In this second part of the discussion, we will look further into several more of the challenging conditions that can be addressed with PBMt. By no means is this list inclusive of all the difficult and oftentimes multicentric conditions we are presented with, but it does show how the laser delivery platform can be utilized for a variety of conditions.
Polyarthritis can be especially difficult to address due to several factors. This condition usually occurs with geriatric patients who thus have a decreased ability to physically respond to medical modalities than their younger counterparts. Keep in mind that more complex comorbidities may also come into play when dealing with systemic medications. With multiorgan involvement, it may not always be appropriate for a certain medication to be used depending on the drug pathway and which organs are affected. Depending on the number and locations of the joints affected, there is usually a very dynamic compilation of various compensatory mechanisms that patients will naturally use. To complicate things further, these sites of compensation will likely change as the patient improves and their kinematics change.
Thankfully, there are multiple protocol selections from which the operator can choose to address conditions such as arthritis, pain/trauma, and edema/swelling. To compound things even further, the laser operator needs to be familiar with the anatomy of each site being treated, as well as any other biomechanically-associated sites secondary to these. These cases may require even experienced operators to review their A&P notes since not everyone has to deal with these structures on a regular basis. Examples would include the iliopsoas and pectineus, which are more often assessed in a rehabilitation setting than in a general practice. Consider the patient that comes in with a markedly kyphotic stance: Not only do we have to address this site, but they are likely to be weight shifting forward, thus increasing load on thoracic limbs and decreasing the load on pelvic limbs. Treating multiple sites at the same time will require the operator to be skilled in accurately assessing the patient’s overall glide path of response to therapy, as well as assessing each site individually. The wise laser operator will remain flexible in the treatment design and delivery as per the patient’s glide path of response to therapy as these changes occur. Further supportive information on treating chronic conditions can be found here (click link).
The dreaded acral lick granuloma (ALG) can also be one of the more challenging case presentations we have to contend with. Due to the chronicity of these cases and amount of tissue planes involved, these will require patience and consistency in order to be treated effectively. While it is a challenging condition to treat, we can expect substantial improvement when treatments are consistently applied as an adjunct to standard of care. It is important that the appropriate diagnostics are used in these cases, as they can help rule out the etiology of the granuloma. Simple diagnostics such as a fine needle aspirate and radiographs can quickly give the attending veterinarian a much clearer picture from which an appropriate treatment plan can be formulated. For example, a radiograph could show an underlying early osteosarcoma- this would greatly impact the diagnosis, and thus the treatment recommendation. There is also evidence that these cases involve a certain amount of psychological changes with these patients. Data suggests that with these chronic cases, there is a serotonin release which reinforces this self-soothing mutilation (similar to OCD with humans). This is a prime example as to how PBMt is always best applied as an adjunct to standard of care.