Learn & Go With Dr. Laurie
How to prevent Another Cranial Cruciate Ligament (CCL) Tear
Second CCL tears are unfortunately a huge problem for dogs that have already had one. In this Learn & Go, I show you how to spot issues and more importantly, what can be done to prevent second tears and surgeries.
Time to talk about Rio again. If you missed the last Learn & Go, Rio is a 10 year old Border Collie who was doing Agility and Flyball his whole life until he tore his right cranial cruciate ligament (CCL). He had surgery five months before I saw him, but hasn’t been the same since.
Rio had a typical post-cruciate “sit.” That is to say, the injured side was externally rotated, pushed forward, and there was a significant reduction in knee and hock flexion. All dogs, even Border Collies who have some external rotation in their hind limbs, should sit with their hind limbs well bent at the hock and stifle with the limbs tucked under them. Rio clearly held the affected limb abnormally.
We knew Rio was at risk of tearing his good CCL because he was overusing his good leg while he was off weighting his surgery leg. This is common after a CCL tear because the other limb ends up holding most of the weight when standing, walking, and rising from a sit or down position.
In Rio, there were already changes in his good knee that were warning signs. He had effusion, an indication of inflammation, which is the first sign of trouble. It can be reduced with supplements, possibly medications, and specific treatments, including ice, laser and Pulsed Electromagnetic Field (PEMF) therapy. But, the most important steps are to reduce the excess weight bearing on this limb and to strengthen the structures around this joint.
During his assessment, I found other complications, including back pain, elbow tenderness, and inability to stretch the biceps brachii muscle on both sides. His biceps can get excessively tight while he pulls his weight forward and over uses his front legs. As he continues to overuse his front end, we may see continued or additional areas of damage. If this happens, he will likely become less active overall as his compensations are now part of the problem. He can develop generalized atrophy and discomfort.
We were able to make him more comfortable immediately. I gave him exercises to do at home to strengthen the muscles that support the knees, hocks and elbows. We also worked on improving his range of motion at the tarsus so he can use his surgery leg appropriately, bending it underneath him, allowing for him to lift from a sit using that leg. All of these exercises will ultimately balance all 4 limbs bringing him back to a level of strength he had before the surgery.
Watch the video below all the way to the end. The last slide has great pictures of him after treatment, definitely worth watching for.
Consider Cavaletti Jacks for Great At-Home Strengthening and practice
Cavaletti Jacks are lightweight, durable, portable cavalettis designed for the Rehab Therapist or Pet Parent working on proprioception, strength, balance, weight bearing, flexion, and so much more. Quickly adjustable from 2” up to 11” with color coding for exercising fun.
Made to order in the USA.
Order today and get your own amazing dog gym pieces!
We have found shipping costs to locations outside the US, the West Coast and HI to be inaccurate/higher, please contact us for the most accurate price to ship.
Diagnosing and Treating A Dog’s Tarsal INjury
Rio, a 10-year-old Border Collie, came to me with some lameness. What was at the root of his issues? I’ll explain how I spotted it and how I treated him.
Let me introduce you to Rio, a 10-year-old Border Collie who went from being active and highly competitive in agility and flyball to slowing down considerable.
Rio’s dad drove 6 hours to see me; I had to find and fix his problems.What I found was not what we expected.
It's common to lose flexion of the hock on the same side as a cruciate rupture, but in Rio’s case, his other hock was a mess. Being that this was his good leg and most of his weight was shifted on to it, we needed to find a way to make it better.
I'm not going into his primary issue in this video (that will be the next Learn & Go). Today I'm showing you how easy it can be to miss something big, how to spot it and treat it.
In Rio’s case, effusion (abnormal collection of fluid) of the hock was visible, but this is not always the case. Take a look at the X-rays in the video to understand what you can look for.
Laser for Inflammation
Laser is always a great go-to when faced with inflammation. In Rio’s case, I was able to decrease the size of his hock by ~30%. There wasn’t complete success, however, because of bony or hard fibrous tissue changes.
Adding in Traction and A Mulligan Technique
Range of motion and discomfort were still an issue until we used traction and a Mulligan Technique. See 2:15 in the video to learn more about traction and 2:55 to understand the Mulligan Technique.
Strengthening After Treatment
Once pain is gone and the range of motion is back to normal, we need to strengthen the muscles, tendons and ligaments to prevent further injury.
Cavaletti Jacks are the perfect piece of equipment for strengthening the hock because you can set the height and distance for maximum hock flexion.
Incline sitting in another exercise that helps hock flexion and unilateral side strengthening. If you watch the video, you’ll see me demonstrate with my dog, Ollie, using our OctoBoard on four different levels so you can see how gravity affects his body.
Supplements for Musculoskeletal Support
Canine Musculoskeletal Support from Standard Process and good collagen will provide the support dogs need to heal even better and stay healthier for longer.
Order your own set of Cavaletti Jacks
Cavaletti Jacks are lightweight, durable, portable cavalettis designed for the Rehab Therapist or Pet Parent working on proprioception, strength, balance, weight bearing, flexion, and so much more. Quickly adjustable from 2” up to 11” with color coding for exercising fun.
Made to order in the USA.
Order today and get your own amazing dog gym pieces!
We have found shipping costs to locations outside the US, the West Coast and HI to be inaccurate/higher, please contact us for the most accurate price to ship.
The most common laser mistakes – #1
In this series I’m covering The 5 Most Common Laser Therapy Mistakes. If you’re not getting amazing results with your laser you should listen
The number one mistake I see most often is…aiming.
It’s not too surprising given that most manufacturers instruct users to place the laser perpendicular to the skin, which is absolutely true if you’re not in contact with tissue. BUT, once you have contact with tissue, aiming makes all the difference.
Did you know if you shine most lasers on a special surface (see below) you can see the beam that comes out of them?
Why aiming matters
Once the laser energy enters the tissue, there is refraction or scatter, meaning that the surface size of the treatment area expands, yet the tissue directly under the laser gets significantly more energy than the tissue around it. If you are treating a specific area, such as an OCD lesion or the cranial cruciate ligament, changing the probe’s position and the aim will significantly change how much energy gets to the target tissue.
Treating the cruciate ligaments
You can target the laser energy to have a direct effect on the cranial cruciate ligament. One way is to treat from the back of the stifle, through the popliteal fossa, aiming your beam and fanning the line of the CCL.
Treating the menisci
Feel the joint line and aim your light energy along this line to treat directly into the menisci on the cranial, caudal, and at least medial surfaces. Most meniscal tears are in the medial meniscus. If there is a lateral tear, or if you are not sure if there is a tear, treat the lateral surface as well. By aiming directly on the joint line, parallel to the meniscus line, significantly more energy will be absorbed by the menisci than if there is an angle to the probe and the energy has to pass through bone.
Are you feeling like there is more to using a laser machine than turning it on and pointing at the tissue you want to treat?
There absolutely is!! We want to help you have optimal outcomes with all of your patients, and that comes with a better understanding of what is going on in the tissue and how the laser can affect it. Improving your outcomes leads to happier clients and believe it or not, improved job satisfaction. We have had hundreds of veterinarians take the Optimum Laser Therapy course and rave about how much it has helped them and their patients.
What Others have Said
“Now our team feels very confident, and they are seeing results from the treatments. Thank you Dr. McCauley for offering this course, it has made a huge difference in our use and success of laser therapy.” — Angel Mitchell, DVM, CVA
Learn more & Sign up
The most common laser mistakes – #2
In this series I’m covering The 5 Most Common Laser Therapy Mistakes. If you’re not getting amazing results with your laser you should listen
Have you ever watched someone pick up a laser they weren’t used to using expecting the same results from their normal go to? Maybe that’s been you.
Different lasers have widely different treatment (dosing) parameters depending on the variables of the laser. Using the wrong dosing unintentionally means your patient isn’t being treated properly. They could get no effect from the treatment, they could fell discomfort or in worst case scenarios, the laser can hurt the patient.
Let’s get into the variables.
The SECOND mistake I see most often is not knowing the variables of the laser.
Hopefully after watching the video your interest is piqued, and you will investigate your laser.
The power of LEDs
LEDs in the 600nm range can be used to heal corneal ulcers, wounds and burns; they can a be great for treating acupuncture points, anxiety and depression, and strokes. They may not, however, perform as well in treating arthritis, according to current research.
High Wavelengths
980 nm wavelength lasers have been shown to have significant effects when treating dogs with degenerative myelopathy and elbow arthritis. In fact, research has shown that when using this wavelength,10-19 J/cm2 had optimum effects when treating elbow arthritis. If you were to use that dosage with some of the other wavelengths there would be deleterious effects.
Considering your patient’s skin color
Melanin has to be considered when treating in the 800nm wavelength range because it absorbs a significant amount of laser photons in the range, and the tissue will heat up more than we want if the appropriate amount of energy is delivered too quickly.
Power with Pulsing
When looking at power of the laser machine, any laser that has 904nm or 905nm will need significant Peak Power. You may see 36 W, 50W, 75W or even 100W of peak power.
That is because in order to deliver this wavelength without severely heating the tissue it, needs to be either chopped (i.e., on 50% of the time, then off 50% of the time), or super-pulsed (i.e., on for nanoseconds, then off for a proportionally longer time). We usually need the least amount of total energy to have a significant effect with this wavelength.
Are you feeling like there is more to using a laser machine than turning it on and pointing at the tissue you want to treat?
There absolutely is!! We want to help you have optimal outcomes with all of your patients, and that comes with a better understanding of what is going on in the tissue and how the laser can affect it. Improving your outcomes leads to happier clients and believe it or not, improved job satisfaction. We have had hundreds of veterinarians take the Optimum Laser Therapy course and rave about how much it has helped them and their patients.
What Others have Said
“Now our team feels very confident, and they are seeing results from the treatments. Thank you Dr. McCauley for offering this course, it has made a huge difference in our use and success of laser therapy.” — Angel Mitchell, DVM, CVA
Learn more & Sign up
The most common laser mistakes – #3
In this series I’m covering The 5 Most Common Laser Therapy Mistakes. If you’re not getting amazing results with your laser you should listen
It’s been said that expectations are the precursor to disappointment. Maybe that’s true with some things, but laser therapy is not one of them.
With laser therapy, expectations are extremely important. And not having them is the third top mistake I see professionals make. What are the other expectations we should be looking at; they are equally important? In this video, I walk through what to expect when targeting muscles, nerves, tendons, wounds and burns, discolored tissue, and urethras.
Not knowing what to expect is the 3rd top mistake that I see
Without an understanding of what to expect with a laser, you are likely not getting what you could. It’s similar to getting into a Ferrari with the belief that it drives just like any other car. Sure you can drive it that way, but you will be missing out on a lot of performance.
A clear understanding of what you’re treating and what you’re measuring is key with laser Therapy
If, for example, you are only looking at pain management as the parameter with your treatment, then you may not be watching at how quickly the wound you are treating is healing. You could also miss noticing that the effusion in the stifle is gone (remember it is chronic inflammation in the stifle that is the biggest predeterminer of a torn CCL).
High Doses vs. Low Doses of energy
With laser therapy, high doses of energy are used to treat pain because it decreases ATP production, which reduces nerve impulses and creates a form of an axonal nerve block. But that high dose of laser energy does not actually aid healing. It has been shown that high doses of laser energy have been shown to reduce fibroblast migration.
Lower doses of energy, on the other hand, may not have as big of an effect on pain, but it can accentuate healing because it helps to increase ATP in the targeted cells, which allows them to do what they need to do faster and more efficiently.
Knowing your goal to set your dosing
In short,
Pain calls for higher doses
Tissue healing calls for lower doses
Learn more about laser power and ATP production in this Learn & Go.
get the most from any laser
Learn essential concepts and application techniques needed to use any laser with maximum efficiency and efficacy in this learn-at-your-own-pace course.
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The most common laser mistakes – #4
In this series I’m covering The 5 Most Common Laser Therapy Mistakes. If you’re not getting amazing results with your laser you should listen
Every year more research comes out on when to use laser therapy, which parameters have superior effects. Changes in power, wavelength, frequency, and total dosage can make significant changes in outcomes.
In one study, athletes were treated with laser therapy in four different situations: before working out with placebo after, before and after working out, after working out with placebo before, and placebo both before and after working out. Researchers found that athletes increased their endurance when they were treated both before and after working out. Strength, on the other hand, was built the fastest when athletes were treated before exercise and had the placebo after.
With so much that can be done with lasers, let’s make sure you’re doing everything right. Ready for the fourth most common mistake I see in laser treatment?
The #4 the most common laser mistakes covers dosing.
Using the wrong dosE is the 4th top mistake that I see
Laser manufacturers provide a dosing guidelines for each of their lasers, and this is always where you should start. They get a lot of input on the best dose for different ailments, but you will know what is going on with your patient on the day of treatment better than anyone else, especially the laser manufacturer.
Laser Tip
The easiest way to know when you need to add more laser therapy treatments or when to stop treatment earlier than recommended, is when dealing with trigger points. If the trigger point dissipates when you are treating, then ceasing treatment is a good option.
Get used to feeling the tissue before and after a treatment so you can quickly differentiate a trigger point that needs more energy from one that is resolved.
get the most from any laser
Learn essential concepts and application techniques needed to use any laser with maximum efficiency and efficacy in this learn-at-your-own-pace course.
Learn more
The most common laser mistakes – #5
In this series I’m covering The 5 Most Common Laser Therapy Mistakes. If you’re not getting amazing results with your laser you should listen
I have spent over 20 years studying, researching and working towards perfecting laser therapy, and I want to share some very important points with you that will help you improve your laser outcomes today.
Today we’re starting with #5 of the most common laser mistakes.
One of the most common laser mistakes I see Vets make is Not using their laser!
You would be amazed at how many vets say, “yeah, I've got a laser and it's sitting over there in the corner.”
But let’s get into why this isn’t working for them.
Everybody knows about the contraindications – the reasons not to use a laser. But some vets don't realize what all the indications are. So let's talk about both.
Contraindications
Cancer
Cancer seems like a clear contraindication. Except laser therapy can be a great treatment for palliative reasons.
Injection Sites
When we inject something into the tissue, it can have a direct effect or it can be metabolized, and the metabolites can have an effect in the body. The effects of the injection have been studied, so we have an expected outcome, but if laser energy, with or without heat, may change that outcome.
The substance may be altered and/or the tissue around the substance may be altered. We know there are effects on circulation, usually vasodilation and changes in the permeability of the blood vessels. The cells in the treatment field can have changes in electrolyte transmission through the cell membrane, and we may even affect cell messenger complexes. We just don't know how laser therapy can affect the injected substance or how it is metabolized, so for now, it is best to consider this a contraindication until we know more.
Indications - These are just a sampling of those you may not have thought of
Dental issues
Surgery healing
Osteoarthritis
Stroke
Nerve Regeneration
Kidney Perfusion
Bronchitis
Chronic Cystitis
Degenerative myelopathy
Behavioral issues
Cellulitis
Perianal fistulas
Snake bits
Anal glands
and more!
get the most from any laser
Learn essential concepts and application techniques needed to use any laser with maximum efficiency and efficacy in this learn-at-your-own-pace course.
Learn more
How the shape of a laser’s lens changes the beam and affects the power
Did your laser come with flat lenses, convex lenses, or both? Did you know that depending on the surface of the laser lens, and the distance the lens is from the tissue you are treating, there can be a huge difference in the amount of energy you are putting into the tissue?
Did your laser come with flat lenses, convex lenses, or both? Did you know that depending on the surface of the laser lens, and the distance the lens is from the tissue you are treating, there can be a huge difference in the amount of energy you are putting into the tissue?
Flat vs. Convex Lenses and the impact on power
Light energy flows through a convex lens in a converging manner, meaning it becomes more and more intense as it reaches its focal point. This focal point is where all of the energy that comes out through the lens is concentrated into a pinpoint size space if there is just one diode and into the most focused pattern if there are multiple diodes.
Different lenses treat tissues differently. A convex lens will provide the most energy in one place, making it great for precise applications, like when treating an acupuncture point. While a flat lens with a more diffuse and weaker beam is better when treating skin where the goal is to have minimal penetration.
Why do we need to know this information?
The more we know, the better effects we can have each and every time we use our lasers. and better effects mean better patient care, better outcomes, and better job satisfaction.
Learn everything you need to know about lasers in our Optimum Laser Therapy Course
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Learn everything you need to know about lasers in our Optimum Laser Therapy Course 〰️
New Laser Study - Power, ATP & Oxidative Stress
Turns out that you need higher power when using a laser with a 980 nm wavelength to increase ATP production and decrease oxidative stress.
A recent study on different power levels and their effect on ATP production and oxidative stress had some surprising results.
We always want to increase ATP to help cells heal, or do whatever they need to do, better. Concurrently, we want to diminish oxidative stress, i.e., reactive oxygen species (ROS) or free radicals. The problem lies in the fact that when mitochondria make ATP, ROS are a byproduct.
In this study ATP production and ROS are measured when cells are treated with a laser with 980 nm wavelength with power levels of 0.1W to 1.1W in 0.1 increments. Watch the video below to see the results, you may be surprised!
MORE ON LASER
We have known for a long time the effects of therapeutic laser (photobiomodultion) on tissues. Laser treatment can reduce inflammation, improve blood flow, and reduce pain. We know that wavelengths from 400-1064nm can affect tissues. We know the overall mechanisms of how lasers work but in some cases we are still figuring out the specific details for each wavelength.
Mitochondria
As we know, mitochondria generate ATP, which is then used by the cell as a source of energy. Oxidative stress from ROS, which are generated during the metabolism of the mitochondria, is a by-product that cannot be avoided.
These ROS will uncouple the mitochondria, increasing the oxygen consumption. Overall, this makes the mitochondria work harder but not increase ATP production. A normal cell will have a balance of ROS and ATP production that will keep the ROS from further damaging the cell. However, a cell that has been affected by local trauma will become out of balance, the ROS production will go up and there will not be enough ATP to prevent further damage to the cell. By increasing the ATP production in a cell, balance, homeostasis, is returned to the cell.
The 980 nm wavelength is commonly used in several of the lasers we use in veterinary medicine. We know these lasers work, and as we can see from this study, we know we will need higher levels of power at our target tissue to have beneficial effects. With laser therapy we can definitely create those beneficial effects. By increasing the energy metabolism of the mitochondria, and therefore the ATP level, the oxidative stress is reduced and an unhealthy, out-of-balance cell can be moved back to health and homeostasis.
For the full article, see: Photobiomodulation and Oxidative Stress: 980nm Diode Laser Light Regulates Mitochondrial Activity and Reactive Oxygen Species Production
Take the Optimum Laser Therapy course
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Take the Optimum Laser Therapy course 〰️
Dog Brain Shapes and Why I Care
Dog Brain Shapes and Why I Care
A cool new MRI study looked at the actual shape of different dog breeds brains and how they fit inside the skull. This is interesting in and of itself, but it can also help us plan better when we use laser to treat the brain.
In this video, I’ll show you how to select which areas of the brain to target.
Using lasers to treat the brain
There are studies that show that in the 800 nm wavelength range and with 904/905 nm wavelengths, we can penetrate the skull and treat the brain. With this information and knowing where to treat, we can treat dogs for a variety of issues, including OCD-like behavior, anxiety and depression, aggression, syringohydromyelia, and stroke.
For the full article, see: Digital Endocasting in Comparative Canine Brain Morphology. Kálmán Czeibert1, Andrea Sommese, Örs Petneházy et al. Frontiers in Veterinary Science. published: 06 October 2020 doi: 10.3389/fvets.2020.565315