Category Archives: LILT Developments

MEDICAL PRACTICE & LASER THERAPY – REFLECTIONS

Today, it is of the ultimate importance that healthcare professionals have an overview of medicine as practiced internationally − not just as it is practiced in Canada. Around the world, it has been demonstrated that governments and medicine seldom mix. Accordingly, all healthcare professionals, particularly physicians, must be independent practitioners who have only the best interests of the patient at heart and must therefore focus their efforts on this objective.

Unfortunately, system administrators seem to sprout ever enlarging bureaucracies often advised by physicians who are motivated by exercising political clout and their own pecuniary interest, rather than the welfare of patients.

Pharmaceutical companies, with their extensive lobbies and the support of government bureaucracies, are primarily driven to generate profits but nevertheless exert an excessive and unwarranted degree of influence in formulating healthcare policies, extending even to the educational process.

Insurance companies, as is increasingly evident, again are economically oriented and pose one of the most pernicious influences in healthcare today. Claims adjusters and low-level administrators frequently impose incredible hardship on patients desperately in need of funds to pay for both their specialized and routine health care, for which they have contributed premiums over many years.

The combination of gatekeepers consisting of governments, HMOs, Wall Street corporations, etc., further muddy the waters. There is no clarity existing with all the vested economic interests that at this point almost totally control healthcare delivery systems, whether in England, Cuba, Canada or Sweden.

In many instances, unfortunately, no healthcare at all may be preferable to what is actually provided. For example, wounds secondary to diabetes, atherosclerosis, and other etiological factors often show rapid improvement with simple elevation of the extremity and saline compresses to the wound 24/7, as compared to the utilization of multiple dressings, antibiotics and analgesics that are provided in such abundance, accompanied by rising costs. All too often, the latter approach leads to the eventual amputation of the afflicted limb.

Does anyone really care about these issues? Not as long as the care provided is perceived to be ‘free’. And what of the latter fact? A perfect excuse to levy more taxes, to expand the bureaucracy and order more diagnostics and consumables, all excluding the most important item – the correct therapy designed to cure the patient’s problem.

To elaborate on the insurance situation: each day, we see new patients at our clinics and invariably, at least initially, the priority item they wish to discuss is their insurance plight – rather than their medical condition. These patients rant on about how the insurance companies keep reneging on the promise to pay for their care. How can you blame them? This premise, after all, is why they bought insurance in the first place.
I recently uploaded on my blog the story of one particular family which serves as an excellent example of this growing problem. The husband was severely injured in an automobile accident over five years ago and has been unable to work since. The couple went broke paying their medical bills and were recently evicted from their home. Several insurance policies had been purchased by this individual, who owned a number of businesses that were thriving prior to the accident. Financial failure ensued after the trauma as the wife was busy taking care of her husband and two children and could not continue to manage their affairs.

Over five years later, the insurance companies are still fighting about who should pay for what. Anyone familiar with this paradigm knows that it can go on for many years, or at least until the patient expires.

At the same time, insurance companies spend considerable funds on diagnostics and these are seldom questioned, no matter how expensive they may be. They also spend unlimited funds carrying out assessments, investigations, etc., which allow them to renege on claims, aided and abetted by a hoard of assessors, bought and paid for by the carrier. The latter almost invariably find that there is no objective evidence to substantiate the disputed claim.

As for pharmaceuticals, these in many instances confer significant benefit. For example, insulin, thyroxin, cortisone, and analgesics, along with many other drugs, provide viable solutions – primarily in the short term, although often only by masking symptoms. Furthermore, drugs do have limitations and can produce adverse effects. In some instances, the latter may be significant. However, because the pressing need for these medications may override the objection to prolonged use, dependence becomes ‘justifiable’. That is certainly the case with diabetes and insulin, ACTH for adrenal insufficiency, thyroxin for hypothyroidism and a number of similar situations.

On the other hand, alternative therapies can and do provide highly effective solutions in the treatment of a plethora of medical conditions and do not produce adverse effects, either long or short-term, particularly in the treatment of arthritis, back problems and most conditions with the common factor of inflammation, a major component in most disease processes.

I first learned about Laser Therapy in 1988, having injured my right shoulder in a skiing accident in 1986. The injury included a complete tear of the supraspinatus tendon and a fracture of the humeral head generating chronic inflammation of the shoulder joint. Subsequent to this episode, I consulted a number of orthopedic surgeons and the general consensus was to perform an arthrogram to be followed by immediate surgery. Being a trained surgeon, I resisted the temptation to follow this approach, based on past experience, notwithstanding the fact that both orthopedic surgeons I consulted were highly competent and had the best of intentions. My conclusion was that this intervention, fully approved by the regulatory bodies, would not substantially benefit me and I therefore pursued an alternative course. Above all, I did not wish to be subjected to an additional trauma.

Unfortunately, prior to Laser Therapy, from 1986-1989 I was unable to play golf or swim on a regular basis, secondary to the discomfort and pain. Analgesics and anti-inflammatory medications produced undesirable side effects; moreover, I objected to them on basic principles. Periodically, when the symptoms became unbearable, I submitted to cortisone injections which, when properly placed, provided temporary relief. A permanent cure proved elusive.

Finally, I found a therapist equipped with a primitive European Laser device and in a short period of time, my shoulder pain subsided significantly. Inspired by this turn of events, I began my pursuit of self-education in the emerging technology of Laser Therapy. Over the course of two years, I read over 300 articles and 13 texts on this topic and participated in many national and international meetings exploring the subject.

Here are some observations noted on this journey:

 How little was really known about this therapeutic medium at that time.
 How much remained to be learned.
 How we must open our minds to new ideas, thoughts and solutions.
 How we must question tradition and “the way things have always been done”.
 How we must be critical of the massive amount of information and disinformation coursing through the net. This is extremely challenging and reminds me of my mother who often said, “I read the following in the newspaper.” My usual response would be, “I know that this is not true.” Her invariable retort was that “It would not be in the newspaper if it were not true!” She also believed in the infallibility of physicians, with the exclusion of myself. Unfortunately, that was the cause of her demise at the age of 93. Had it not been for a series of hospital blunders, she might still be alive today.
 We must always be aware of how the internet disseminates a mountain of data, all of which is of course documented by humans, many of whom have a vested interest in benefiting the propagator of the information provided.
 Creativity and independent thought must be encouraged. In a civilized world, these qualities inevitably lead to progress.
 Never be afraid to question or criticize authoritarianism in its varied forms.
 Do not permit economic conventions, inappropriate regulations, and other obstructions to get in the way of implementing better therapeutic solutions.

To cite some recent advances, I refer to:
o Stem Cell Therapy
o Genetic Modification (gene splicing)
o Robotic Surgery
o Laser Therapy, etc.

 All healthcare professionals should be encouraged to make the patient’s clinical status the focus of their endeavors.
 Most significant of all, are the advances in Laser Medicine over the past decade and the wide impact this should have on the quality of medical care, now and in the future.

When asked how he conducted research surveys indicating what product the company should build, Steve Jobs, the late departed CEO of Apple, stated, “Surveys of that type have no interest to me. I know what people need and that is what I give them.” To me, this represents a greater wisdom than the many aphorisms espoused daily by the leaders of the corporate world.
Steve Jobs may have been, in the eyes of some, a “son of a bitch” but he is one of the few who had the vision and courage to nurture his original concepts and ideas and translate them into reality. All of us should adopt this type of guidance to a greater degree. Personally, I like to think that in many ways Laser technology is developing along a similar trend.

At our clinics, the most significant results produced are in the treatment of arthritis, musculoskeletal problems, particularly the spine, dermatological conditions including wound healing, along with the all too common soft tissue and sports injuries, many of which have acquired the characteristics of chronicity.

In addition, we have discovered and are learning that Laser Therapy has the potential to treat more complex systemic conditions, particularly in situations where conventional methods have been ineffective.

In the past several years, stimulated by several neurological researchers, we have developed and refined some exciting new applications in the field of neurology, particularly with regard to the following conditions:

• Concussion
• CVAs
• Dementias
• Multiple Sclerosis
• Depression
• Anxiety Disorders
• Nerve Regeneration
• Spinal Cord Injuries
• Demyelinating Diseases (Gene 7 Paresis)

While only a relatively small number of these conditions have been treated, it must be noted that we have achieved a greater degree of success than anticipated. In keeping with the conventional one-line disclaimer so common in academic circles, “more studies are indicated”. At the same time, I must emphasize that we continue to meet, if not exceed, our expectations.

The constant road block? Insurance companies. They may be willing to pay for diagnostic services, but refuse to pay for actual therapy that may not yet be “authorized”. Again, this is one of the regressive forms of behaviour dictated by managed healthcare systems in the interest of economic considerations. While the focus is on diagnostics, there is a clear lack of enthusiasm for selecting and applying therapies designed to actually benefit the patient. This is commonly described as “risk management”.

Another problem I mentioned is that pharmaceuticals are generally paid for by the management systems in place. Whereas prescriptions are often written under the mystique of providing instant benefit, the reality is that an undetermined number of prescriptions are never filled, which may be a blessing in disguise. Two-hundred and ninety patient deaths are reported daily in North America – the result of pharmaceutical utilization. In reality there are probably thousands!

In 1998 an article in the Journal of the American Medical Association concluded that prescriptions legally written by physicians are the 4th leading cause of death.
In his 2012 book, Unaccountable, Dr. M Makary, a Johns Hopkins School of Medicine researcher, shows how “mining sickness for profit” makes everybody “unaccountable” – hence the book’s title. The book illuminates a description of how hospitals are a major cause of death and how at least 30% of conventional “healthcare” is unnecessary and leads to deadly results.

From my personal perspective, effective therapeutic solutions have always been integral to the agenda of any ethical medical practice. Again, instituting immediate treatment when the disease process begins, circumvents the obstructive process of bureaucracies in the treatment of both routine and complex medical conditions, while substantially reducing the cost of healthcare.

Remember that administrators and other gatekeepers have no real interest in finding the best possible medical solutions but focus instead on cost controls and their primary interest remains the bottom line.

For a good clinician, defining the correct diagnosis does not require a major effort. In most instances, it can be accurately determined by taking a detailed history and performing an equally thorough physical examination. This aspect of medical practice, unfortunately, is no longer de rigeur.

Diagnostic studies, which can be expensive and harmful, should only be employed when the practitioner is unable to arrive at a working diagnosis or to confirm the clinical diagnosis, if this is essential.

All too frequently, prolonged diagnostic studies, the prescription of inappropriate pharmaceuticals, cross consultations, and other non-relevant assessments delay the initiation of therapy and therefore the healing process. This approach is wasteful and one must remember that no pathology can be cured without initiating appropriate treatment, preferably immediately.

It is therefore paramount that Laser Therapy, which can be easily administered by therapists with a modicum of medical training, can and should be more widely implemented, particularly in situations where urgent and effective treatment is essential.

Today, evidence-based medicine is all too often related to double-blind studies, peer reviews and the literature. Sometimes these imply or provide automatic approval of therapies that may have minimal benefit at best. In view of this, one must always ask:
• Who finances these studies?
• How relevant are they?
• Who conducts them?
• And for what purpose?

My personal view is that when a patient presents with a problem and has undergone many studies and treatments without any measurable improvement that is clear evidence of failure. Unfortunately, in healthcare systems today there is no real accountability and supervision of progress may be spurious or even non-existent.
Confusion surrounding terminologies such as “evidence-based”, “scientific”, “double blind”, etc. may often be categorized as time based illusions. Healthcare professionals must adopt therapies that cure the problem rather than focusing on the modulation of symptoms and physician compensation codes. The latter is comparable to following a road leading to nowhere.

In our clinics, the problems that we treat most frequently include multi-level degenerative disc disease and single disc herniations, often accompanied by stenosis, radiculitis, etc. The success rate in these situations is over 90% and no adverse effects are produced. In a select number of cases we have performed follow-up MRIs and were not surprised to see that the problem had been resolved (i.e. the disc herniation could no longer be visualized).

Contrary to current concepts, we frequently encounter young athletes with dysfunctional knees. The basis of these pathologies consists of varying degrees of disruption of the anterior cruciate and/or other ligaments, meniscal tears, contusions, etc. Currently, these are almost invariably treated with surgical intervention, which can lead to complications and permanent dysfunction.

As the number of patients presenting at our clinic with these types of injuries has increased over the past several years, we have again been able to conduct follow-up MRI studies and complete healing has been reported most notably in cases where the original MRI read complete anterior cruciate ligament tear. It is my belief that in these instances, a portion of the anterior cruciate ligament remains intact, perhaps only 10%. Again, further studies are indicated and we are conducting these on an ongoing basis.
Without question, if my knee were injured I would use the conservative Laser Therapy approach and surgery could always be instituted at a later date if necessary; this is rarely the case.

It should be noted that frequently patients are successfully treated with Laser Therapy for conditions that have not improved with traditional therapies. Nevertheless, some physicians will comment that they do not believe in this therapy, and this often repeated statement stimulates some reflection on my part.

I believe that our planet sustains approximately 7 billion people and that over 90% of the entire population, I am informed, believes in some God, religious power or tradition. Without invoking blasphemy at any level, I have never been informed that anyone has actually had a conversation, discussion or meeting with a God. Nevertheless, a God of some form exists in almost everyone’s mind and historically the belief in a Dogma survives, particularly in the face of political repression attempting to dissuade citizens from maintaining this practice.

Obviously some remediation of the medical profession is indicated. It should be noted that in all cultures ignorance and non-believers exist. These have always been a mainstay of the human condition and the effort to maintain this status is sacrosanct to many. It feeds their ego, as they have established an opinion – right or wrong – and free-choice philosophy dictates that individuals can choose to be ignorant and incompetent if they wish and there is really nothing that can be done about that. Eventually, these non-believers may become extinct, hopefully replaced by those with more open and educable minds.

Needless to say, progress will require some leadership from educational institutions and governments. Hopefully this process will stimulate further reflection on our ethical and moral values. And then there is always the matter of mass conditioning. For instance, several years ago when a flu epidemic was rampant in Canada, people dealt with infinite lines to obtain the vaccine. Individuals lined up day and night to receive the shots and information was rapidly circulated about the clinics that had the shortest wait times. This persisted for several weeks. As soon as the flu vaccine became widely available, the lines almost instantly evaporated.

CONCLUDING COMMENTS:

• My vision is to exchange a Laser Therapy Unit for every prescription pad in existence.

• To take control of healthcare away from governments and other vested interests and return it to properly educated and trained healthcare professionals who possess an understanding of quality healthcare.

• Everyone reviewing this article should strive to become a creative and effective Laser Therapist.

• Embracing these concepts will improve every citizen’s healthcare immeasurably and wide application can reduce costs of delivery by billions of dollars.

What happens when your insurer won’t pay?

It’s the fear every consumer has buying insurance. When it comes time to make a claim, your insurer will have some reason not to pay out.

The doomsday scenario isn’t just fantasy, it’s reality, say many people who fight insurance companies on a regular basis.

The issue was highlighted this week when a Saskatchewan judge awarded Luciano Branco $5-million, saying the actions of his insurance companies established “a pattern of abuse” — Justice Murray Acton noting he wanted to send a message to the industry.

The case could be a template for anyone paranoid about getting his or her claim cashed out.

The claimant in this case was a welder who was injured on the job. The judge noted the man, who suffered a permanent disability, was offered a “ridiculously low” settlement as the insurance companies dragged its feet for years on the claim.

While cases like this may not be the norm, Toronto lawyer Sivan Tumarkin has built a legal practice around getting insurance companies to pay up.

“I’m just getting more and more of these,” said Mr. Tumarkin, who used to work for insurance companies in a defense capacity. “I only started doing this because I had people coming to me who were having issues with insurance companies. You have a flooded home and they won’t cover. I have someone [who gets sick] in New York with travel insurance and they won’t cover.”

He says the insurance companies don’t out and out reject claims for no reason but their objections are in many cases for negligible reasons.

Mr. Tumarkin had an older couple as clients recently who put in a health claim for a fracture suffered by the wife while on vacation in the U.S. The claim was paid but the insurance company when back into their medical records and found out some of the information filled out in the application was incorrect and demanded $30,000 back.

The basis of many insurance claim rejections is something on a policy being filled out incorrectly, either on purpose or because of a misunderstanding.

You buy a life insurance policy and say you don’t smoke even though you have the occasional butt at a bar. One day you get killed in a car accident. If your insurer finds out about your occasional indulgence, there’s a good chance they’ll fight the claim.

“The law is you have to answer truthfully but it is ambiguous about the way you might answer the question as a lay person,” says Mr. Tumarkin. “They’ll look at absolutely everything they can to try and not cover you. I’m not saying in every case but a lot of them.”

He says insurance companies in property damage claims on car accidents will drag their feet on an investigation, knowing there is time limit to sue.

Out and out rejection of claims to meet some quota is probably more something you see in movies, says Mr. Tumarkin. “There is willful blindness on the part of adjusters,” he says. “There is never absolutely no reason they don’t pay. They’ll just use every excuse in the book.”

Pete Karageorgos, manager of consumer and industry relations with the Insurance Bureau of Canada which represents home and auto insurers, says there are no statistics on what percentage of claims get rejected.

But on the auto front, the industry has statistics that show in Ontario in 2010, the sector took in $9.4-billion in premiums and paid out $8.3-billion.

“It goes to show you the majority of money coming in goes right back out to pay claims,” said Mr. Karageorgos.

He adds insurance is a contract and any insurance adjuster will look at the conditions that could negate the agreement.

“Insurance companies are not just going to take your word for it,” said Mr. Karageorgos. “For any contract to be valid and effective, the conditions on both parties parts need to be satisfied.”

The issue for many people in hiring a lawyer is the up front cost. In the Saskatchewan case, the welder who sued his insurance companies had to be bailed out financial by family members.

One thing you can work out in some cases is an agreement whereby your legal bill is covered based on a contingency fee basis, your lawyer gets his bill paid from the winnings.

You can also consider taking your insurance company to Small Claims Court.

Another suggestion for consumers is buy insurance products from a broker, who is compensated by the insurance company but not employed by them. By using the broker, you have the added possibility of suing the broker if he or she gave you bad information when filling out your policy.

Some policies get reviewed by insurance companies before they are issued and people are rejected or assessed at a higher rate, such as in life insurance. But for low margin products like travel insurance, there is no investigation until a claim is submitted.

“You have the policy underwritten at the time of application not at the time of claim, so there is no surprises and it is completely on the up and up,” said certified financial planner Mark Halpern, of illnessprotection.com.

Sometimes he’ll get a client who wants to say he doesn’t smoke when he does occasionally and Mr. Halpern rejects that business because he doesn’t want to see the claim eventually dismissed.

In other cases, people make innocent mistakes about the type of medication or the maladies they have had in the past.

“It’s really important you keep a record of your medical history,” said Mr. Halpern.

He doesn’t dismiss the notion that insurance companies will reject claims for flimsy reasons and says a broker can be an important advocate on your behalf in that situation.

“If that doesn’t work, there is always [a lawyer],” said Mr. Halpern, noting in many cases the presence of lawyer leads to some type of settlement.

“The insurance don’t like to have bad press but they don’t want these things lingering if there is something [that could work against them]. In the worst case, you might get some settlement,” he says.

Alex Saltykov, founder of InsureEye Inc. which follows the industry, says there are no statistics to show what percentage of claims are paid out.

He says consumers really have to make sure they know what is covered and not because insurance policy are so complicated.

Mr. Saltykov found himself not completely covered for treatment he needed for physiotherapy because he had not read the terms of his insurance contract.

“You want it to be there in the worst moment of your life,” said Mr. Saltykov. “If you are not sure of what should be disclosed, you better disclose it even it makes your insurance go up. Otherwise you risk your company not paying.”

Breaking Branco

The article below obtained from the Northern Miner, April 24th, once again demonstrates the deceptive practices of insurance companies who collect premiums on the basis of false advertising and then fail to honor their obligations to the patient. When will our politicians take note and rectify these serious problems?

Luciano Branco’s long and soul-destroying battle with insurance firms AIG and Zurich has finally reached some satisfaction in the courts, with a Saskatoon judge awarding the injured Portuguese-Canadian welder $450,000 in aggravated damages and $4.5 million in punitive damages. It’s the largest award of its kind ever given by a Canadian court against insurance companies.
Branco, now 62, immigrated at age 24 to Canada, where he learned to weld and worked out West and up North. In 1994 he moved back to Portugal, and by 1997 was working at Cameco-subsidiary Cameco Gold’s (now Centerra Gold) huge Kumtor open-pit gold mine in Kyrgyzstan.
During a 12-hour shift on Dec. 25, 1999, he dropped a steel plate on his foot. He finished his shift, packed his foot in ice, and returned to Portugal at the end of his 28-day rotation to recuperate. Towards the end of his next rotation, he stepped on a piece of steel and reinjured his foot, and then sought medical treatment in Portugal, missing his next rotation.
He only reported his injury to the Kumtor operating company on his next rotation in June 2000, when he did not work at the camp. Kumtor continued to pay his base salary of $51,920 to the end of his contract in March 2001 (in fact, overpaying him $12,000 by mistake).
Anxious to get back to work, Branco had surgery on his foot in January 2001, but it was unsuccessful. Despite physiotherapy and rehabilitation treatments, Branco’s Portuguese doctor determined that he was permanently disabled and in chronic pain, a prognosis repeated many times in the following years by specialists in Canada.
American Home Assurance Co. (AIG) was advised of Branco’s work-related injury in mid-2000, which triggered the Saskatchewan Workers’ Compensation Board-equivalent claim handled under the AIG policy. His long-term disability benefits were covered by Zurich Insurance.
To make a long story short, AIG and Zurich refused to pay out the benefits owed to Branco, hoping the outrageously long delays, transcontinental complexities and non-stop legal bills would grind him down and force him to accept a much lower settlement.
In the recent judgment, Justice Murray Acton found that AIG and Zurich had acted in a “cruel and malicious” manner towards Branco for more than a decade, offering him “ridiculously low” settlements, including AIG initially offering him a cash settlement of just US$22,500. AIG didn’t make some of its payments owed to Branco until the day of the trial.
Zurich, for its part, internally approved Branco’s long-term disability payment in 2002, but never informed Branco, who didn’t receive his first funds from Zurich until 2009 and had turned down Zurich’s settlement offer of $62,900, minus $9,000 in legal costs in April 2003. “This court cannot imagine a more protracted and reprehensible behaviour than that of Zurich in blatantly refusing to pay what had been owed in monthly payments for almost eight years,” Acton writes in his decision. “The actions of AIG and Zurich establish a pattern of abuse of an individual suffering from financial and emotional vulnerability.” (The judge said that the mining company had treated Branco fairly, and only the insurance companies were liable for damages.)
The judge noted that prior to his injury, Branco was a “proud, athletic and hard-working individual” who was “warm, friendly and sensitive” and an “excellent employee” at Kumtor. After the injury and the withholding of benefits, however, he had become a “demoralized man full of sadness and loss of pleasure,” and an individual “full of anxiety and depression.”
The insurance companies, Acton writes, “virtually destroyed Branco’s life over the last 13 years,” causing his marriage to break down and financial burdens to be placed on his daughter and other family members, and his legal representation. The judge writes that the insurance companies tried to use Branco’s diminished life to “gain leverage” over him and force him to accept a low settlement.
“That Branco was able to continue to withstand this pressure for so many years from two different fronts is truly remarkable and almost superhuman, even though his resistance may have resulted in irreparable mental distress, which may last for the remainder of his lifetime,” Acton writes. “The question remains: how many individuals have been unable to withstand the financial and psychological pressure of these tactics?”
The insurance companies are expected to appeal the decision.

Reflections on Neurological Conditions

Many illnesses share common DNA roots. The five most common mental illnesses present in the following order:

1. Autism.
2. ADD.
3. Bipolar disease.
4. Schizophrenia.
5. Depression.

The latest research published in the journal Lancet indicates that all these diseases are the result of genetic variations, some of which have been extensively reviewed. i.e.:

• Chromosome 3
• Chromosome 10
• Calcium channels, which play a significant factor in controlling cell function
• Environmental influences

This synopsis of mental illnesses and the factors involved (many of which are unknown) are challenging, particularly with regard to effective therapies.

Currently, there is an extensive amount of research being carried out in many leading clinical and research centres throughout the world and it would appear that genetic factors may be pre-eminent as the etiological causes responsible for these disease processes.

Laser Therapy is beginning to play a role in this therapeutic area, which of course is important, in order to achieve positive clinical outcomes. Some of the effects of Laser Therapy on neurological tissue include the following:

• Increase in ATP production raising energy levels within the cells
• Increased deoxyribonucleic acid (DNA) and ribonucleic acid (RNA)
• Increased nitric oxide (NO) release
• Enhanced cytochrome c oxidase activity
• Modulation of reactive oxygen species (ROS)
• Modifications to intracellular organelle membrane activity
• Cytoprotective effects
• Down-regulation of pro-inflammatory mediators
• Increase in secretion of anti-inflammatory mediators
• Angiogenesis
• Neurogenesis and neuroplasticity facilitation

All of these physiological activities produce a neuromodulating or neuromedation type of effect, particularly on brain tissue.

This commentary is appropriate as at this time more effective therapies need to be developed to deal with these problems. At Meditech, we have had a long standing interest in these pathologies and recent discussions with several neuroscientists stimulate our efforts to accelerate the development of reliable therapeutic options.

As an increasing number of patients are treated, we gain experience, establish effective protocols and expect that our work in the treatment of these complex and problematic conditions will be particularly rewarding for patients.

The Psychological Status of Wound Patients

A disproportionate number of patients in this category have been suffering from lesions in existence from a matter of months to over five years. They have been exposed to an extensive number of therapeutic modalities at multiple centres. These range from dermatological offices to specialized hospital wound clinics. Generally and invariably, they have seen a number of specialists including vascular surgeons, dermatologists, infectious disease controllers, neurologists and family physicians. Most have been treated with several courses of antibiotics, comprising oral, topical and intravenous delivery, along with analgesics, sleep medications and an almost unlimited number of dressing options. Topical applications are so diverse that the attempt to classify them, boggles the mind. Some incorporate silver, others are iodine-based – the list is without end.

Often despite best efforts, wounds continue to increase in dimension at a gradual pace, whether diabetic, atherosclerotic, venous, inflammatory, iatrogenic or of other origin. As the days pass and turn into months, even years, the patient becomes increasingly depressed with the feeling that there is no light at the end of the tunnel. In essence, they lose faith in the power of the healing professions. Many become resigned to their fate; others become angry at the journey that eventually may encompass the loss of a limb. Gradually, they lose interest in the proceedings and cease to care with regard to the objective or the end result. The wound and the extremity on which it is located, from their perspective, ‘now belongs to the therapist’. In the course of this development, they tend to become non-compliant with regard to the prescribed regimen and often, somewhat like alcoholics, disappear for a week or two until someone in their family persuades them to continue with treatment, which by then may present new complications.

At the same time, no matter how caring or attentive the therapeutic environment may be, there is always the danger at this stage of failing to penetrate the patient’s mental armour. They become guarded and somewhat reclusive in communicating their problems and anxieties and may retreat into a shell, which inures them from outside influences and the reality of their situation. On occasion, indeed, they lose total interest in their progress and the objective of the therapeutic exercise, along with the administration thereof. Even when significant healing is demonstrated by serial photographs, they become disinclined to reveal any interest or emotion with relation to these positive events.

The most negative factor often prevalent and frequently reinforced has been the debridement process. The administration of this step is often heavy-handed, painful and engenders the feeling that it may even be destructive. Whereas on occasion it may be required, in our experience, natural debridement, based on the use of hydrogen peroxide and saline compresses, is vastly preferable. Moreover in our opinion, it is better tolerated, more effective and permits new cells to survive.

In an effort to penetrate the negative mindset of these patients, one must reflect on their psychological status and educate them about treatment objectives. The Meditech Laser Therapy Program for Wound Healing stresses a positive approach, along with the development of relevant insight into the patient’s psychological status. The latter involves psycho-therapeutic techniques including guidance to enhance comprehension conversion to become a participant in the healing process and sharing the responsibility for the outcome. It is mandatory that all centres specializing in wound healing understand and incorporate these principles into their programmes.

For references regarding the Meditech Method for Wound Healing, email Fernanda Saraga, our PhD Director of Research: fernanda@bioflexlaser.com

BioFlex Laser Therapy Advantage

The Application of Laser Therapy in Cosmetic Surgery

It has been my observation that cosmetic/plastic surgeons, no matter how meticulous they may be with regard to technique, including adequate visualization, lighting, hemostasis and suturing with extremely fine filaments — may still obtain results that are unsatisfactory, from an esthetic perspective.

The complications that may occur include hematoma, infection, scar tissue and even keloid formation, with sometimes unsightly healing. This should not produce feelings of guilt or inadequacy on the part of the competent surgeon.

More importantly, we now offer a solution to these universal problems with the utilization of Laser Therapy, which may be administered on completion of the surgery, 2-3 days subsequently or at any time thereafter.

The visual outcome can invariably be elevated to a more acceptable level and may sometimes result in dramatic cosmetic improvement.

If you are interested in exploring this now standardized approach, please feel free to contact Fernanda Saraga, Ph.D. at fernanda@bioflexlaser.com or 416-251-1055 ext. 138 for additional information.

Sports Medicine – An Advisory

High profile athletes, much like MDs, often receive inadequate medical therapy, thereby compromising the quality of health care they need and deserve. It is therefore incumbent that all athletes take note of the following advice. Unfortunately, physicians often do not accept advice beyond their sometimes narrow scope of knowledge.

Over the past twenty years, our company has worked with an extensive number of high-level professional and amateur athletes and sports organizations. Some of our prominent clients have included the Toronto Maple Leafs Hockey Club, the Toronto Raptors, the Miami Heat and periodically, individual members of the Blue Jays. On most occasions, we have been able to successfully rehabilitate players suffering from a variety of musculo-skeletal problems that failed to heal utilizing traditional methods.

During this period, we have learned that team owners, managers, agents and trainers come and go – each with their own particular objectives and philosophies. Many of the teams are guided by a variety of advisors with regard to the maintenance of the athlete’s health, the treatment and prevention of injuries and related problems. All too often, this arrangement is not in the athlete’s best interest.

Most significantly, I would like to stress that all athletes should take a measure of control with respect to their individual welfare and health status. Do not rely on those who may lack the medical knowledge and expertise to provide the best possible solutions. The list of high-level athletes whose careers have been cut short by adhering to inappropriate therapies, is infinite. In my mind, there is no question that the correct application of Laser Therapy could have healed most of these injuries rapidly, thereby prolonging the athlete’s career.

I read the sports pages daily and see many top-level athletes plagued by back injuries, shoulder problems, tendonitis, epicondylitis, etc. who elect to have surgery with subsequent termination of their career. In many of these instances, ten Laser Therapy sessions over approximately two weeks, could have resolved these problems promptly and completely.

The most productive associations that we have experienced in the field of sports medicine have been formed by working with the individual athlete, unencumbered by agents, decision makers and those who have a vested interest in advancing their personal agendas. It is for this reason that I appeal to the athlete directly. Remember – when your career is finished, no one will care about you, your pain or your arthritis. It is therefore incumbent that you educate yourself to make the appropriate choices regarding to the most effective medical solutions available today.

In the past four years particularly, an increasing number of athletes have acquired BioFlex Laser Therapy Systems for their personal use, in order to be able to treat their injuries immediately after occurrence and utilize the therapy with protocols specific for their particular problem. In these situations, rapid and complete recovery is almost assured. Indeed, employing the BioFlex Laser Therapy System almost invariably results in a success range approaching 100%, when dealing with the athlete directly and no third party interferes in the process or compliance.

A number of golf professionals have learned “never to leave home without it” (i.e. the BioFlex System), knowing that they can independently treat their injuries on the road and immediately when a new injury occurs. Several baseball pitchers in the Major Leagues have followed suit. The benefits resulting from this approach are vastly superior to the utilization of the large jars of toxic pharmaceuticals (analgesics, anti-inflammatories, muscle relaxants) that are so often indiscriminately dispensed, in almost every locker room.

Finally, you, the athlete, owe it to yourself to become educated with regard to the most effective therapies available, in order to maintain your physical skills, as long as possible and prolong your career, beyond what is commonly regarded as normal. Moreover, this approach also provides preventative therapy, precluding the need for knee replacements, back surgeries, etc. – areas that so frequently become symptomatic soon after retirement. Baseball pitchers, gymnasts, golfers, etc. are just some of the professionals who benefit most significantly. Pitchers in baseball particularly should utilize Laser Therapy, prior to pitching and at the termination of a game. Careers can be extended for an extra decade or even more. Early institution of therapy that cures the problem, coupled with the ability to prevent progression, is the optimal solution, both short and long term.

For further information, please contact Slava Kim at slavamd@bioflexlaser.com or 416-251-1055.

Laser Terminologies – A Commentary

The truth and misconceptions with regard to the terms, “superpulsed” and “high-powered” in laser therapy.

Historically, a number of manufacturers utilize the adjectives, “superpulsed” or “high-powered” to describe the products they market. Their sales material is clearly designed to indicate that these terms make their systems superior to more appropriately powered devices. From our perspective, we support the distribution of systems where specifications are accurately stated and have proven to be consistently effective in the treatment of clinical pathologies.

The word “super” implies performance beyond normal. Within the context of laser terminology however, it merely indicates a short burst of energy delivered for a millisecond in time. Similarly, the word “high-power” creates the impression that higher levels of energy are better, but in practice, that is definitely not the case. Indeed, an excessive burst of energy can produce a significant inhibitory effect on cellular physiology and the integrity of tissue proteins, resulting in the prolongation of the period required to achieve healing. We comment on this type of misrepresentation in order that healthcare professionals planning to integrate laser technology into their practice, may obtain some clarity with regard to the confusing and misleading terminologies so frequently used.

One should also be aware that the parameters of light, including wavelength, frequency, duty cycle and other characteristics of diodes, such as superpulsed, cannot be patented. Only the physical design of the device delivering a light stream can be described in this manner. With regard to design, the optimal therapeutic dosage can be delivered when there is an accurate, consistent transfer of the photons generated into tissues. This permits the penetration of multiple layers and is the objective of the BioFlex System design.

What does superpulsed mean?

• Superpulsed refers to a pulsing technique, during the course of which the laser emits an emission train of high intensity for an extremely brief duration (nanoseconds). A number of superpulsed lasers exist which describe laser irradiation from low intensities for conventional Laser Therapy applied to tissues and extending to high intensities for the precise cutting of materials such as steel. A superpulsed carbon dioxide (CO2) laser is used for the purpose of vaporization of tissue in surgery. This type of high intensity, short duration pulsed laser produces minimal protein coagulation and results in reduced peripheral heating, while providing precise surgical incisions. In addition, it coagulates vascular channels facilitating homeostasis. Specifically this refers to a short, high intensity pulse, in order that the peak power can be much higher than the average power output of the light source. While there is a clear advantage to this method of application for surgical use, the physiological advantages of superpulsed lasers for Laser Therapy to be applied for tissue healing is unclear and has no established scientific basis.

What is a low-level superpulsed laser?

• Superpulsed lasers, made primarily with gallium-arsenide (Ga-As) or indium-gallium-arsenide (In-Ga-As) laser diodes, emit light at a wavelength of 904-905 nm. Again, these laser diodes produce very brief pulses (200 ns) at high intensities (1-50 W) and extremely high frequencies (in the kilohertz range) with an average power of 60 mW (based on a 20 W Ga-As diode).

What are the differences between continuous wave, pulsed and superpulsed lasers?

• Superpulsed lasers can only operate at a particular wavelength, pulse width and high frequency. Continuous wave and conventionally pulsed lasers are available in a range of therapeutic wavelengths (600-1000 nm) and can be modulated in an extensive number of pulse widths, frequencies and waveforms. The ability to change a wide range of parameters permits an optimally designed therapy program, personalized for each patient.

• While the peak output power of a superpulsed laser may be high (up to 50 W), the average output power is in the same range as continuous wave and pulsed lasers (1-500 mW) but without the additional flexibilities available in parameter settings and therefore protocol modulation. The latter characteristics are considered to be the most essential features in the delivery of effective therapy.

Which type of laser provides the optimal therapeutic outcome?

• There is much clinical data and published research to support the therapeutic benefit of continuous wave and pulsed lasers at a range of wavelengths from 600-1000 nm. Currently, there are about three times as many peer-reviewed articles featuring the wavelengths 660, 830 and 840 nm, compared to those using 904 or 905 nm. To date, there have been no clinical studies carried out that compare the efficacy between continuous wave, pulsed or superpulsed lasers. The claim that superpulsed lasers are superior from a therapeutic perspective can therefore be termed as patently false.

Penetration versus absorption and its relevance from a therapeutic perspective

• The first law of photochemistry (Grotthuss-Draper law) states that a photon must be absorbed to produce a physiological effect. The wavelength of 904-905 nm, in the infrared spectrum, has a lower coefficient of absorption by cytochrome c oxidase, the most widely accepted target for laser emissions, compared to lasers operating at 660 nm (red) or 830-840 nm (infrared). The wavelength used by superpulsed lasers penetrates further due to the fact that it is not readily absorbed by the key target molecules. This in itself is a distinct negative feature. Moreover, the intensity of light drops off rapidly as it penetrates the tissue layers, which means that less photons are available for absorption at deeper levels. The density of photon absorption in relation to tissue depth has not actually been measured for any wavelength. This would clearly indicate that greater depth penetration, the result of minimal absorption occurs but clearly cannot result in a significant therapeutic benefit.

Are shorter treatment times as effective as longer ones?

• Treatment times with superpulsed lasers anecdotally are shorter than those with continuous wave or pulsed lasers. Whereas shorter treatment times may seem to be convenient, there are a number of disadvantages which again make this type of treatment application less effective.

Longer treatment times confer distinct benefits: i.e.,

• The longer the period of laser application (duration), the greater the degree of the stimulatory dosage and its extension into the deeper tissues (cascade effect).

• The systemic benefits, including the stimulation of the immune system and the development of angiogenesis are time dependent and therefore related to the duration of application. These benefits are not obtained from the application of superpulsed lasers.
Needless to say, the two features described above are integral to effective therapy.

Meditech continues to conduct independent clinical research and monitor the literature with regard to all laser devices produced. Until research dictates otherwise, the company will continue to operate utilizing red (660 nm) and infrared (830 and 840 nm) diodes which have proven to be consistently effective in over one million treatments delivered to date. “Res ipsa loquitur” – the results speak for themselves.

It should be evident that extensive dermal wounds, stenosis of the spinal canal and many systemic diseases are beyond the scope of effective treatment using superpulsed laser devices and by extrapolation, it may be deduced that these systems are inefficient in treating other pathologies.

It is interesting to note that a laser manufacturer recently distributed a document comparing their product with the BioFlex System, one that states that the latter device “penetrates minimally”. This is not a scientific comment and is completely erroneous and misleading. In 1998, research carried out under our auspices in conjunction with Ryerson University in Toronto, demonstrated depth of penetration with laser diodes to extend over 20 cm. This is further supported by researchers in Sweden where penetration of 22 cm was found to be the established norm utilizing suitable laser diodes.

No concrete evidence has been presented at any time that the company publishing this incorrect data has a laser that penetrates to this level. Readers should always beware of statements that are not supported by some form of scientific evidence. Furthermore activities of this type, not only detract from the historic lack of veracity prevalent in the industry, but potentially harm companies that operate under legitimate guidelines. At Meditech, we choose to counter inappropriate advertising by publishing the truth based on science, as part of our educational process.

Wound Healing

Revised: April 6, 2009 @ 5:45pm

Oxygen & the Hyperbaric Chamber

In the past, I have always attempted to combine Laser Therapy in wound healing with the Hyperbaric Chamber when available, which is not as often as would be ideal. Along with Laser Therapy, patients under optimal conditions are subjected to a series of Hyperbaric Chamber treatments which expedite the healing of wounds. In addition, the therapy is frequently utilized with great benefit, not only for diabetic-related ulcers but in the promotion of post-surgical healing and situations of major trauma, including concussions. Positive results are frequently immediate. Whereas wide application is currently not feasible for economic reasons, the role of this therapy should definitely be expanded. Raising the awareness of healthcare professionals and the public in general will be necessary to achieve this objective.

Oxygen is a vital ingredient necessary to sustain life. When tissue oxygen perfusion is diminished, as occurs in the depletion of oxygen in the environment, respiratory dysfunction, congestive failure or a plethora of other causes, an oxygen deficiency develops and as a result, the body becomes vulnerable to disease. Many bacteria, viruses and other pathogens seek out this type of environment as they thrive best under these conditions (oxygen deprivation of tissues).

The father of pathology, Dr. Rudolf Virchow, was once quoted as stating, “that if you deprive a cell of 35% of its required level of oxygen for over 48 hours, the cell is likely to become victim of a pathological process or become non-viable”.

The Hyperbaric Chamber exposes the body to pure oxygen. These systems have been in existence in some form or other for over sixty years. Only recently, however, has medical science recognized the importance of their utilization in healthcare. Whereas much research is still required, it has become evident that the Hyperbaric Chamber delivering 100% oxygen at up to 2.8 times atmospheric pressure, restores high-level oxygen perfusion of tissue, to levels of 2,000% saturation. This treatment is indicated for many disease processes, such as anaerobic infections, wound healing, respiratory and neurological diseases and can play a vital role in restoring tissue health.

At Meditech, where we have a particular interest in wound healing, we have always been of the opinion that combining Laser Therapy with the Hyperbaric Chamber would enable us to heal all wounds, in a relatively short period of time. Currently, we are in negotiations to initiate the establishment of a clinic combining these treatments in order to make this a reality and undoubtedly establish the “gold standard” for the management of wounds worldwide.

A Critical Review of the Pharmaceutical Culture

– with reference to the treatment of gout

Today, medications are available for the treatment of most illnesses. Patients are generally made aware of the potential complications and side effects of these drugs. The problems that frequently occur are complicated by the unknown factors, particularly with long-term multi-drug therapies.

No one can dispute the necessity of insulin for the control of diabetes or thyroxin for the treatment of hypothyroidism. At the same time, many conditions can be treated or even prevented, utilizing certain long-term measures or less dangerous therapeutic approaches. Aside from a balanced diet, the utilization of vitamins and supplements and the minimum of one-half hour of vigorous daily exercise, there are therapies available for the treatment of medical problems that can control or cure the pathological process involved, without risk.

This article focuses on a patient who was on a pharmaceutical regimen for the treatment of gout for a period extending over three years. The results were a number of undesirable consequences. The management of this patient clearly illustrates the need for re-evaluation of current medical practice. The drugs utilized were a combination of Allopurinol and Colchicine.

At Meditech over the past several years, we have demonstrated that Low Intensity Laser Therapy can completely resolve the symptoms and physical findings associated with gout. This usually occurs after two to four treatments over consecutive days. Patients may be inconvenienced with regard to travel and time, however this approach obviates all the dangers and complications involved with drug therapies.

Diagnosis

Gout has such a distinct clinical signature that it can generally be diagnosed by history and physical examination alone. Elevated serum urate (7 mg/dL) supports the diagnosis, but is not specific. It should be noted that 30% of patients have a normal serum urate level at the time of their first attack. The diagnosis of gout can be confirmed by histopathological analysis of the aspirated joint fluid, which will clearly demonstrate intracellular monosodium urate crystals. In addition, hypertension and renal insufficiency are typically present.4

Treatment

The initial treatment administered is generally directed to relieve the pain. This comprises the use of analgesics, NSAIDs, ice, etc. Drug therapy programs may include Allopurinol (xanthine oxidase inhibitor), Colchicine (microtubule polymerization inhibitor), corticosteroids, hormones or Probeniset (uricosuric). The intended effect is to lower uric acid levels and reduce inflammation in the joints.

Allopurinol is often prescribed to prevent recurrence, reduce the incidence of renal calculi and manage uric acid levels. Administration for an extended period of time may be required before the full effect of the drug is noted. Patients may also be advised to continue taking this medication even if they are asymptomatic. During the first few months, Allopurinol may cause an increase in attacks of gout, secondary to the inflammatory response. Colchicine is therefore often co-prescribed to minimize inflammation.

The potential side effects related to the administration of Allopurinol can be mild to serious.2 Skin rashes are common and may be evidence of an allergic reaction. Allopurinol may also cause irritation of the gastro-intestinal tract and produce drowsiness. A series of additional side effects have been reported, including hypersensitivity reactions manifested as hepatitis with symptoms of eosinophilia, dermal lesions, aplastic anemia and vasculitis. Some studies report that hypersensitivity leading to morbidity may be inordinately high in cases with prior liver or renal functional impairment. Gastrointestinal bleeding has also been reported. Discontinuation of Allopurinol is usually recommended to avoid progression of these complications.

Allopurinol is considered to be the drug of choice in treating and preventing gouty arthritis and instances of uric acid accumulation.6 Whereas this drug is generally deemed to be safe, hypersensitivity exists, primarily in patients with chronic renal insufficiency.2 In these cases, a significant increase in mortality rates has been observed. The mechanisms leading to complications are still under investigation, however there is evidence suggesting that complications may be due to bacterial infection or viral reactivation, such as cytomegalovirus or human herpes virus-6.7, 8 A chronic history of renal insufficiency often characterizes a state of immunodeficiency, manifested particularly by impaired T-cell mediated responses with lower than normal levels of CD4+ and CD8+ lymphocytes.

Colchicine is often prescribed in conjunction with Allopurinol as a potent anti-inflammatory. This approach usually limits attacks of gout9 which tend to increase for the first few months of Allopurinol administration. Biologically, Colchicine is a mitotic inhibitor, which affects tissues with high rates of cellular division and is lethal to cellular replication in general. Clinically, some therapeutic value can be derived from this drug as a chemotherapy agent and indeed, it may have a role to play in this area. In high doses, it can cause gastrointestinal and renal problems and may even cause paralysis. Colchicine also acts as an immunosuppressant and therefore relieves the pain and discomfort associated with attacks of acute gout. The drug is generally administered to individuals who may be at risk of developing gout and in patients with pre-existing chronic inflammatory conditions such as rheumatoid arthritis. Potential risk factors associated with Colchicine vary from mild to extreme and may elevate morbidity and mortality rates significantly.

The case histories outlined below, demonstrate the potential hazardous complications of a drug therapy programme:

1. A Gutiérrez-Macías et al. reported the case of an 80-year-old male with a history of chronic renal insufficiency, who was given 300 mg Allopurinol per day to control uric acid levels. At initiation of the drug programme the patient was asymptomatic. After six weeks of treatment, he developed loss of muscle strength, anorexia, fever, diarrhoea, jaundice, abdominal pain and dermal lesions, in addition to severe eosinophilia. Essentially, his immune system ceased to function. Immune suppressants (Prednisone) were insufficient to reverse the effects and due to deterioration of liver function, hepatic encephalopathy ensued and the patient expired.1

2. M. Arakawa et al. describe a 43-year-old man with a history of chronic renal insufficiency who was given an open-ended prescription of Allopurinol (100 mg qd). After the first month of therapy, he began to experience symptoms (malaise, elevated body temperature) and was admitted to hospital. Two weeks later, he had a high fever with skin rashes (erythema multiforme) and a drug reaction was suspected. The administration of Allopurinol ceased immediately but his status continued to deteriorate, resulting in renal failure and virtual destruction of the integumentary system. Extensive blood testing revealed the presence of Cytomegalovirus. Despite blood transfusions and resuscitory efforts the patient died.5

It is important to stress that although these cases were are not common, the rate of deterioration was rapid. Individuals with chronic renal or liver insufficiency appear to be most vulnerable to Allopurinol hypersensitivity reactions although the mechanisms responsible for these adverse events remain unclear.

Case Report – Meditech Clinic

A 66-year-old Caucasian male presented for treatment of a pre-gangrenous right lower extremity on September 10, 2008. He had been on daily insulin for several years; he was also taking Allopurinol and Colchicine daily over the past 3 years, for the prevention of gout. While on these medications, he had not had any acute attacks of gout. Over this period of time however, the patient developed renal failure in addition to progressive peripheral arterial occlusive disease involving all extremities in varying degrees. This was accompanied by generalized deterioration both physically and psychologically. At the time of his initial examination, there were several ulcers on the right foot and amputation of the right lower extremity had been suggested. The hands and the left foot were only moderately affected.

Following one treatment with Low Intensity Laser Therapy, symptoms diminished and physical findings improved dramatically. Needless to say, all medications except insulin were stopped. His physical status continues to improve with regular treatment (Bioflex Professional system) at a clinic located close to his home (two hours drive to Meditech).

Discussion
• It is important to categorize this situation with regard to healthcare in general and to initiate changes to alter the management of these types of clinical conditions.
• Medical supervision in this instance was clearly inadequate and the pharmacist who kept filling repeat prescriptions on demand should come under scrutiny.
• Whereas the clinicians at Meditech have not conducted tests with regard to the toxicities of the drugs in question, it has become increasingly clear to us over the years that all pharmaceuticals have side effects which may be highly undesirable.

Conclusions
• The therapeutic approach to gout requires re-evaluation.
• The initial treatment of gout should be directed to the relief of pain.
• This may include analgesics initially, however the long-term strategy should include preventative measures which treat the pathology, rather than modulating symptoms.
• A combination of pharmaceuticals may be effective on a short-term basis; the risks associated with this approach, however, must be carefully considered.
• Hyperuricemia levels may be controlled with medications initially, however the course of treatment should be monitored frequently and medications should not be considered a satisfactory long-term solution.
• Preventative measures including diet, control of diabetes, hypertension and obesity should be stressed as preventative measures.
• Low Intensity Laser Therapy in the treatment of gout is safe, effective and devoid of any complications3 and should therefore be the treatment of choice.
• Sustained good health implies the use of the minimum number of pharmaceuticals essential to the maintenance of good health.

References
1. Gutiérrez-Macías, A et al (2005) Fatal allopurinol hypersensitivity syndrome after treatment of asymptomatic hyperuricaemia
2. Singer JZ et al (1986) The allopurinol hypersensitivity syndrome: unnecessary morbidity and mortality. Arthritis Rheum
3. Soriano F et al (2006) Photobiomodulation of pain and inflammation in microcrystalline arthropathies: experimental and clinical results, Photomedicine and Laser Surgery 24(2):140-50.
4. http://www.emedicine.com/med/topic924.htm
5. Arakawa M et al (2001) Allopurinol hypersensitivity syndrome associated with systemic cytomegalovirus infection and systemic bacteremia, Internal Medicine 40(4):331-5.
6. A Kumar (1996) Allopurinol, erythema multiforme, and renal insufficiency, BMJ 312:173-174.
7. Koike M et al (2008) Viruses may trigger allopurinol hypersensitivity syndrome, NDT Plus 1(4):273-274.
8. Masaki T et al (2003) Human Herpes Virus 6 Encephalitis in Allopurinol-induced Hypersensitivity Syndrome
9. Morris I (2003) Colchicine in acute gout, BMJ 327:1275-1276.