 2017
Sharon Kirkey

Recently, after morning rounds seeing patients admitted to his hospital through emergency, Dr. David Juurlink tweeted: “Can the next doctor wanting to prescribe Seroquel for sleep, just not?”

Of the roughly 20 patients he had seen that morning, four had been prescribed Seroquel, an antipsychotic, for insomnia.

Seroquel and its generics aren’t approved as sleeping pills. Quetiapine, the active ingredient, has been officially approved in Canada for schizophrenia, bipolar disorder and major depression only.

Yet drug-safety experts are growing increasingly alarmed by the drug’s use as a doctor-prescribed nightcap for insomnia, with a 10- fold increase in quetiapine prescriptions for sleep problems in Canada between 2005 and 2012 alone.

Quetiapine is sedating. Like over- the- counter sleep aids, it makes people drowsy. But it also comes with a multitude of potential side effects, according to experts.

These side effects include an odd sensation of tension and restlessness (akathisia), Parkinson’s- like tremors and movement abnormalities, weight-gain, high blood sugar, new or worsening diabetes and, in rare cases, heart arrhythmia that can cause sudden cardiac death. A recent Health Canada review linked quetiapine and other so- called “atypical” antipsychotics to an increased risk of sleep apnea — breaks in breathing during sleep.

Juurlink, a clinical toxicologist at Sunnybrook Health Sciences Centre in Toronto, said quetiapine can also cause a particularly nasty complication known as neuroleptic malignant syndrome, a rare but potentially life- threatening reaction to antipsychotics or major tranquillizers. “Over the last decade, I have seen several patients who have had quetiapine as part of, or one of the contributing causes to NMS,” said Juurlink, whose frustrated tweet to doctors last week was a repeat of one he has sent before.

“I’ve certainly seen people who have been diagnosed with Parkinson’s disease that I’m confident were from quetiapine,” he added. “It’s getting to the point now where, when I admit a patient with Parkinson’s, I reflexively look at their other medications to see, ‘are they on quetiapine?’ ”

According to drug market research firm IMS Brogan, of the 33 million prescriptions for tranquillizers dispensed by Canadian retail drugstores in 2016, one quarter — 8.3 million — were for quetiapine.

Doctors say the drug is being prescribed in low- dose formulations to people with no underlying psychiatric conditions, the majority for sleep. University of B.C. researchers found that 58 per cent of B.C. quetiapine prescriptions in 2010 were for the 25 mg tablet. The dose range for the approved disorders is 150 to 800 mg per day.

“It’s popping up as a patient’s typical medication for insomnia all the time,” says Kamloops emergency physician Dr. Ian Mitchell. “It’s not well supported by any science for use in sleep, it has significant side effects and yet it’s massively prescribed.”

“Seroquel is not benign,” Dr. David Gardner, a professor of psychiatry and pharmacology at Dalhousie University said in an email. “It may be more dangerous than our standard sleeping pills, but without research we cannot know or quantify its risks.”

It’s not clear how antipsychotics have become such a big thing for sleep. But observers point to aggressive marketing and industryfunded “opinion leaders” who’ve described quetiapine as a “mild, not harmful” drug that seems to help with sleep.


Some users swear by it. “Seroquel helps me for sleep when nothing else will,” according to one online reviewer. “The only bad thing is 30 ( minutes) to one hour after taking it, I’m starving!!” Others describe feeling spacey and foggy the next morning.

Juurlink said quetiapine might shorten sleep latency — the time it takes to fully fall asleep — by a few minutes. It can also make people less aware of their “nocturnal awakenings” than they might otherwise have been. It’s a potent antihistamine, like diphenhydramine, the active ingredient in Benadryl and other “nighttime” cold remedies.

“But what’s really driving this is a societal expectation that we should all get eight hours of sleep a night, a pill is a way to go about it, and the willingness of some providers to accede to requests for sleeping pills,” Juurlink said.

While quetiapine has proven safe and effective for approved conditions, and most of the side effects have been reported during highdose treatment, side effects such as tardive dyskinesia — abnormal movements of the face and jaw — have been reported with low-dose regimens as well, according to the UBC Therapeutics Initiative.

Abuse of quetiapine is also a growing problem, with people inhaling or injecting crushed or dissolved tablets.

Mitchell says it’s hard to explain the “inherent hypocrisy” of the massive prescribing of an antipsychotic for insomnia, while medical leaders are warning doctors to be wary of prescribing marijuana for sleep.

“I’m not asking people to smoke a joint in a nursing home for sleep, that’s not what this is about,” he said. “But there may be some alternatives to some of the damaging medications that are out there, or ways to replace them with cannabis.”



October 3, 2017

Niilo is a Toronto-born international Long Driving Competitor who has established a world-wide reputation. He has won a number of international competitions including Mexico, South Africa, etc. His strengths are his work ethic, competitive drive and discipline. Since his first long drive competition six years ago he now ranks among the best long drive golfers internationally.
Niilo spends countless hours training in the gym and at the range. At all times he keeps sight of his goal to become the World Long Driving Champion. He possesses great natural athletic ability and this has been enhanced by many hours in the gymnasium and improving his psychological focus.

Niilo’s efforts have been facilitated over the past 10 years by the ongoing use of the BioFlex Laser Therapy System. He is now using his third device and states unequivocally it has been helpful in keeping his joints, neck and back, pain-free. This is a great asset in an endeavor where injuries invariably end the careers of most competitors at an early age.

At Meditech we take great pride in supporting Niilo’s endeavors and will continue to maintain his health status at an optimal level in order that he may achieve his final objective: a World Championship in International Golf Ball Distance Driving.

Some Statistics
• Club Head Speed: 140mph
• Ball Speed: 210mph
• Longest drive: 435 yds.
• Equipment utilized: Heads – Geek Golf, No Brainer
Shafts – Execution, Triple X Flex

A Passing Thought


Simple Solutions Are Best – the reason!

− not only because they are simple but logical. Generally, they have a scientific basis and are effective − and so it is with the treatment of pain. Conventional methods of managing pain consist of modulating symptoms, much like venting smoke from a burning fire. Usually, pharmaceuticals in varying doses are utilized to achieve this objective, which is only temporary at best and not devoid of adverse effects.

With the utilization of Laser Therapy, one treats the cause of the pain or the existing pathological condition. The logical sequence – the pain disappears, much as smoke will vanish when you put out the fire.

Many people simply defy logic and as scientific solutions evolve, it is sometimes absurd how simple the process can be. Subsequently, people will state, “Why didn’t I think of that?”. The fact is, they didn’t and therein lies the problem.

In our society, independent thought and creativity are stifled by an overwhelming number of factors including excessive regulations, the challenges of technology and expanding governments, not to mention a flawed educational system. All these matters will need to change if our civilization is to survive.

A Commentary


The article enclosed “Looking For the Contradictions” is an outstanding commentary that not only challenges the status quo but makes an extremely sound case for reviewing current medical thinking and practice, encompassing all areas from nutrition to cancer therapy. Medical education has not been reviewed since the Flexner report funded by The Rockefeller Foundation, composed between the years 1915 to 1925. This would clearly indicate that further review would be appropriate at this point in time.

Health care systems today are largely controlled by governments, insurance companies, and Wall Street corporations with additional and often adverse influence exerted from the pharmaceutical sector.

It takes a great deal of courage for people such as Dr. Kendrick and others to attempt to bring logic into the many false concepts currently in vogue. Many myths are disseminated on the basis of conscious or subliminally motivated greed.

Personally, I take this opportunity to compliment Dr. Kendrick for writing this article, which everyone concerned with healthcare should read. It is apparent that our culture has deviated sharply from the concepts of integrity, creativity and independent thought. In essence the individual has been destroyed and replaced by governments whose main objectives are to get elected and increase taxes, insurance companies whose primary interest is the bottom line and pharmaceutical companies that are similarly motivated, having long given up the challenging task of developing specific curative products.

When will all this stop and how can the negative process going forward be reversed? I welcome your suggestions and trust that you will enjoy the article by Dr. Kendrick.



There are many forms arthritis, the most common being degenerative osteoarthritis. Some facts excerpted from The World Health Organization literature indicate a number of shocking realities.*

  • Arthritis is considered to be the nation’s number one crippling disease and the most common chronic disease of people over the age of 40.
  • According to the Center for Disease Control and Prevention, an estimated 46 million adults in the United States have been told by a physician that they have some form of arthritis, including degenerative osteoarthritis, rheumatoid arthritis, gout, lupus or psoriatic arthritis.
  • By 2030, a startling 67 million Americans age 18 years or older are projected to have arthritis—a 45% increase from current statistics.
  • The average age that arthritis begins is 47 years, with 1 in 2 Americans over age 65 dealing with some form of arthritis.
  • The cost of arthritis due to lost wages, medical treatment and other related expenses can run an individual over $150,000 in expenses over their lifetime.

These facts are significant–the solutions less so. Physicians are prone to prescribing analgesics, anti-inflammatory medications and muscle relaxants or inject cortisone, xylocaine and a variety of lubricating solutions. All of these mask symptoms temporarily, however they do not provide a permanent solution.

Laser Therapy, a relatively new technology perfected by Meditech International Inc. in Toronto, Canada currently offers up-to-date, professional therapeutic systems along with Home Units for utilization by individuals who have not had their problems resolved by conventional and traditional methods, including surgical procedures. Symptoms generally improve immediately following the institution of Laser Therapy. Applying treatment in a cumulative fashion stimulates the reduction of symptoms over time resulting in the patient’s return to a normal range of activities without the utilization of analgesics or other medications.

Unfortunately Laser Therapy is seldom mentioned as a solution as it is not covered by the codes, insurance programs, national health care systems and other mainstream regulatory bodies. The reasons: medicine is slow to change and vested interests will go to great lengths to provide protection for their products, regardless of the lack of value induced.

At this point in time, it must be clearly understood that the BioFlex Laser Therapy Systems offer ongoing relief of symptoms of arthritis in all areas of the body by restoring the normal morphology and function of the cells. In addition the therapy provides a potent anti-inflammatory effect and boosts the immune system while restoring the integrity of the cells. Regeneration of cartilage is also a part of this process, which is administered in a pain-free and completely safe manner. Comparatively speaking, the cost is minimal and each treatment stimulates the healing process to a higher level, making surgical interventions such as arthroscopy, joint replacements and spinal surgeries in the majority of instances redundant. As time
progresses the patient can discard all pharmaceuticals and focus on a healthy diet and activities such as swimming, stretching, walking to achieve a complete recovery.

The facts regarding the efficacy of Laser Therapy are undeniable. At our Meditech Rehabilitation Clinics, this reality can be seen many times many times over the course of each day and the changes which patients often describe as “a miracle”, have come to be the standard outcome.

A recent example of results achievable is the case of Jerome Williams, also known as “].Y.D.” or Junk Yard Dog, a brand label that he has acquired over a stellar ten year career in the NBA. Jerome presented for treatment at one of our clinics in April and immediately noted improvement. He acquired a Home System and a month later, a Professional System for stationary therapy at his home in Las Vegas, Nevada. The results achieved have been so dramatic that at the age of 44, he has returned to a professional career in basketball in the newly formed 3D League.

Once again, his play is outstanding and in addition he is continuing his long-standing career with the NBA as a good will ambassador of the league. J.Y.D. is also involved in many charitable and educational organizations in his post-NBA career. I am pleased to state that he is a perfect example of what can be accomplished with the intelligent application of BioFlex Laser Therapy, a technology that can replace all current and conventional treatments for arthritis. For additional information, contact Meditech International Inc., Toronto, Canada (416-251-1055), or review our website (

Junk Yard Dog Sees The Light


‘Jerome ‘JYD’ Williams has two BioFlex Laser Therapy Systems… and he’s protecting them like a Junk Yard Dog with a bone.’

Former NBA star and currently on the Power Team of the Big 3 Basketball League, Jerome “Junk Yard Dog” (JYD) Williams relies on BioFlex Laser Therapy to eliminate the pain in his knees. The latter was not only chronic but at times acute, preventing Jerome from playing basketball, the sport that is relevant to his sense of completeness in life. After just two months of self-administered therapy, the pain was relieved to the degree that he was able to resume his professional basketball career in the 3-on-3 league, demonstrating his high level abilities while playing along with other notable former NBA stars. He travels with a BioFlex Personal System on the road and uses a Professional System at home.



Top: Jerome being treated with the BioFlex DUO+ Treatment Array
Bottom: Jerome performs in the 3up League

Jerome attended Georgetown University on a full athletic scholarship and as a further testament of his tremendous athletic ability, was picked in the 1st round of the NBA’s 1996 Draft by the Detroit Pistons. His impressive career as an NBA Power Forward spanned nine years with Detroit, the Toronto Raptors, the Chicago Bulls and the New York Knicks. . At all times, he demonstrated his ability to be a team player and in 2000, he led the league in high rebounding percentages and was ranked third overall in offensive ratings.

Jerome Williams brought his talent, heart and extraordinary passion to the court and holds an impressive 6.6 points per game and 6.4 rebounds. His NBA career included a total of 587 games. Nicknamed “JYD” for his extraordinary work ethic by his teammates in Detroit, he furthered the JYD persona into his own brand.

JYD was excited to join the Toronto Raptors in 2000; so much so that he passed up a morning flight, electing instead to brave a brutal February snowstorm and drive from Detroit to Toronto the night before. He wanted to make certain that he was in the city in time for his first practice with his new teammates.

Toronto fans were jubilant on his arrival. The greetings at the Air Canada Centre by the fans when he played as a Raptor for the first time were overwhelming. Toronto Raptor fans continued to show their love even after JYD was traded, always providing a standing ovation whenever he was on the court.

His impressive NBA career and work ethic, matched by his stellar character, continues to be demonstrated by his involvement in many charitable organizations and his work as a good will ambassador for the NBA.

He initiated an after-school program in the Brewster community in Detroit “right in the middle of the projects”, devoting extensive time and effort to this task.

In an effort to bring his unparalleled knowledge and understanding of the game of basketball to underdeveloped nations, he joined “Basketball Without Borders”. Jerome’s post-NBA career is highlighted by numerous community service awards over the years. He was honoured with a National Home Team award by the Fannie Mae Foundation, was invited to the White House and led a drive to raise money for the Toronto District School Board to buy books for students. His passion to give back to the community was recognized by the NBA principals and he was awarded the NBA Community Assist Award in May 2005. A father of four, he currently serves as Chairman of the non-profit organization, JYD Project Inc. Although Jerome celebrated many firsts as an NBA player, he was the first role player, featuring his own tennis shoe and a Sprite deal.

Incidentally, he is not the first NBA star to rely on BioFlex Laser Therapy systems but he is no doubt the most grateful and enthusiastic individual with regard to the effectiveness of the treatment. As he recalls, many of his Toronto Raptor teammates, including Vince Carter, Tracy McGrady, etc. relied upon this amazing technology to treat their many injuries. Feel free to enter Jerome’s DoggPound but with the BioFlex Systems in his healthcare arsenal, don’t ever expect to hear the Junk Yard Dog whimper.

From my interactions with Jerome, he is an outstanding human being, a basketball player for the ages, a solid family man and someone who cares about everyone inhabiting our planet. His existence makes the world a better place. I am certain he will bring all of his stellar qualities to the Big 3 League and entertain everyone that has the privilege and opportunity to watch him perform.


Jerome Williams with Dr Kahn at the Meditech Downtown Clinic

Traumatic Brain Injury– A Commentary


RETHINK-REDO-REWIRED-BOOK-COVER-1150x1721Anthony Aquan-Assee, M.Ed. recently presented me with a book titled “Rethink, Redo, Rewired”. The book is an excellent treatise devoted to the course of recovery from a series of major brain injuries. The book describes Anthony’s prolonged struggles to regain his life, along with the many impediments and inappropriate therapies that litter the path to recovery.

On pages 65-68, he describes his experience with Laser Therapy, which played the major role in his return to normal health. Personally, I can state unequivocally that all cases of traumatic brain injury treated at our clinic, more than 80% achieve this level of recovery and the remainder are improved in varying degrees. During the year 2016, we treated over 500 cases of traumatic brain injury and this year, our expectations are that we will exceed 800 patients treated at the Meditech Rehabilitation Clinics.

The book confirms that Anthony has made a relatively complete recovery from the injuries sustained during the past decade. He is fully functional and once again making contributions to our society in a normal fashion.

His case is just one example of the numerous patients that we return to a normal health status after struggling for many years in the black void of traumatic brain injury.

To learn more or purchase a book, visit

Case Study: Erythromelalgia/Reynaud’s Phenomenon


The patient is a 71-year-old female Ph.D. who presented at our clinic 18 months ago complaining of edema, pain and multiple ulcers of both feet. The lower extremities demonstrated a marked erythematous/cyanotic discolouration that existed at all times.
The pain was frequently excruciating and ambulatory activities were minimal.

The diagnosis of her condition had been established at age 20 years. Over time, painful nodules developed on the skin of the lower extremities and these would periodically rupture, leading to the formation of recurrent ulcers. Symptoms were aggravated by elevation of ambient temperatures above 19°C.

The patient was unable to wear socks, shoes or tolerate any piece of clothing that had prolonged contact with the skin. She was forced to keep the ambient temperature at her home at a constant 20°C in order to be relatively comfortable. She was unable to take walks, particularly during the summer, as she was not able to tolerate elevated temperatures and the resulting induced pain.

The formation of multiple ulcers of the lower extremities complicated her condition. Her hands were only minimally to moderately affected and demonstrated mild erythema. The dermal ulcers were most pronounced over the plantar aspects of the feet and sometimes involved the toes and the dorsum also.

The patient is a non-smoker and worked as a principal researcher in the field of psychology.

Periodically she took Cymbalta (duloxetine) and Lyrica (pregabalin) in titrated dosages.

PHYSICAL EXAMINATION: At the time of her initial presentation, both feet were cold to the touch and demonstrated marked tenderness to palpation.
Multiple ulcers were noted over the plantar aspects of both feet and some of these showed marginal epithelialization.
There was significant acute inflammation over the soles of both feet.
A moderate degree of edema, extending to the ankle, was present.
The erythematous/cyanotic disolouration was pronounced.
Peripheral arterial pulses were within normal limits.

TREATMENT: A course of treatment was initiated using the BioFlex Laser Therapy System. This was continued in the office three times per week using the Professional System. Treatment included application to the lumbar spine (autonomic nervous system), and locally in circumferential fashion around the ankles and feet.

Appropriate protocols were developed over 2.5 months and these were transferred to a Home Unit for application at the patient’s home two more times each week. The patient was last seen in our office on July 4, 2017. The edema had disappeared completely, along with the sensitivity. Discolouration was minimal. There were a few areas of thickening of the dermis over the plantar aspects of both feet but there was no tenderness and no evidence of ulceration.

The patient is now able to walk normally, work in the garden and activity levels are relatively normal. She has some minor sensitivity to temperature changes but she is able to control that to a significant degree. In essence, there has been over 90% overall improvement with regard to both symptoms and physical findings. Prior to the institution of Laser Therapy, numerous medications and other therapies had been utilized, none of which provided any benefit.

This case demonstrates what can be achieved utilizing the correct application of Laser Therapy to a compliant patient.

Erythromelalgia, also known as Mitchell’s disease, is a rare vascular peripheral pain disorder in which blood vessels, usually in the lower extremities or hands, are episodically blocked (frequently on and off daily), then become hyperemic and inflamed. There is severe burning pain (in the small fiber sensory nerves) and skin redness. The attacks are periodic and are commonly triggered by heat, pressure, mild activity, exertion, insomnia or stress. Erythromelalgia may occur either as a primary or secondary disorder (i.e. a disorder in and of itself or a symptom of another condition). Secondary erythromelalgia can result from small fiber peripheral neuropathy of any cause, polycythemia vera, essential thrombocytosis,[1] hypercholesterolemia, mushroom or mercury poisoning, and some autoimmune disorders. Primary erythromelalgia is caused by mutation of the voltage-gated sodium channel α-subunit gene SCN9A.
In 2004 erythromelalgia became the first human disorder in which it has been possible to associate an ion channel mutation with chronic neuropathic pain; when its pathophysiology was initially published in the Journal of Medical Genetics.

Primary erythromelalgia may be classified as either familial or sporadic, with the familial form inherited in an autosomal dominant manner. Both of these may be further classified as either juvenile or adult onset. The juvenile onset form occurs prior to age 20 and frequently prior to age 10. While the genetic cause of the juvenile and sporadic adult onset forms is often known, this is not the case for the adult onset familial form.

The most prominent symptoms of erythromelalgia are episodes of erythema, swelling, a painful deep-aching of the soft tissue (usually either radiating or shooting) and tenderness, along with a painful burning sensation primarily in the extremities. These symptoms are often symmetric and affect the lower extremities more frequently than the upper extremities. Symptoms may also affect the ears and face. For secondary erythromelalgia, attacks typically precede and are precipitated by the underlying primary condition. For primary erythromelalgia, attacks can last from an hour to months at a time and occur infrequently to frequently with multiple times daily. Common triggers for these episodes are exertion, heating of the affected extremities, and alcohol or caffeine consumption, and any pressure applied to the limbs. In some patients sugar and even melon consumption have also been known to provoke attacks. Many of those with primary erythromelalgia avoid wearing shoes or socks as the heat this generates is known to produce erythromelalgia attacks. Raynaud’s phenomenon often coexists in patients with Erythromelalgia. Symptoms may present gradually and incrementally, sometimes taking years to become intense enough for patients to seek medical care. In other cases symptoms emerge full blown with onset.

Primary erythromelalgia is a better understood autosomal dominant disorder. The neuropathological symptoms of primary erythromelalgia arise from hyperexcitability of C-fibers in the dorsal root ganglion. Specifically, nociceptors (neurons responsible for the sensation and conduction of painful stimuli) appear to be the primarily affect neurons in these fibers. This hyperexcitability results in the severe burning pain experienced by patients. While the neuropathological symptoms are a result of hyperexcitability, microvascular alterations in erythromelalgia are due to hypoexcitability. The sympathetic nervous system controls cutaneous vascular tone and altered response of this system to stimuli such as heat likely results in the observed microvascular symptoms. In both cases, these changes in excitability are typically due to mutation of the sodium channel NaV1.7. These differences in excitability alterations between the sympathetic nervous system and nociceptors is due to different expression of sodium channels other than NaV1.7 in them.

Erythromelalgia is a difficult condition to diagnose as there are no specific tests available. However, reduced capillary density has been observed microscopically during flaring; and reduced capillary perfusion is noted in the patient. Another test that can be done is to have the patient elevate their legs, and note the reversal (from red to pale) in skin color. Tests done at universities include quantitative sensory nerve testing, laser evoked potentials, sweat testing and epidermal sensory nerve fiber density test (which is an objective test for small fiber sensory neuropathy). Due the aforementioned factors, patients may face delays in diagnosis.

Some diseases present with symptoms similar to erythromelalgia. Complex regional pain syndrome (CRPS), for instance, presents with severe burning pain and redness except these symptoms are often unilateral (versus symmetric) and may be proximal instead of purely or primarily distal. Furthermore, attacks triggered by heat and resolved by cooling are less common with CRPS.
Primary erythromelalgia management is symptomatic, i.e. treating painful symptoms only. Specific management tactics include avoidance of attack triggers such as: heat, change in temperature, exercise or over exertion, alcohol and spicy foods. This list is by no means comprehensive as there are many triggers to set off a ‘flaring’ episode that are inexplicable. Whilst a cool environment is helpful in keeping the symptoms in control, the use of cold water baths is strongly discouraged. In pursuit of added relief sufferers can inadvertently cause tissue damage or death, i.e. necrosis. See comments at the end of the preceding paragraph regarding possible effectiveness of plastic food storage bags to avoid/reduce negative effects of submersion in cold water baths.
One clinical study has demonstrated the efficacy of IV lidocaine or oral mexilitine, though it should be noted that differences between the primary and secondary forms were not studied. Another trial has shown promise for misoprostol, while other have shown that gabapentin, venlafaxine and oral magnesium may also be effective,[5] but no further testing was carried out as newer research superseded this combination.

Strong anecdotal evidence from EM patients shows that a combination of drugs such as duloxetine and pregabalin is an effective way of reducing the stabbing pains and burning sensation symptoms of erythromelalgia in conjunction with the appropriate analgesia. In some cases, antihistamines may give some relief. Most people with erythromelalgia never go into remission and the symptoms are ever present at some level, whilst others get worse, or the EM is eventually a symptom of another disease such as systemic scleroderma.

The patient elected to have treatment with the BioFlex Light Therapy System. The technology is utilized to treat a multitude of conditions that require healing along with the relief of pain and the reduction of inflammation. In addition, Laser Therapy attempts to restore normal cell function. Her condition responded to Light Therapy during which the photons emitted are absorbed by mitochondrial chromophores within the cell. Consequently electron transport, adenosine triphosphate (ATP) nitric oxide release, blood flow, and reactive oxygen species increase and diverse signaling pathways become activated. Stem cells can be activated to permit tissue repair and result in healing. In dermatology, Laser Therapy has beneficial effects on scarring, burns, and other damage to the dermis. Furthermore, Laser Therapy can reduce ultraviolet damage both on a preventative and therapeutic basis. In pigmentation disorders such as vitiligo, Laser Therapy can increase pigmentation by stimulating melanocyte proliferation and reduce deep pigmentation by inhibiting autoimmunity. Inflammatory diseases such as psoriasis and acne can also be helped to a significant degree. The non-invasive nature and almost complete absence of side-effects encourage therapeutic benefits in dermatological practice.

Laser therapy has also been shown to reduce inflammation and edema, induce analgesia, and promote healing in a range of musculoskeletal pathologies. The peripheral nerve endings of nociceptors, consisting of the thinly myelinated A∂ and unmyelinated, slow-conducting C fibers, lie within the epidermis. This complex network transduces noxious stimuli into action potentials. Moreover these nerve endings are very superficial in nature and thus are easily within the penetration depths of the wavelengths used in Laser therapy. The cell bodies of neurons lie within the dorsal nerve root ganglion, but the elongated cytoplasm (axons) of the neurons extends from the cell body to the bare nerve endings in the surface of the skin. The direct effect of Laser therapy are initially at the level of the epidermal neural network, but the effects move to nerves in subcutaneous tissues, sympathetic ganglia, and the neuromuscular junctions within muscles and nerve trunks. Laser therapy applied with a sufficient level of intensity causes an inhibition of action potentials where there is an approximately 30% neural blockade within 10 to 20 minutes of application, and which is reversed within about 24 hours. The laser application to a peripheral nerve does have a cascade effect whereby there is suppressed synaptic activity in second order neurons so that cortical areas of the pain matrix would not be activated.

Adenosine triphosphate (ATP) is the source of energy for all cells, and in neurons this ATP is synthesized by mitochondria while they are located in the dorsal root ganglion. These mitochondria are then transported along the cytoskeleton of the nerve by a monorail system of molecular motors. Laser therapy acts like an anesthetic agent, in that both Laser therapy and anesthetics have been shown to temporally disrupt the cytoskeleton for a matter of hours as evidenced by formation of reversible varicosities or beading along the axons, which in turn cause mitochondria to “pile up” where the cytoskeleton is disrupted. The exact mechanism for this effect is unknown but it is not a thermal action. It has been shown that Laser therapy at the correct dose decreases mitochondrial membrane potential (MMP) in DRG neurons and that ATP production is then reduced so perhaps the lack of ATP could be cause of this neural blockade. The most immediate effect of nociceptor blockade is pain relief which occurs in a few minutes and has been shown by the timed onset of a conduction blockade in somatosensory-evoked potentials (SSEPs). This inhibition of peripheral sensitization not only lowers the activation threshold of nerves but also decreases the release of pro inflammatory neuropeptides (i.e. substance P and CGRP). In persistent pain disorders this reduction of tonic input to activated nociceptors and their synaptic connections, leads to a long-term down-regulation of second-order neurons. The modulation of neurotransmitters is a further possible mechanism of pain relief, as serotonin and endorphin levels have been shown to increase in animal models and following laser treatment of myofascial pain in patients. Thus Laser therapy can have short, medium and long term effects. Fast acting pain relief occurs within minutes of application, which is a result of a neural blockade of the peripheral and sympathetic nerves and the release of neuromuscular contractions leading to in a reduction of muscle spasms.

In the medium term there is a decrease of local edema and a reduction of inflammation within hours to days. The action of Laser therapy in reducing swelling and inflammation has been well established in animal models as well as in clinical trials. The numbers of inflammatory cells has been shown to be reduced in joints injected with protease, in collagen-induced rheumatoid arthritis, and in acute pulmonary inflammation. The expression levels of pro-inflammatory cytokines have been shown to be reduced by Laser therapy in burn wounds, in muscle cryo lesions and in delayed type hypersensitivity. The long term effects of Laser therapy occur within a week or two and can last for months and sometimes years as a result of improved tissue healing.
This case profile has demonstrated marked improvement of symptoms since the patient commenced Laser Therapy. There are no lesions existing currently and the toenails of both feet have grown back normally and appear to be healthy. She has a mild degree of discomfort with elevated ambient temperatures but can now tolerate wearing open-toed sandals and is able to engage in most physical activities without discomfort. She continues to use a Home Laser Therapy System periodically and finds this to be a most satisfactory arrangement.

Case Study


June 30, 2017

This patient is a 61-year-old retired geophysicist who resides in Texas. She has a long history of pain in the cervical and lumbar spine pain areas, with severe sciatica on the left side and moderate pain in the left upper extremity for an extensive number of years. Her symptoms have been relatively acute since 2013.

Prior to initiating treatment, an MRI of the lumbar spine was performed by her family physician on March 31, 2014. The radiological diagnosis, aside from degenerative osteoarthritis in both areas, describes a large paracentral disc herniation at L3 causing severe left lateral recess effacement and impingement at the L3 nerve root. This would appear to account for the patient’s severe left-sided radiculopathy.

The patient presented at the Meditech Clinic on June 17, 2016.

The diagnosis established reads as follows: Degenerative Osteoarthritis of the Cervical and Lumbar Spine Complicated by a Disc Herniation L3-4.

The patient had 10 therapeutic sessions on successive days at the Meditech Clinic between June 17-27. She then continued periodic therapy at home utilizing the LED Large Surface Array known as the Duo +180.

By the end of last year, her symptoms has largely disappeared and an additional MRI of the lumbar spine was performed in December 2016. The result—no evidence of any disc herniation. The patient was relatively asymptomatic with only minor pains following excessive activity. She had not required any analgesics in over one year.

Conclusion: This case demonstrates a classic example of the healing effects of Laser Therapy in cases of osteoarthritis with disc herniation resulting in complete resolution of the pathology confirmed by the pre and post treatment MRI’s.

F. Kahn, MD, FRCS(C)