Re: Laser pitch for more X-rays

[Guest guest]

Given that most indications for Laser therapy are soft tissue it seems like an irresponsible reason to recommend the diagnostics. If you think laser is appropriate it should be because you have already done your diagnostics to coordinate a treatment plan, not the pther way around. apraying daily for the 4-4 CAVSender: VetRehab Date: Thu, 30 Jun 2011 12:20:18 -0000To: <VetRehab >ReplyTo: VetRehab Subject: Laser pitch for more X-rays Hi, wondering what others think of this pitch from a DVM in Amarillo, TX, who is trying to help Cutting Edge sell lasers: " The therapy is very well received with a short explanation of how it works. The Harmony Laser has increased our radiographic procedures. We explain that we must know the location of the ailment to use the correct treatment. Clients are more willing to have diagnostic radiographs done for this purpose, than they were before we had the therapy laser. " Liz Powers, MPT, CCRT

[Guest guest]

 

As someone who has two hats, working in both a rehab facility and a GP (that has a laser), I can sort of see their point  although I agree the pitch seems poorly worded. For example how it is sometimes working for us is people have heard about this laser thing or their friend's dog had laser treatment etc so they come and ask " is laser helpful for my pet with XXX condition " , at which point we might be saying " well it could be but do we really know that your pet has XXX condition? I think we need some radiographs " .

 

For example OA, lots of people have been told or are convinced their dog has OA or hip dysplasia and maybe on palpation I can feel pretty confident of this or maybe not (plus many of the rest of the vets in my GP who are NOT rehab vets are not as good at finding these on PE, they are just not trained and practiced in doing it). So do we just go ahead and put the laser on the presumptive OA joint or do we get rads to see if we really see the evidence (bearing in mind that radiographic evidence of OA and especially CHD does not correlate exactly with severity of clinical severity). I guess they are advocating using the " carrot " of laser treatment as the incentive to persuade more diagnostics so I don't necessarily see that as a bad thing, depends how it is worded and used. In my experience people are often a lot more interested in spending money on treatment (fix it!) than on diagnostics so while you are correct we SHOULD always have our diagnostics and then think up the treatment plan (which might include reommending laser), it doesn't always happen like this.

Pam Mueller PhD DVM CCRT pending

www.animaltherapycenter.com

[Guest guest]

Pam,

Excellent comments from a practicing veterinarian!

Therapeutic lasers, which I now have 3, are an important part of our pain

management program however they are only one of the modalities I employ in the

management of pain. While it is never wrong to manage pain in our patients

arriving at an accurate diagnosis enables better patient care. I think the DVMs

wording is somewhat awkward and I am not certain where this statement was made

or published but I doubt he/she is receiving any compensation from Cutting Edge.

In contrast, my practice consultant, for my primary care practices, has made the

observation in clinics he provides services, a decline in radiographs have been

seen following the purchase of a laser. So my concern with modalities such as

this is that they decrease diagnostics rather than increase!

Rick Wall, DVM

Certified Canine Rehabilitation Practitioner

Diplomate, American Academy of Pain Management

Certified Myofascial Trigger Point Therapist

Center for Veterinary Pain Management and Rehabilitation

The Woodlands, TX

www.vetrehabcenter.com

[Guest guest]

I just wanted to pipe in with my 2cents on this, on a few different points. Radiographs cannot replace a good thorough physical exam. We have all heard – ‘treat the patient not the radiograph’ – and I do believe that there is an overreliance on such ‘arms length’ diagnostics.We know very well (on both the human and animal side) where radiographs for ‘other purposes’ have revealed otherwise ‘incidental’ findings of OA (mild, moderate, and even severe), or calcifications, or DDD... in otherwise asymptomatic joints.‘Human’ research studies have shown that physical therapy assessments are able to diagnose mild osteoarthritic / pre-arthritic joint changes PRIOR to radiographic evidence of degeneration. (So just another plug for that thorough eval, and caution against relying on the x-ray to pinpoint a joint problem). Physical therapy ‘pathofunctional assessments’ are also able to reveal when a symptomatic joint (say the human complains of knee pain) is the result of a pathology/movement restriction/weakness/ etc at a different location (i.e. hip or low back).As pointed out already, radiographs do not localize soft tissue lesions.Thirdly, it has been reported on the human side that upwards of 60% of the asymptomatic population will show to have a disc herniation on MRI, and of that populous, 20% will have a frank compression of the spinal cord .... (and recall, this is in the asymptomatic population)... So, should a diagnostic test ‘find something’, it should be balanced and weighed against the physical findings and symptoms. Thus, I think it is unfortunate that specialized equipment (such as lasers, underwater treadmills, acupuncture needles, etc) are sold to persons without sufficient training to operate them safely, professionally, or appropriately – and that there are no pathways to control such occurrences. I am not sure how we progress forwards on this... Better educate the veterinary profession? Better education the consumer? Better educate the manufacturers and retailers? Or just plug along and hope that it all sorts itself out? Interesting discussion points all around. Cheers, Laurie Edge- From: VetRehab [mailto:VetRehab ] On Behalf Of Rick Wall, DVMSent: June-30-11 7:29 AMTo: VetRehab Subject: Re: Laser pitch for more X-rays Pam,Excellent comments from a practicing veterinarian! Therapeutic lasers, which I now have 3, are an important part of our pain management program however they are only one of the modalities I employ in the management of pain. While it is never wrong to manage pain in our patients arriving at an accurate diagnosis enables better patient care. I think the DVMs wording is somewhat awkward and I am not certain where this statement was made or published but I doubt he/she is receiving any compensation from Cutting Edge. In contrast, my practice consultant, for my primary care practices, has made the observation in clinics he provides services, a decline in radiographs have been seen following the purchase of a laser. So my concern with modalities such as this is that they decrease diagnostics rather than increase!Rick Wall, DVMCertified Canine Rehabilitation PractitionerDiplomate, American Academy of Pain ManagementCertified Myofascial Trigger Point TherapistCenter for Veterinary Pain Management and RehabilitationThe Woodlands, TXwww.vetrehabcenter.com __________ Information from ESET NOD32 Antivirus, version of virus signature database 6253 (20110630) __________ The message was checked by ESET NOD32 Antivirus. http://www.eset.com __________ Information from ESET NOD32 Antivirus, version of virus signature database 6253 (20110630) __________ The message was checked by ESET NOD32 Antivirus. http://www.eset.com __________ Information from ESET NOD32 Antivirus, version of virus signature database 6257 (20110701) __________ The message was checked by ESET NOD32 Antivirus. http://www.eset.com __________ Information from ESET NOD32 Antivirus, version of virus signature database 6258 (20110701) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com

[Guest guest]

" Thus, I think it is unfortunate that specialized equipment (such as lasers, underwater treadmills, acupuncture needles, etc) are sold to persons without sufficient training to operate them safely, professionally, or appropriately – and that there are no pathways to control such occurrences. "

 

I am in the process of researching lasers for purchase so I find this discussion very timely.  Thank you. 

 

The comment made above by Laurie is also very concerning to me. I have seen underwater treadmills  sold to non-veterinary/rehab professionals for the purposes of  " conditioning " dogs for agility, etc.  I think the people purchasing the UWTM think they are purchasing a " souped up " bathtub with controls that anyone could run.  I too wish there were a way to get through to the manufacturers/distributors that the sale of such equipment without proper knowledge of how to use it could be detrimental to the animals.

 

Blanchard LVT, CMT, CCRP

 

I just wanted to pipe in with my 2cents on this, on a few different points.

 

Radiographs cannot replace a good thorough physical exam.  We have all heard – ‘treat the patient not the radiograph’ – and I do believe that there is an overreliance on such ‘arms length’ diagnostics.

We know very well (on both the human and animal side) where radiographs for ‘other purposes’ have revealed otherwise ‘incidental’ findings of OA (mild, moderate, and even severe), or calcifications, or DDD... in otherwise asymptomatic joints.

‘Human’ research studies have shown that physical therapy assessments are able to diagnose mild osteoarthritic / pre-arthritic joint changes PRIOR to radiographic evidence of degeneration.  (So just another plug for that thorough eval, and caution against relying on the x-ray to pinpoint a joint problem).  Physical therapy ‘pathofunctional assessments’ are also able to reveal when a symptomatic joint (say the human complains of knee pain) is the result of a pathology/movement restriction/weakness/ etc at a different location (i.e. hip or low back).

As pointed out already, radiographs do not localize soft tissue lesions.

Thirdly, it has been  reported on the human side that upwards of 60% of the asymptomatic population will show to have a disc herniation on MRI, and of that populous, 20% will have a frank compression of the spinal cord .... (and recall, this is in the asymptomatic population)...  So, should a diagnostic test ‘find something’, it should be balanced and weighed against the physical findings and symptoms.

 

Thus, I think it is unfortunate that specialized equipment (such as lasers, underwater treadmills, acupuncture needles, etc) are sold to persons without sufficient training to operate them safely, professionally, or appropriately – and that there are no pathways to control such occurrences.  I am not sure how we progress forwards on this... Better educate the veterinary profession?  Better education the consumer?  Better educate the manufacturers and retailers?  Or just plug along and hope that it all sorts itself out?

 

Interesting discussion points all around.

 

Cheers,

 

Laurie Edge-

 

From: VetRehab [mailto:VetRehab ] On Behalf Of Rick Wall, DVM

Sent: June-30-11 7:29 AMTo: VetRehab Subject: Re: Laser pitch for more X-rays

 

 

Pam,Excellent comments from a practicing veterinarian! Therapeutic lasers, which I now have 3, are an important part of our pain management program however they are only one of the modalities I employ in the management of pain. While it is never wrong to manage pain in our patients arriving at an accurate diagnosis enables better patient care. I think the DVMs wording is somewhat awkward and I am not certain where this statement was made or published but I doubt he/she is receiving any compensation from Cutting Edge.

In contrast, my practice consultant, for my primary care practices, has made the observation in clinics he provides services, a decline in radiographs have been seen following the purchase of a laser. So my concern with modalities such as this is that they decrease diagnostics rather than increase!

Rick Wall, DVMCertified Canine Rehabilitation PractitionerDiplomate, American Academy of Pain ManagementCertified Myofascial Trigger Point TherapistCenter for Veterinary Pain Management and Rehabilitation

The Woodlands, TXwww.vetrehabcenter.com

 

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[Guest guest]

Laurie,

I would hope that my previous comments did not lead others to believe that I

somehow down play the importance of a good examination. The physical exam in

pain patients is the basis for everything done afterwards. Clinical history and

physical examination should be used to select appropriate diagnostics in an

effort to arrive at an accurate diagnosis. To establish a therapy protocol on

the result of diagnostic test(s) only is a recipe for failure.

<<<<<<<<<<<< " Thus, I think it is unfortunate that specialized equipment (such as

lasers, underwater treadmills, acupuncture needles, etc) are sold to persons

without sufficient training to operate them safely, professionally, or

appropriately – and that there are no pathways to control such

occurrences " >>>>>>>>>>>>>>>

I totally agree.

Rick