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.

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.

March 21, 2009

Laser Therapy has been found to be highly effective in the treatment of Dupuytren’s Contracture. Fascial thickening of the palms and the fibrous bands extending to the digits have been markedly reduced in thickness and extent following a series of treatments utilizing Laser Therapy. Moreover, they have resulted in diminished pain, improved mobility and more normal configuration of the soft tissues involved.

In order to treat this pathology effectively, appropriately designed equipment must be utilized. The earlier the condition is treated (small nodules and minimal fibrous bands), the more effective the therapy will prove to be. Advanced situations do not preclude the application of Laser Therapy, however the course of treatment may be prolonged.

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.

Almost daily, we see some dramatic results from the application of Laser Therapy.

This photograph depicts the foot of a 66-year old diabetic and indicates what can be achieved:

The right forefoot on presentation was cool to the touch, the toes were immobile, cyanotic and no peripheral arterial pulses were present.

The photographs of 9/10/2008 are indicative of his initial status.

Prior to his second treatment on 9/12/2008, the photographs were repeated and significant change had occurred. On the occasion of his second visit, the toes were mobile, the edema and cyanosis had largely disappeared and the patient was relatively pain-free. The foot was no longer in jeopardy.

This case clearly demonstrates the healing potential of Low Intensity Laser Therapy.

Recently, I received an unsolicited communication critiquing the contents of Meditech’s three volumes on Laser Therapy published June 1st, 2008. Without question, there are always differences of opinion with regard to any printed material and these texts are no exception. The process may even be beneficial provided that the reviewer is completely conversant with the nature of the subject matter.

The critic in this instance happened to be a physiotherapist, who has been established in practice for thirty years and pointed out that he was extremely proud of his profession and his accomplishments. At the same time, it was apparent that his knowledge of the contents of this material was limited and based on established concepts, which are invariably behind the times.

We are all aware of the axiom, that once a text is published it immediately proceeds to obsolescence. Moreover, original work, where the focus of research must be placed, is generally not published or accepted by the academic community, for many years after the work has been completed.

The reviewer expressed his enthusiasm with regard to other texts he had read in the past, with all of which I am quite familiar. The publications to which referred had compiled a significant database and established a useful library of the current consensus. At the same time, the authors had limited experience in the clinical application of laser therapy and their efforts were largely restricted to the definition of terminologies and established concepts in this field. Whereas this is commendable, it does not advance the frontiers of the technology, nor is it cognizant of the fact that change is occurring at an accelerated pace.

Our publications, in essence, record the evolution and observations of almost twenty years of original work, including the development of the BioFlex series of systems and their highly successful application in the treatment of many thousands of diverse and challenging medical conditions. The results achieved are based on the combination of appropriate synergies, including basic research, innovative engineering and extensive medical knowledge. Only through this process can optimal objectives be obtained.

It is encouraging to note that many of foremost physiotherapists in North America and around the world have integrated Low Intensity Laser Therapy successfully in the scope of their practice. Traditionally, physiotherapists have relied almost exclusively on manual techniques and a variety of established modalities such as ultrasound, interferential current etc., which may preclude researching other potentially more effective solutions. Moreover, as in the health care sector in general, the focus appears to be primarily on the modulation of symptoms, rather than curing the pathology. At a time when medicine is moving into the molecular/cellular age of healing, I believe that the utilization of more productive therapies requires emphasis.

Almost twenty years ago, when I began to explore the Laser Therapy field, educational opportunities were limited. The research available was often documented in foreign languages which were difficult to translate. In the course of my self-education, I consulted many basic researchers, manufacturers and a variety of therapists involved in this relatively novel field of endeavour, all of whom were acknowledged to be the leaders in their particular area of expertise. Upon completion of this process, I arrived at the conclusion that more original and independent thought and work were necessary. While deriving significant benefit from the knowledge of these pioneers, I recognized that departures from the prevailing concepts were indicated and even more important, today I realize that this process needs to be intensified as we move forward.

At Meditech’s certification seminars I always state to those attending, “Over the next three days you will be exposed to the history and current understanding of this technology, however our educational programmes are directed to enable you to become a proficient student of this science; hopefully, your views will be flexible and open to change, while the frontiers of the science continue to advance.”

At our clinics, at least several times daily, patients will inquire, “Why does my healthcare professional/physician not know about this therapy? Prior to attending here, I have been following many courses of treatment recommended and my condition has continued to deteriorate; yet, after less than three weeks of treatment at your clinic, I no longer require analgesics and am able to carry on with most normal activities.”

This question is easy to answer. Medical care today is more focused on delivery systems and control of the mode of treatment, rather than what may be most effective. These sentiments should be a clear indicator that all professions must re-examine their teachings, their knowledge and preconceived concepts – frequently, otherwise, they will fail to adopt more effective therapeutic approaches which may benefit the patient.

I think it can be generally conceded that nature is the greatest healer of all. The body’s own homeostatic mechanisms control many functions, leading to natural healing; a healthy immune system is a significant part of that mechanism.

– then there is the placebo effect. If a patient can be psychologically induced to believe that something is proceeding that assists in the healing process, whether it is a pleasant sound, the flashing of bright lights or other external influences, a number of patients will obtain temporary relief which may even become permanent. Patients will improve for a few days or even weeks, allowing the body’s natural healing processes to continue to move forward. From this it can be safely assumed that a large percentage of all patients, no matter what the injury or the disease, will heal spontaneously without any therapy provided – including the placebo effect.

A number of pathologists in their studies have indicated that with all malignancies a spontaneous remission rate of somewhere between 2-5% is reported, again without any treatment whatsoever. Just imagine, cancer cured by the body’s own natural, protective mechanisms. It should also be understood that once chemotherapy or radiation is initiated, the immune system breaks down and is largely destroyed and in many cases this may be more detrimental than the disease itself.

In our society, pharmaceuticals unduly influence all therapeutic approaches. It has been documented by accredited scientific researchers that approximately 80% of all prescriptions written, do more harm than good, not to mention the deleterious unknown effects of the interaction between many medications. Whereas I cannot attest to the accuracy of this comment personally, I always tell patients that the fewer medications they are taking, the better the chance of maintaining good health and obtaining a speedy recovery from illness.

With due respect to the pharmaceutical industry, diabetics cannot survive without insulin, patients suffering from hypothyroidism require thyroxin in order to function normally and many medications are not only useful but essential.

In situations of acute pain, I condone the use of analgesics in sufficient doses until the acute phase has passed. Similarly, I recommend the use of antibiotics, again in adequate doses, if the offending organism can be identified and eradicated using this approach. This does not mean that when a patient has an upper respiratory infection caused by a virus, that this rule should be followed. Indeed, in these instances the use of antibiotics is contraindicated.

Cortisone, probably one of the best medications ever developed, has tremendous value in cases of acute trauma, deficiency states such as Addison’s disease and in the treatment of anaphylactic reactions. Its prolonged use is also justified in a number of chronic systemic illnesses. One must also recognize that after several weeks of use, continued ingestion of this drug can be counterproductive. It is important to understand that many medications are best avoided, particularly if one realizes that NSAIDs are the eighth largest cause of death in patients in the USA, a fact that speaks for itself.

The potential problems associated with the extensive use of the “statin” family of drugs as the best protection against coronary artery disease, almost universally prescribed to reverse atherosclerosis should give pause for reflection. The long-range adverse effects of these medications remain in question, despite the research presented to the medical profession by the pharmaceutical industry. Not only should the long-term effects be studied more thoroughly but also the potential adverse effects on the hepatic, renal and other organ systems.

The healthcare dollars diverted to the pharmaceutical therapy approach should definitely be re-evaluated in light of the hardcore negative evidence emerging from an increasing number of sources. We all need to be aware of the political factors, lobbying and the pursuit of material gain in our society and their role in this scenario. Disturbingly, a disproportionate degree of influence of this type of activity has crept into medical education, in the pharmaceutical industry’s quest for profit. No one to date has attempted to counter this trend.

The inhalation of a variety of medicines, particularly those prescribed by respirologists, should also be monitored and reassessed. It is my observation that these are being utilized too frequently, again with significant adverse effects. This puts the net benefit to patients under the microscope.

As previously stated, a healthy lifestyle, which can be considered preventative medicine is the best approach to the avoidance of health problems. This incorporates a balanced diet, thirty minutes of vigorous daily exercise in addition to the ingestion of certain minerals, vitamins and supplements on a regular basis, together with the complete avoidance of tobacco and alcohol ingestion in moderation. These tenets form the cornerstone for good health and longevity. Moreover, these measures instituted early in life and continued religiously represent a positive expenditure of energy, much like putting a few dollars into a bank account from the moment you earn remuneration in order to ensure your future economic health.

Diseases, nevertheless, will continue to occur whether conferred by genes, environmental influences and other factors not yet recognized. In many of these situations, Low Intensity Laser Therapy is rapidly establishing its value as the preferred therapeutic approach. Wide dissemination of these facts must be encouraged. All schools involved in the education of healthcare professionals should take note and researchers should increase the scope of their scientific studies. At the same time, clinicians must pursue a more aggressive course integrating this technology into their practice in an effort to help millions of patients immediately in a safe, effective manner and at a low cost.

These systems are unique and represent the ultimate in design, therapeutic effectiveness and engineering ingenuity. Most importantly, their healing capability is unparalleled. The products are derivatives of the world-renowned BioFlex Low Intensity Laser Therapy Professional System and are superior in efficacy to the majority of professional systems offered in the marketplace today.

Numerous features are integrated in these devices. They are completely portable and can therefore be used in transit, on the playing field and in the comfort of your own home. Significantly, they can be used frequently and for more prolonged treatment sessions and utilized on this basis, can approach the healing power of the BioFlex Professional System. Recommended use is one to two times per day for any acute area of pathology; other conditions can be treated sequentially.

Once economics, the time perspective and travel are taken into account, their value is readily apparent. Whereas they are not designed to replace the Professional Systems, in many situations their usefulness is clearly evident, i.e:

• in situations where access to professional care is unavailable
• when treatment with a professional system has been completed and continuing therapy will enhance the treatment outcome
• to ensure a long-range positive result
• for patients traveling long distances to attend a clinic (once symptoms have substantially diminished and where ongoing treatment is desirable to achieve a more advanced level of permanent healing) 
• in instances where continuation of therapy stimulates further progress and prevents regression of the pathology (cartilaginous regeneration of joint surfaces, etc.)
• maintenance of results achieved
• preventative care on a regular basis (i.e. baseball pitchers, golfers, dancers, gymnasts, etc.)

It should be readily apparent that the usefulness of these systems is unlimited. Athletes, arthritis sufferers, patients with chronic back problems, psoriasis and other dermatological problems, once they acquire a system, find that treatment becomes a prerequisite to improved functional levels and often purchase additional systems for other members of their family.

Ideally and particularly with advanced pathologies, such as stenosis of the spine, severe degenerative osteoarthritis, the Professional System’s three-step treatment is optimal. At the same time, in the many instances described, the Home Units I & II, used in a judicious and timely fashion, achieve a more than satisfactory standard of pain-free function.

For optimal effect, the following criteria should be observed:

• whenever possible, the correct diagnoses should be established by a healthcare professional
• frequency of treatment and protocol selections are prescribed in the Clinical User’s Manual, which provides an easy-to-use point of reference
• if progress is slow or plateaus, customization of protocols invariably provides a solution.

The Home Unit I, which utilizes the large surface infrared array, is the “workhorse” of the system. The Home Unit II is similar in design and content, except that it also includes a large surface red array. The latter will heighten the degree of effectiveness in the treatment of superficial lesions and dermatological conditions, either in combination with the infrared array or in stand-alone configuration. In certain deep-seated lesions, combined with the infrared array, it will also enhance cellular regeneration and the healing process.

Generally, the Home Unit I will be adequate for most pathologies, however as indicated, the addition of the red array adds another dimension and as such is an additional positive factor in the therapeutic equation. The Home Unit I, in most situations, is adequate and additional treatment arrays can always be added at a subsequent date.

After reviewing these guidelines, should you still require answers to certain questions, you may contact your personal therapist or a member of the clinical staff at Meditech International. Suffice it to say, the Home Systems provide the optimal home care currently available on a global basis and should be highly effective in the treatment of the medical conditions listed in the manual.

The majority of patients undergoing Low Intensity Laser Therapy for a variety of medical conditions respond rapidly. After one to six treatments, a positive response occurs with significant reduction of pain in over 60% of all patients. On the other hand, a number of patients demonstrate a slower response. Problem patients requiring more than 10 treatments to obtain positive change are less than 10%. At the same time, both patients and therapists can become frustrated and in essence an impasse may occur. This is best dealt with in the following manner:

1. Periodic re-examination to determine the correct diagnosis
2. Further tests to establish additional pathologies that may be responsible for symptoms
3. Consultation with a specialist to obtain another opinion

Most important, however is an ongoing dialogue with the patient to help them understand that the condition which may have been developing over decades, cannot necessarily be resolved in a matter of days, or even weeks in certain situations.

Almost invariably this approach is effective.

Just in the past two weeks, I have seen two patients who fall into the “difficult” category. One was a portly gentleman of 75 years with extensive degenerative osteoarthritis/stenosis of the lumbar spine. On the cerebral level, no improvement had been noted. Although I assured him that the cells were benefiting from the therapy, he was not convinced.

After his twelfth visit, he came in quite excited about his situation; following the last visit he had experienced three days without any pain and had actually resumed many normal activities. He was truly “beaming” and felt that he had achieved a major breakthrough. Moreover, he has continued to improve rapidly.

Another patient, somewhat younger and more active, but with many problems including degenerative osteoarthritis of the spine, a stubborn plantar fascitis (biomechanical factor) and two knees suffering from degenerative osteoarthritis, returned one month after completing treatment. I asked him how he was doing and his response was, “fine.” I inquired whether he needed additional treatment and he stated, “no.” The purpose of his visit was to thank me for the efforts of the staff and he took it upon himself to make a personal visit to express his appreciation.

Practicing medicine is never easy but does have its rewards. The problems with these two patients emphasize the axiom that you must persist and follow an intelligent course of therapy as the situation demands. I have also written the following notes which may help both therapists and patients to understand procedure.

Patient Directives

Patients are frequently concerned about the number of treatments required to improve or cure their medical condition.  The number can vary from 1-30 or more and is often dependent on the severity of the disease and its duration.  The average number of treatments for all problems treated is 9.5.

30% of all individuals notice a significant improvement after 1-4 treatment sessions.  For others, 10 or more treatments may be required in order to reduce symptoms and the need for analgesics.

The reasons for this are numerous: i.e.

• the genetic makeup of individual cells
• the extent of the pathology involved 
• the chronicity of the disease process 
• activity factors
• other factors still undefined   

What is required at all times is patience on the part of both the therapist and the patient undergoing treatment. Our objective is to cure your problem in as few treatments as possible.

All parties need to cooperate in order to attain our common objectives:  i.e.

• a return to normal activities
• an existence that obviates the need for medication 
• the elimination of pain

We are dedicated to this process and ask for your compliance with the recommended treatment program.

Over the weekend, I had the opportunity to review Jan Tunér's article entitled, "Is the Blue Cross Meta analysis Reliable?" This again, is an excellent review of the many aspects of Low Intensity Laser Therapy.

Most importantly, it points out the lack of standardization in applying Laser Therapy to various tissues, therefore it is impossible to draw conclusions from many studies.

The article delineates that many lesions vary from the norm and classification of the lesion is critical, in order to characterize any study. Moreover, it points out the importance of wavelength, dosage, duration and other parameters utilized in any treatment. Unless such factors are standardized, the study cannot be deemed reliable and no conclusions with regard to the effectiveness of Laser Therapy can be derived from it. It is important for all Laser Therapists to recognize these differentiations.

Another study commenting on the efficacy of Laser Therapy for musculoskeletal and skin disorders by Beckerman, et al., at the Department of Rehabilitation Medicine, Free University Hospital, Amsterdam, indicates that in a criteria based Meta analysis involving over 1,700 patients, studies with a positive outcome were generally of a better quality than studies with a negative outcome. Further comment  discusses the methodological quality of the 36 randomized clinical trials comprising the 1,700 patients included study and indicates that many studies were considered of low quality. Moreover, it found specifically that for rheumatoid arthritis, joint trauma and myofascial pain, laser had a substantial positive therapeutic effect.

The above certainly confirms my opinion that if laser is applied in relatively random fashion, without due attention to wavelength, waveform, frequency, duty cycle, energy density, etc. the information obtained may not be useful. When attention is paid to detail, conclusions have a higher degree of validity.