Erchonia?

[Guest guest]

Anybody have any experience with Erchonia Lasers?

LaCross DVM

[Guest guest]

My human dept purchased one 5 years ago when they first came out. It was 5 mw power, 630nm wavelength and cost almost $9,ooo. The sales person was a PT and promised the moon. After about 6 mos it collected dust. They may have significantly improved them since then, but I would be cautious. Pavlakos, PT, CCRP From: VetRehab [mailto:VetRehab ] On Behalf Of Sent: Thursday, July 14, 2011 3:55 PMTo: vetrehab Subject: Erchonia? Anybody have any experience with Erchonia Lasers? LaCross DVM

[Guest guest]

Good to know, thank you... So many to choose from & all the companies say theirs is the best. 3b or 4 ? Ugh! 's I-Phone

My human dept purchased one 5 years ago when they first came out. It was 5 mw power, 630nm wavelength and cost almost $9,ooo. The sales person was a PT and promised the moon. After about 6 mos it collected dust. They may have significantly improved them since then, but I would be cautious. Pavlakos, PT, CCRP From: VetRehab [mailto:VetRehab ] On Behalf Of Sent: Thursday, July 14, 2011 3:55 PM

To: vetrehab Subject: Erchonia? Anybody have any experience with Erchonia Lasers? LaCross DVM

[Guest guest]

Hello All,I asked from SpectraVET if he knew much about Erchonia, Class 3 vs Class 4 and what to look for when considering a laser purchase. He said it was ok to share this with the group. This was his response....leThe classification scheme for laser devices has nothing to do with the efficacy of a therapeutic laser device. Lasers are classified solely on the basis of potential hazard: Simplistically, higher power = greater hazard. Nothing more, nothing less. For information about efficacy, one must go to the literature...There is available the accumulated knowledge from 40+ years of research into laser therapy, its basic mechanisms, clinical applications and, importantly, its upper- and lower-thresholds of dose, time and intensity, and the evidence stacks very strongly in favour of irradiation parameters (power, intensity, irradiation duration, etc.) that, whilst also achievable by some Class 1-3A and Class 4 devices, are most easily and cost-effectively achieved by devices falling within the 3B classification. If one were to consider the evidence base as a bell-shaped curve, there would be some evidence of effect from parameters deliverable by devices within lower hazard classes (1-3a) on one outer lobe, some evidence of effect from parameters deliverable by devices falling within the range of higher-powered Class 4 devices on the other, and the sheer bulk of the centre portion of the curve would be comprised of parameters falling within the realm of Class 3B emissions. These same parameters that lead to clinical efficacy may also be deliverable when using a high-power Class 4 device that’s operating at substantially less than its rated maximum output power.Take a look, for example, at the references provided by most high-power laser purveyors to support the efficacy of laser therapy, and it will quickly become clear that none of the effective irradiation parameters found therein require the very high-powered laser devices they’re selling.As someone with commercial interests in the development and supply of medical and veterinary lasers of all classifications, I could save a lot of time and effort in the laser therapy market by simply riding on the coat-tails of the likes of K-Laser and Companion, flogging off high-powered lasers to unsuspecting customers, and I’d make an absolute motza doing so! But I don’t – I guess that’s why I can’t afford to buy a Ferrari...Instead, I prefer to sell an appropriate horse for each given course. I recommend that:Where thermal/ablative/disruptive/destructive effects are required, choosing an upper-range Class 4 is the way to go.Where the desired clinical outcomes are dependent upon photochemical/photobiological mechanisms of action in deeper tissues, choosing a near-infrared (800-900 nm continuous wave, or 904 nm super-pulsed) device which falls within the upper-range 3B and lower-range 4 classifications is indicated.Where those clinical outcomes are similarly dependent upon photochemical/photobiological mechanisms of action, but in superficial tissues such as skin, mucosa and open wounds, one could choose either a visible red or near infrared emitting device at the lower end of the 3B range.There are other considerations, of course, that should also weigh heavily in your purchase decision, not the least of which is bang-for-your-buck.There are products which, despite offering parameters that fall within the clinically-useful range, are either badly-designed, over-priced or poorly-made and, therefore, not good value.Take the Erchonia device, for example: This 5-10 mW 635 nm (visible red) laser, although incapable of achieving the deep-tissue effects for which it is often promoted, is quite suitable for treating skin, mucosa and open wounds. However, at prices ranging upward from $9000 it is definitely NOT good value, even if you specialize in dermal/superficial tissue indications.One can then also look at similarly-expensive devices at the other end of the power scale, such as K-Laser, Avicenna or LiteCure (a.k.a. Companion & Pegasus), et al. These products are sold on the supposed benefits of very high power, i.e. treating larger, deeper, volumes of tissue more quickly, yet it is the rare case indeed when the clinician would actually want to use them at full power, let alone need to. (maybe I’m too conservative, but I question the wisdom of paying top-dollar for a capability, such as high-power, that cannot be safely or effectively utilized – probably another reason why I don’t own a Ferrari...)Further, the need for these devices to be able to deliver their maximum power without smoking a hole in your patient ensures that, even when operated at lower power settings, they are ill-designed to get the energy into the tissue where it is actually needed. Which brings me to the topic of penetration depth, and the myth that cranking up the power can increase the effective depth of penetration to any clinically-meaningful degree. In looking at typical Class 4 laser purveyors’ claims that “power = penetration”, I am drawn to sharing the following from K-Laser’s website, where they attempt to refute the fact that wavelength (and other factors, such as e.g. tissue compression) has a greater impact than power upon the depth of penetration than power. “Whether this phrase’s proponents don’t understand this idea [i.e. that power determines penetration depth], or just can’t sell it remains unknown.”. <http://www.k-laserusa.com/results-research/really-think-power-doesnt-influence-penetration/>This statement is accompanied by a series of very attractive illustrations which ‘prove’ that power DOES increase penetration... It looks so convincing! ...yet it is factually inaccurate, psuedoscientific codswallop that is designed purely to deceive the dollars right out of your hands.“...or just can’t sell it”... Speaks volumes about their motivation for fighting so hard to ‘prove’ such fallacious claims, don’t it?!? Depth of penetration – more importantly, the maximum effective penetration depth – depends on many different parameters, including the wavelength, intensity, polarization and coherence of the light source, compression of the tissue and coupling of the light source to the tissue, and those of the irradiated tissues themselves, like pigmentation, fibrotic structure, hydration and composition, in addition to more obvious factors such as hair and clothes. Of course it’s not always the Class 4 guys who are gilding the lily in terms of the marketing claims being made (but boy, can they SPIN!!), especially when it comes to depth of penetration. The side-show promoters behind the Q1000 device, for example, claim it is capable of producing “six soliton waves” that allow “subtle energy to penetrate deep into body tissues to resonate cells and balance organs”. Crikey!! And then there’s Erchonia (again...), claiming that the penetration of photons into the tissue (where they can be absorbed and, thus, contribute to the cascade of photochemical effects that form the basis of laser therapy) isn’t even necessary to affect clinically-relevant outcomes.My advice for those of you looking to purchase a laser device is, first, to look at the large evidence base for laser therapy and consider the emission parameters that are most effective in your target application, then use common sense, prudence and a whole swag of scepticism to guide you through the myriad exaggerated claims and marketing fluff toward a laser that:offers features and functions that are relevant to your specific clinical needs;is capable of delivering the appropriate irradiation parameters (per the evidence base) for the types of conditions which present in your practice;is comparatively good value and fits your needs and budget.So, in short, our field is FULL of crap. And on behalf of every honest and ethical manufacturer, marketer and salesperson, I apologise for that. But laser therapy is also a very useful and effective addition to one’s clinical armamentarium, and the scope of its promise in medicine is growing every day, so it is worth persevering.Some good, factual, resources to help you on your way are:Laser World (Swedish Laser Medical Society) website: <http://www.laser.nu>World Association for Laser Therapy website: <http://www.walt.nu>American Society for Laser Medicine and Surgery website: <http://www.aslms.org>BiOS Conferences & Proceedings: <http://spie.org/x7777.xml>Photomedicine and Laser Surgery (Journal): <http://www.liebertonline.com/loi/pho>Lasers in Medical Science (Journal): <http://www.springer.com/medicine/journal/10103>Lasers in Surgery and Medicine (Journal): <http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1096-9101>Photochemistry and Photobiology (Journal): <http://www.wiley.com/bw/journal.asp?ref=0031-8655>...to list but a few.You may also consider purchasing ‘The New Laser Therapy Handbook’ by Tunér & Hode (2010). A steal at around $93 including shipping, and an inexpensive investment that may just save you thousands... Google it.And if, at the end of the day, you just can’t help but buy that Erchonia barcode scanner, a blunderbuss-like K-Laser, or a Ferrari, at least you’ll be doing so from an educated standpoint, replete in the knowledge of its relative capabilities and deficiencies, and of the opportunity costs of not buying something more sensible ;-)

[Guest guest]

wow-I have a class 3b laser, and have wondered for 2 years about a colleagues claim that he is treating otitis ext., fel. kidney failure, and IBD with his class 4-he is even speaking at the big laser conference North American I believe) regarding his results- he has a human MD friend who has a " laser " center and he too swears by the patient outcome.

This is wonderful. I just had peter do some repairs for me-not only was the price fair, but he was honest. once he had it, he could just as easily have told me he couldn't fix it and tried to sell me a new one. This email has been great, as well as the references below.

Freedman VMD CCRT

 

Hello All,I asked from SpectraVET if he knew much about Erchonia, Class 3 vs Class 4 and what to look for when considering a laser purchase. He said it was ok to share this with the group. This was his response....le

The classification scheme for laser devices has nothing to do with the efficacy of a therapeutic laser device. Lasers are classified solely on the basis of potential hazard:  Simplistically, higher power = greater hazard. Nothing more, nothing less. 

For information about efficacy, one must go to the literature...There is available the accumulated knowledge from 40+ years of research into laser therapy, its basic mechanisms, clinical applications and, importantly, its upper- and lower-thresholds of dose, time and intensity, and the evidence stacks very strongly in favour of irradiation parameters (power, intensity, irradiation duration, etc.) that, whilst also achievable by some Class 1-3A and Class 4 devices, are most easily and cost-effectively achieved by devices falling within the 3B classification. 

If one were to consider the evidence base as a bell-shaped curve, there would be some evidence of effect from parameters deliverable by devices within lower hazard classes (1-3a) on one outer lobe, some evidence of effect from parameters deliverable by devices falling within the range of higher-powered Class 4 devices on the other, and the sheer bulk of the centre portion of the curve would be comprised of parameters falling within the realm of Class 3B emissions. 

These same parameters that lead to clinical efficacy may also be deliverable when using a high-power Class 4 device that’s operating at substantially less than its rated maximum output power.Take a look, for example, at the references provided by most high-power laser purveyors to support the efficacy of laser therapy, and it will quickly become clear that none of the effective irradiation parameters found therein require the very high-powered laser devices they’re selling.

As someone with commercial interests in the development and supply of medical and veterinary lasers of all classifications, I could save a lot of time and effort in the laser therapy market by simply riding on the coat-tails of the likes of K-Laser and Companion, flogging off high-powered lasers to unsuspecting customers, and I’d make an absolute motza doing so!  But I don’t – I guess that’s why I can’t afford to buy a Ferrari...

Instead, I prefer to sell an appropriate horse for each given course. I recommend that:Where thermal/ablative/disruptive/destructive effects are required, choosing an upper-range Class 4 is the way to go.

Where the desired clinical outcomes are dependent upon photochemical/photobiological mechanisms of action in deeper tissues, choosing a near-infrared (800-900 nm continuous wave, or 904 nm super-pulsed) device which falls within the upper-range 3B and lower-range 4 classifications is indicated.

Where those clinical outcomes are similarly dependent upon photochemical/photobiological mechanisms of action, but in superficial tissues such as skin, mucosa and open wounds, one could choose either a visible red or near infrared emitting device at the lower end of the 3B range.

There are other considerations, of course, that should also weigh heavily in your purchase decision, not the least of which is bang-for-your-buck.

There are products which, despite offering parameters that fall within the clinically-useful range, are either badly-designed, over-priced or poorly-made and, therefore, not good value.Take the Erchonia device, for example:  This 5-10 mW 635 nm (visible red) laser, although incapable of achieving the deep-tissue effects for which it is often promoted, is quite suitable for treating skin, mucosa and open wounds. However, at prices ranging upward from $9000 it is definitely NOT good value, even if you specialize in dermal/superficial tissue indications.

One can then also look at similarly-expensive devices at the other end of the power scale, such as K-Laser, Avicenna or LiteCure (a.k.a. Companion & Pegasus), et al. These products are sold on the supposed benefits of very high power, i.e. treating larger, deeper, volumes of tissue more quickly, yet it is the rare case indeed when the clinician would actually want to use them at full power, let alone need to.  

(maybe I’m too conservative, but I question the wisdom of paying top-dollar for a capability, such as high-power, that cannot be safely or effectively utilized – probably another reason why I don’t own a Ferrari...)

Further, the need for these devices to be able to deliver their maximum power without smoking a hole in your patient ensures that, even when operated at lower power settings, they are ill-designed to get the energy into the tissue where it is actually needed. 

Which brings me to the topic of penetration depth, and the myth that cranking up the power can increase the effective depth of penetration to any clinically-meaningful degree. In looking at typical Class 4 laser purveyors’ claims that “power = penetration”, I am drawn to sharing the following from K-Laser’s website, where they attempt to refute the fact that wavelength (and other factors, such as e.g. tissue compression) has a greater impact than power upon the depth of penetration than power. 

“Whether this phrase’s proponents don’t understand this idea [i.e. that power determines penetration depth], or just can’t sell it remains unknown.”. <http://www.k-laserusa.com/results-research/really-think-power-doesnt-influence-penetration/>

This statement is accompanied by a series of very attractive illustrations which ‘prove’ that power DOES increase penetration... It looks so convincing! ...yet it is factually inaccurate, psuedoscientific codswallop that is designed purely to deceive the dollars right out of your hands.

“...or just can’t sell it”... Speaks volumes about their motivation for fighting so hard to ‘prove’ such fallacious claims, don’t it?!?  Depth of penetration – more importantly, the maximum effective penetration depth – depends on many different parameters, including the wavelength, intensity, polarization and coherence of the light source, compression of the tissue and coupling of the light source to the tissue, and those of the irradiated tissues themselves, like pigmentation, fibrotic structure, hydration and composition, in addition to more obvious factors such as hair and clothes. 

Of course it’s not always the Class 4 guys who are gilding the lily in terms of the marketing claims being made (but boy, can they SPIN!!), especially when it comes to depth of penetration. The side-show promoters behind the Q1000 device, for example, claim it is capable of producing “six soliton waves” that allow “subtle energy to penetrate deep into body tissues to resonate cells and balance organs”. Crikey!!  And then there’s Erchonia (again...), claiming that the penetration of photons into the tissue (where they can be absorbed and, thus, contribute to the cascade of photochemical effects that form the basis of laser therapy) isn’t even necessary to affect clinically-relevant outcomes.

My advice for those of you looking to purchase a laser device is, first, to look at the large evidence base for laser therapy and consider the emission parameters that are most effective in your target application, then use common sense, prudence and a whole swag of scepticism to guide you through the myriad exaggerated claims and marketing fluff toward a laser that:

offers features and functions that are relevant to your specific clinical needs;is capable of delivering the appropriate irradiation parameters (per the evidence base) for the types of conditions which present in your practice;

is comparatively good value and fits your needs and budget.

So, in short, our field is FULL of crap. And on behalf of every honest and ethical manufacturer, marketer and salesperson, I apologise for that. But laser therapy is also a very useful and effective addition to one’s clinical armamentarium, and the scope of its promise in medicine is growing every day, so it is worth persevering.

Some good, factual, resources to help you on your way are:Laser World (Swedish Laser Medical Society) website:  <http://www.laser.nu>World Association for Laser Therapy website:  <http://www.walt.nu>

American Society for Laser Medicine and Surgery website:  <http://www.aslms.org>BiOS Conferences & Proceedings:  <http://spie.org/x7777.xml>

Photomedicine and Laser Surgery (Journal):  <http://www.liebertonline.com/loi/pho>Lasers in Medical Science (Journal):  <http://www.springer.com/medicine/journal/10103>

Lasers in Surgery and Medicine (Journal):  <http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1096-9101>Photochemistry and Photobiology (Journal):  <http://www.wiley.com/bw/journal.asp?ref=0031-8655>

....to list but a few.You may also consider purchasing ‘The New Laser Therapy Handbook’ by Tunér & Hode (2010). A steal at around $93 including shipping, and an inexpensive investment that may just save you thousands... Google it.

And if, at the end of the day, you just can’t help but buy that Erchonia barcode scanner, a blunderbuss-like K-Laser, or a Ferrari, at least you’ll be doing so from an educated standpoint, replete in the knowledge of its relative capabilities and deficiencies, and of the opportunity costs of not buying something more sensible ;-)

-- Regards,