Page 178 - Veterinary Laser Therapy in Small Animal Practice

164 Veterinary Laser Therapy in Small Animal Practice

• LT has often been avoided as a precaution in patients
on photosensitizing medications. This is because, at
least in theory, those patients could overreact to
a certain amount of light (mainly ultraviolet) and
develop a rash or another type of skin reaction. The
list of potentially photosensitizing agents includes
antihistaminics, sulfonamides, some essential oils,
and tetracyclines, among others. Some herbal sup-
plements such as Hypericum perforatum have also
been described as potentially photosensitizing.
Photosensitivity has also been described in lupus and
secondary to severe liver disease. However, there is
no reported case of laser having adverse effects in
photosensitive patients, or in those on photosensi-
tive medication. Current advice is to create a list of
photosensitive medication and the peak wavelength
of radiation required to activate the drug. [425] It is
always advisable to wash off any topicals, such as
antiseptics and massage oils/creams, before apply-
ing LT.
• Concerning the contraindication to using LT over
the gonads: considering masculine gonads are more
superficial and accessible, and how heat-sensitive
they are, we would avoid treating the scrotal area
with a high power, but that would be the only pre- Figure 10.5 Ear ID tattoo in a patient with ear canal
caution. Navratil and Kymplova considered it more inflammation. Direct laser over the tattoo should be avoided,
of a doubtful contraindication than a real danger. for example by covering it with your finger.
[426] Nevertheless, their article was published in
2004, before class IV therapy lasers were in use. about their device as well as which safety categories it
• When treating areas with reduced or absent sen- falls under. The other half of that responsibility falls on
sitivity, keep that fact in mind, since you won’t you to research the local laws and points of contact at
get any feedback from the patient. Just keep a the appropriate agencies.
hand in contact with the treatment surface to be That said, here is a (by no means comprehensive) list
fully aware of the temperature, or in the case of of topics you’ll need to address in order to stay compli-
a wound, treat it as you would other wounds, but ant and safe.
never slower.
• Although they are not very frequent nowadays, it • Appointing a Laser Safety Officer, and the responsi-
is still possible to find ID tattoos on some patients; bilities of the person in that role.
avoid that area, since the ink can absorb the light • Training your staff on laser safety.
and cause pain (Fig. 10.5). • Training your staff on the basic usage of the device.
• Laser warning signage: what it needs to look like and
10.2.7 Compliance and regulatory considerations where it needs to be hung.
• Calculating the Nominal Ocular Hazard Zone
We are not going to bore you with the paperwork (NOHZ).
involved in making sure your clinic complies with • How to handle windows into the laser therapy
whatever state/province/country agency governs the room.
use of laser-emitting medical devices. About half of • Whether/how to handle inflammable gases (e.g.
that responsibility falls on the manufacturer/distribu- oxygen) around the laser.
tor of the laser, to provide the appropriate information • Setting up a door interlock circuit (which shuts

REDONDO PRINT (4-COL BLEED).indd 164 08/08/2019 09:48