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Implementation of laser therapy in practice 171

achieve and how fast, is what REALLY matters to us as
The clinician of us has a slight problem with clinicians! And of course, part of the answer is that it
this last strategy, thinking it carries the risk of
an improper diagnosis (from a non-veterinarian depends on the case, but there are some guidelines.
receptionist), where a squamous cell carcinoma My recommendation is that before you change your
is mistaken for a simple wound, for instance. Plus protocols (i.e. before you stop doing anything you were
there is the possibility of devaluing the therapy. doing before you had the laser), just add it to your treat-
Both are valid points, but I’ll still emphasize that the ments. Give yourself some time to grow confident in
waiting room is a VERY valuable place, confirmed the clinical results. If discontinuing an antibiotic course
by the amount of money big food and pharma makes you uneasy, just don’t do it (if justified). Keep
companies spend on their marketing in that room. treating the patients the same way, just adding the laser.
Either way, proceed with caution, and choose After a few weeks or months you will feel confident to
what’s best for your clinic and its personnel. try some of the following changes.

• Antibiotics: first of all, whenever possible, please
11.2 How to integrate laser therapy with DO perform cultures and antibiograms as part of
your current treatments your routine to diagnose an infection. Overuse
of antibiotics and resistance expansion is a very
With LT, you are incorporating a new resource into serious and growing problem, and a risk not just for
your tool box. It is certainly one you will use often and our patients: there is resistance transfer from com-
in a variety of conditions, but it is not a magic wand. panion animals to their human companions (and
You are still going to prescribe drugs, perform surger- vets!). [427]
ies, and use other modalities to help your patients. Yes, • If there is a local superficial infection with mild
you will probably use less medication (or none in some signs, you may avoid antibiotics, especially if you can
conditions), a few surgeries will even be avoided, and monitor the patient in upcoming sessions, which is
recovery after injuries may need less rehab visits, but usually the case with LT. You can still use antisep-
let’s talk about how these coexist and integrate with tics. If signs are severe or seem to be progressing,
laser. consider the antibiotic. An acute mild sacculitis or a
hot spot can often be managed without antibiotics,

11.2.1 Medications but if the patient is hyperthermic and deteriorating
it is probably time to think about other things as
As for compatibility, LT can be performed in patients well.
under any oral medication; the only theoretical pre- • Keep using your (topical and/or systemic depending
caution would be with photosensitizing drugs, but as on the case) antibiotics for deep-seated infections
already mentioned, there are no reports of side effects such as bacterial cystitis, deep, purulent fistulae or
nor a list of which drugs are activated at which wave- otitis, osteomyelitis, etc. (please, please perform
lengths. Local drugs can be a different story: they can cultures).
absorb the light and produce a local inflammatory • Analgesics: do not decrease the dose until the patient
reaction; that is why we absolutely avoid LT over joints shows some significant improvement with LT. This
that have been infiltrated with steroids or non-steroi- can take very few days or several weeks, depending
dal anti-inflammatory drugs (NSAIDs) in the last 1–2 on the case, so too early a withdrawal could leave a
weeks, and why it is recommended to clean topical gap of time between that and the effect of LT. Plus,
products from a wound or from an ear canal before it has been described how most of the effect of the
applying laser treatment. NSAID often takes several weeks to be achieved.
One of the most common questions asked when The exception, of course, would be a clinical con-
clinicians start to work with LT is about how much traindication to maintaining the use of those drugs
and how fast it actually decreases the need for drugs. (gastritis, renal conditions, and all those you know).
“When do I taper off painkillers?” “Is this patient going In some cases you will be able to eliminate the need
to need antibiotics or is LT enough?” Because this, for analgesics, in others you will just decrease the
together with how much improvement the patient can dose or frequency, and in some you will maintain all

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