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Daniel: Okay, everybody. Thank you for joining us this afternoon, and welcome to the Tuesday webinar series, Chiropractic Economics Webinar for Doctors of Chiropractic. I’m Daniel Sosnoski, Editor-in-Chief of Chiropractic Economics.
Today’s webinar, Laser Therapy, Take Aim at Pain, is sponsored by Erchonia Corporation, and, as always, our program is being recorded and will be archived at Chiropractic Economics website, chiroeco.com/webinar for one year.
Our expert is on-board here today to speak with you, and when his presentation is complete we will follow with a question and answer period. You can submit questions throughout the presentation by clicking on the appropriate icon on the right side of your screen. We will do our very best to get to all of your questions, but if we run out of time we will forward the remaining questions to our expert and then notify you via email when the answers are posted on our website, chiroeco.com/webinar.
Our presenter today is Jerome Reruca, D.C., owner of Performance Chiropractic and Wellness, who’s here to help you understand the ways in which you can employ laser therapy in your practice to treat chronic pain. Dr. Reruca, thank you for taking the time to participate in our webinar and for sharing your expertise with laser therapy and helping our audience understand how they can use it to treat their own patient base. Before we get started, Jerome, please give us a brief background on yourself and your work with laser therapy.
Jerome: Hey, thank you, Daniel. I’ve been teaching lasers to the chiropractic profession for 15 years now. And throughout this whole time, doctors have some very good foundational questions of how lasers pertained specifically to how they practice. And so in this webinar we’re gonna be going over the big basics that apply to everybody, and then any specific questions you may still have at the end, we will get to those as the program allows. So over the course of that time, I’ve taught a lot of seminars, as well as individual clinical support as people get started early on with lasers, and so I’m happy to be here today to share this information with you.
First and foremost, it’s useful to help chiropractors to understand that what they already are doing in practice applies specifically to easily bringing lasers into the great works that they already do. So some of the questions people would have is what office procedures, how do I need to change everything, is there a lot I have to learn before I can apply these benefits. And even though there’s just a level of confidence for information that needs to be achieved, understanding no matter what type of your primary technique or techniques that you already apply you’re very successful with that. And when you understand the basic foundations of how lasers work, it’s very easy to understand how it just integrates into the great work you’re already doing.
Now there are literally are thousands of research papers in PubMed that validate the benefits of low-level laser therapy. And truthfully speaking, this is the most researched modality that any practitioner can use. So it’s not philosophy, it’s not what if these things work. They have taught us a lot about self physiology. And as simple as they are to use, just like anything, successful practitioners understand you have to be able to communicate this to people in your practice. And also the advantages lasers have for us to be able to communicate with people who currently are not into our practice, and how we can build those things and reach a larger audience.
So how low-level laser therapy works is lasers work on two basic principles. Lasers work by increasing the energy necessary for injured cells to heal and regenerate, and lasers also help injured cells communicate better. It is those two basic principles that all the thousands of research studies validate. Now the details may change significantly, as different metabolic and physiological factors that they’re measuring. But ultimately, it’s taking the physiology of the body and increasing its efficiency.
So whatever you listeners on this webinar already know, and for every reason you already treat the person, just understand lasers help it work more efficiently. Now this is not a substitute for an adjustment by any way, shape for form. This is not a substitute for your clinical skills. So once again, it just helps increase the efficiency for our adjustments, for rehab, for anything you can think of of the current reasons why you’re treating that patient and what you hope to achieve.
Now lasers can be used so simply. You can use them unattended, where you would just put the laser in the stand and you can go work on somebody else in another room. And then there’s also attended applications that we refer to as [inaudible 00:05:02]. So we always wanna break it down to these lowest common denominators of how simple and how efficient it is to bring into our practice with what we’re currently doing. And then doctors, in time, when they become comfortable with that, they do learn that lasers can maybe be applied for certain techniques and applications above and beyond what they’re doing.
So it’s always a fun application to teach people, just like all of us enjoy helping clients and when we see that aha moment go on for them and they get the benefits of what we do as practitioners it makes us feel good. And likewise, me as an educator for not only practicing in my own practice, but to help doctors share that enthusiasm and success to lots of other clinicians, it’s always a fun experience to be able to pass that information on.
As we look from an economical standpoint, and where chiropractic is now, and if you want to grow you practice, there are just three primary huge, huge categories that we can consider as far as how we can do that, and how lasers can fit into these categories.
Now the pain market has been recognized, chiropractic’s successful for that since its conception, even though we do a lot more than pain, there’s a huge need. And then there’s the weight loss industry. And actually even expanding upon that, the non-invasive body contouring. There’s also FDA clearances from Erchonia that’s involved in that category, and myself, I was also a strength coach prior to being a chiropractor and chiropractic fascinated me as far as the performance benefits and the recovery benefits that were totally unique, only to chiropractic and nothing else could do what it did. And that still holds true today, and lasers actually can help us communicate and apply technique applications into all of these different categories.
Now I do like to reverse engineer things, and so as we do look at the need and what’s in your population base and hometown, as well as what’s in my community. And across the nation, pain medication is the number one sold drug in America. And we know there is a huge problem with that, and we are well-equipped to help people where other people can’t help them. So once we can increase our awareness of that, it really is. Even though we’re still recognized for pain as chiropractors, and some people won’t come in to us, only because their neck and back do not hurt, there is still a huge population of people that don’t come in that are in chronic pain. So how can we communicate with these people? If we just look at the money factor that comes with that, once again, pain medication is the number one drug sale out there.
Now this relates to acute and chronic pain, and low-level lasers can help in both situations. And again, it comes down to that common denominator of everything you would know physiologically about pain. It increases the metabolic process, increases circulation, increases neurotransmitters, increases ATP synthesis, all of those things to help speed up that healing process.
Now if we do start breaking it down, not into just the huge category of pain, but we start breaking it down into smaller categories, and just look at the need and the amount of people that have plantar fascitis. So this alone is the most common condition involving foot pain. It’s 8 to 15% of all foot complaints in non-athletic and athletic populations. So it is, it’s diverse through all of the people within our communities that we can look at. And approximately 10% of the entire population over the course of a lifetime will be diagnosed with full-blown plantar fascitis. That’s not even just foot problems.
So when we look at the anatomy, and we look at symptomatically what areas primarily are involved, this is how it breaks down to where people express the most significant pain anatomically. And this would be just fine to use the laser symptomatically over these places. Now hopefully, you would adjust extremities, you do soft tissue work. But it is just amazing how just using lasers alone are so effective at treating plantar fascitis. And this was done with a level 1A double-blind random site clinical trial, specifically with an Erchonia laser, and they did receive an FDA clearance for treating plantar fascitis.
So many of us already know the underlying causes that relate to having plantar fascitis, that sharp pain under the heel that is usually worse in the morning or after being sedentary such as sitting in your desk and then you get up to walk and the first few steps are absolutely excruciating, and it kinda starts to loosen up if you move around a little bit. This pain, many times, does not go away for people, and it just gets chronically worse and worse.
So in this particular research study, they took people with long-term, chronic foot pain already, and plantar fascitis. If you’re not familiar with what a level 1A study is, people do not know who got the real laser and who got the sham laser. It looks exactly the same, and people just had to qualify and fill out a questionnaire. Nobody knew who was getting treated or not treated. And there was absolutely no other treatments being done. There was no adjustments, there was no ice, there was no fish oil, there was no [inaudible 00:10:25] exercises such as strengthening and stretching, or soft tissue work. They only received laser therapy.
And as you look at it on the baseline to the far left and we start seeing where the pain index was here already. So this was a study that people were treated twice a week for three weeks, just a total of six treatments. And these people basically had pain for chronic seven to eight years that were accepted into this study. And again, there was no clinical competency involved in this. It was just simple point-and-shoot laser therapy.
Now even once the baseline was created, right there you see it under 70, this started significantly, right at that 100 point mark. So just in two weeks they got a significant increase in the benefits of laser therapy. But what I really like about this study is if you’ve used lasers you know the benefits of it, but people always wanna know well how long will this last. And it was really useful as I’ve tried to help doctors understand the benefits of lasers do not stop just once you turn the laser off. When you actually energize those cells, the body’s natural healing response can improve the metabolism and it can enhance the healing process when patients aren’t in front of us.
So when they did a two-week followup there was absolutely no further laser treatment, there was no chiropractic treatment, soft tissue treatment. There was absolutely no clinical applications done during this post period, and they got even significantly better than during the study. And then they did a 6-month followup, and people with chronic pain, they’ve had years and years of chronic pain, at 6 months and 12 months they were even still getting better.
So this is always kind of exciting to share with doctors in terms of there’s always variables, what you need to take into history, but other than people being qualified in this study, as I said, there was no clinical skills being provided that we already know is hugely beneficial. And so when you start integrating chiropractic care, soft tissue work, with the value of lasers, you’re really, really gonna see some great progress and how this really can affect inside of our practices.
Now obviously, pain is a huge condition. Back pain is the number one neuromuscularskeletal problem in the world. Neck and shoulder pain is number two. And obviously the complicating factors that go with that are not just based upon that single diagnosis. It has very global problems through people’s quality of life. So when you look at back pain, chiropractic already is well-known to be effective with back pain. But when somebody shared statistics with me I was even kinda surprised at, not the size of back pain, but the percentage of people with back pain that still went to chiropractors even though they were fully aware of the stereotype that chiropractors have with neck and back pain.
Most of us know these statistics already. Low back pain is responsible for 40% of all missed work days. The amount of productivity lost in the workplace goes into the hundreds of billions of dollars. It is an incredible problem. Now I as a chiropractor, I realize how valuable chiropractic alone is. And everybody on this webinar knows that. And so that’s the good point. The bad point is the general public still is not aware even of all of the benefits we provide. And I do consider myself a holistic practitioner. We do lots of valuable nutrition, lab testing in our practice, as well as clinical exercises.
But as we look at this study that was published in “Spines,” the number one orthopedic journal in the world, they looked at the number one pain medication prescribed for pain, and they looked at how did acupuncture and chiropractic, under a level one study, all compete against each other and who got the best results. So this was done in 2003. And what was found is that they took people that had four and a half to six and a half years of pain, and those were distributed to the Celebrex and Viox [SP] group and acupuncture. And chiropractic got the most chronic patients at 8.3 years. This was a 9-week study, and patients that were symptomatic using the drugs was 5%. Acupuncture doubled that success rate at 9.4%, and chiropractic significantly beat both groups by 27.3% or 100% asymptomatic within 9 weeks.
The adverse affects? Obviously drugs had more side effects than they actually had success cases, no surprise. Acupuncture and chiropractic had absolutely no side effects. But this last statement, again, even though I don’t want myself personally to be pigeonholed only dealing and recognized for people’s pain, it is important to understand how we can market to people. And there’s this giant group of people currently still not coming in to see us, but once they do come in to see us for a particular problem, how we can help them with numerous other things.
Just in this study alone, the chiropractic adjustment was the only thing being delivered by the chiropractor. No counseling, no lifestyle changes of any kind. And the percent improvement in general health status was 47%. Once again, when you look at that improvement compared to other things that were given, that was very significant. Because prior to the study they started off with doing full health composite scores. What other symptoms do you have besides pain? And clearly, clearly, not only did chiropractic do great things for these people’s pain, however their general health improved greatly as well.
So we know that as a profession, and we know there’s a very extensive problem out there. However, when we kinda go on here a little bit, it’s like lasers really are very effective by themselves treating back pain, as well as they can help us market to a group that may not be coming in right now for it. The surveys show up to 77% of chronic low back pain sufferers report feeling depressed. Over 57% of sufferers report inability to sleep. And these additional side effects go on and on, people with chronic pain. And that’s where the real problems start coming in, when they have to start taking multiple layers of medication and the cause of the problem is not being addressed.
From 2003 to 2006 there was a study from Health Research and Education Trust that shows chiropractic utilization had 4% of the U.S. population that was using it. And this was back in 2006, so there’s a lot that as happened since that time, even looking at people’s insurance deductibles are going up. And if you just have an insurance practice, obviously you’re aware of the different challenges in reeducating patients.
Now there are 100 million people in the United States with back pain, and currently only 3% of those suffering from back pain are seeing a chiropractor. I was really astounded to learn that those numbers were that low. I figured since we were stereotyped, and there’s been times where I’ve even heard that “I don’t need to come see a chiropractor. I don’t have back pain. I don’t need to come see a chiropractor. I don’t have neck pain.” But even those that do have back pain, only 3% of that group are seeing us. So what also came out of moving forward, the effects we have on people obviously have long-term benefits. And it’s not just for short-term pain reduction. It’s for long-term solutions to their overall health and well being, even taking into their sleep disturbances.
As we start looking at disability indexes and where that starts, arthritis and rheumatism is the number one cause for disability. But then it’s back and spine problems takes us to how we connect the dots to the data. I always tell people there is no small insignificant adjustment that we give, because the people that come to us, they have a major advantage. And we wanna help our success ratios get out to other people so they can really understand the benefits we have.
I don’t like motivating by doom and gloom, however, as we do look at statistics and we look at the most common comorbidities among adults with arthritis. And obviously, this is that top of that disability index. Heart disease is number one, chronic respiratory conditions, diabetes and stroke. So once you are limited by your movement in your activities and daily living, it does cause significant degeneration throughout the entire body. And of course what we can do to help people maintain their activity.
Now here lies an opportunity to communicate. There is obviously a huge problem, and that’s just for the single largest volume of neuromuscularskeletal patients on the planet. Currently, we know what statistics are, but when you do use a device, such as an Erchonia laser, that actually has a specific indication of use for plantar fascitis, it is actually legal for you to market that for that use. And I tell practitioners, look at every Walgreens. Look at every CVS. There’s a Dr. Scholl’s scanner there. Also in every Walmart. And the reason it’s there is because of the significant amount of just foot pain that exists in all of our communities. And if people knew how successful we were at treating plantar fascitis they should be coming in to see us.
But what has shown is by marketing laser therapy, even people who would not come in to see a chiropractor for whatever reason, they definitely trust technology and they will come in based upon those applications. Now there was a low back pain study specifically done with the Erchonia laser as well, even though this did not receive an FDA clearance at this time. It is still going through a long, arduous process, as you could imagine. If you take a non-pharmacological solution and you start showing major correction for the number on neuromuscularskeletal problem in the world it’s gonna raise some eyebrows outside of does it work. Yes it works. However, there can be other delays along that process.
Again, this was a level 1A study where there was a placebo group and the actual group that got treated. Now the group that was used for the sham device, for instance. There’s a lot of products in the marketplace that are specifically light-emitting diodes. So one of the confusing things in the laser market is there’s infrared, there’s light-emitting diodes, and there’s true lasers. It’s not technically illegal to market an infrared or an LED as a laser, but it’s not accurate.
Research is very clear that lasers are much more efficient for photobiology, and that doesn’t mean the others don’t work. But they do lose significant, significant efficiencies in this process. So a lot of products that practitioners end up buying if they don’t know much about the light therapy market are actually light-emitting diodes. And the light-emitting diode was actually the sham treatment in this particular study compared to actual, true lasers.
Now once again, patients could not partake in any other form of therapy or receive adjustments during this time, or even increase water intake or any activities of daily living. There was two treatments per week for three weeks. Again, these people had very, very chronic back pain who were qualified for this. As we look at the test group that actually did receive the laser, and we see the placebo group, once again as we first started, in order to do a level 1A study, if you do not get placebo benefits it will automatically throw that study out. And so people really don’t get any positive involvement that this is going to work. But people also can’t get any negative involvement in terms of any clues that would allow them to understand who’s actually getting treated and who is not getting treated.
So in any study, whether it’s for medication or in this case, a laser, the placebo and the actual treatment group have to have very, very similar results for the study to even move forward. Now in a very short time you start seeing the test group that gets significant improvement in pain symptoms and improved function compared to the placebo group. So once again, this one didn’t go on for that six months and year followup with the statistics we have, even though those are available. But you just see post-14 day from that 2-week treatment period of just how successful lasers alone are for people with chronic, chronic low back pain.
When they started looking at the satisfied group in the test group and the placebo group, and how large a group there was in the dissatisfied group, if you start looking at the values that are hypothesized of what needs to happen before this even gets considered to get an FDA clearance, it completely exceeded any expectation the FDA had as far as what the results would be. And so these are the types of results I tell people there was no clinical competency by a practitioner given. Think of what would happen if you combined this with a little bit of consulting, as far as maybe giving essential fatty acids, tell people to drink water. Of course, number one, chiropractic adjustments, maybe doing some soft tissue work. Obviously, everything you would see in that study would enhance. But you see just the huge, physiological changes and benefits that just laser provides.
There was a secondary study done by one of the practitioners who was involved in this study that he asked people would they ever have considered a chiropractor for their back pain. And 86% of the patients from the study, they said they would have never considered chiropractic. And out of the people participating in this study, 52% of them actually went on to be chiropractic patients once the study was over because they were exposed to at least a chiropractic office, via the laser.
So this kinda tells me, and I’ve gotten those benefits for a long time of being able to sell chiropractic through safe, non-invasive, very efficiently successful modalities such as laser therapy so we can introduce people. So patient perception is clearly that laser therapy and technology attracts new patients, especially when you have the research backed that laser therapy has.
Now even though there’s numerous individual diagnoses that should be taken into consideration, such as just with back pain, and you see on the screen here, none of this was done within the study. And so none of the specifics of how everybody on this webinar treats and creates some of the exams for people to give differential diagnosis, none of that was done. And this is just how universal lasers are for providing cellular metabolism and improvements, no matter what the cause of back pain is.
And when we do look at just typical research and typical information in the medical textbooks as far as stage one is the acute inflammation injury. Stage two is the proliferative sub-acute phase. You get the rehab and strengthening. Lasers are not limited to just one of these stages. You don’t use it just for acute or just for sub-acute, just for chronic scarring. Again, you can use lasers for all phases of the healing process. If people come in with acute injury, or people come in with chronic, chronic pain.
Now some products out there do create heat, and that’s how they’re advertised. They’re high-powered, light therapy devices, and they actually create heat. Now just from putting clinical common sense into that, heat is contraindicated for acute injuries, so those devices aren’t as universal as when you’re using true cold laser or low-level laser therapy that has photobiology benefits. There is no heat, and that can be used in acute, sub-acute or chronic pain patients. And the common denominator always comes down to this proven science of it affects the mitochondria. And this is a well-known, written, publicized concept of how lasers work. These devices are way past the experimental stage. They have numerous FDA clearances just from Erchonia, and they continue to get more and more FDA clearances on seemingly unrelated health professions and unrelated conditions. But it does come down to this common denominator as far as how lasers affect the mitochondria.
So all of us were taught the Krebs Cycle and the electron transport system, and how our body uses nutrients and breaks down molecules in order to create ATP. Lasers seem kinda magical, but they actually don’t use magic for how they work. There is a photon. Light is waves and particles, so the particles are photons. And that photon actually binds to a photon receptor. Low-level laser therapy for photobiological effects has to get absorbed. When it doesn’t get absorbed for metabolic enhancement, it creates heat due to inefficiency. So low-level lasers do not create heat. That photon binds to a photon receptor. That photon donates an electron. Ultimately, that electron will go through the electron transport system, ultimately increasing the efficiency of the mitochondria to produce ATP.
This is absolutely amplified significantly when you’re dealing with any injury to the body. So when you look at the common denominator, the chiropractic [inaudible 00:28:29], and the nervous system uses more ATP energy than any other cells in your body. And every single cell in your body has mitochondria. And it is that mitochondria that tells that cell what to do. And so when you look at the common denominators, if you were the most principled, subluxation-based chiropractor in the world, you should easily understand after this webinar just how significant and beneficial lasers can have on helping heal chronic subluxation, especially in combination with proper chiropractic adjustments.
Because that subluxation is providing a physical stress and an injury to the tissues of that area. Ultimately, the cells of the tissue are injured, and ultimately it is the mitochondria that is injured. And we are trying to influence the nervous system, and when you have injured mitochondria into the system, the nervous system, related specifically to a subluxation and lasers are factually proven to help heal and enhance that tissue healing, you can easily see the benefits that lasers have combined with chiropractic care.
And again, they’re very, very easy to apply. With whatever technique you apply there are attended ways to apply it, or there is unattended. And it’s just based upon your differential diagnosis, if you’re finding specific subluxations, or symptomatic applications. I always like people to look at their chiropractic philosophy and the same carries through for how you apply lasers specifically to the person you are treating.
And when you look at the research papers, they’re gonna talk about therapeutic dose a lot. Research is very, very clear. One to five joules per centimeter squared shows optimum efficiency and absolutely no concern of side effects. When using low level lasers this would be very difficult to extend beyond the five joules per centimeter squared, which is a very safe dosage again, just due to time constraints. And you running a successful practice, you know you don’t have to spend an hour with each person in order to get great results.
Up regulation is a much shorter time and it’s usually done, again, attended. Basic applications of lasers is with what you already do. And this would be your chiropractic indicators, such as you could create laser programs off of your x-rays, [inaudible 00:30:53], leg checks. When we start breaking it down into more standard chiropractic philosophies that they talked about overall, we know every nerve root in the body comes out of the spine and goes to every single muscle and every single organ in the body. So that’s why when we talk about where would you use the laser, it works very well to use a dermatome or myatome chart, specifically the dermatome chart here.
And if you had any symptom anywhere on the body you would relate it to a nerve root that relates to that. And you can easily use the laser symptomatically over the areas involved, but then we definitely encourage people to put your chiropractic knowledge to use. Because you will get better results by also treating the nerve root, whether you do it combination or you do it one area at a time, or even just one area of a particular treatment. This is very effective to relate the central nervous system to any symptom in the body.
Also, chiropractors talk about the safety pin cycle. Now I would not recommend this with any other product on the market other than true low-level laser therapy, and hopefully the FDA’s cleared photobiology products. But when you go to PubMed and you just type in low-level laser therapy and the brain, or you type in low-level laser traumatic brain injury. Low-level laser therapy Parkinson’s. You will be astounded by the amount of research studies that are already published in PubMed showing the validation of using lasers on even very systemic, chronic problems. We shouldn’t have to wait til there’s such a severe problem to get these benefits. And you’re dealing with afferent and efferent neurological pathways, and it is, it’s very safe to use low-level laser therapy, even over specific lobes of the brain. And the laws of neurology that we know, such as with voluntary motion, same-side cerebellum, opposite side cortex, stabilization of particular areas, same-side cortex. It’s very, very simple to very quickly put very safe, efficient laser protocols together for our chiropractic patients, even using research that is based upon chronic, neurological degeneration that’s done out there already.
So this was a study in 2012. Growing evidence supports that neurometabolic enhancement by low-level laser positively impacts neuronal function in [inaudible 00:33:20] and in vitro. And like I said, there’s too many studies to list. That’s just kinda giving you one.
Also we talk about the Meric chart. And so there’s visceral somatic reflexes. So I would tell chiropractors spine, brain, organ, spine, brain, organ. And people go “well, where do I use the laser, and why would I use the laser for these reasons?” And it’s like everybody’s an expert lasering symptoms. And then you get system benefits as well, laser the spine, the brain, the organs. Don’t have to do ’em all at once, but it’s just those large, physiological windows that should fit directly into your physiology, and now you have a tool to enhance the great work you’re already doing.
In many states for chiropractic, acupuncture with a certification is legal as well. And lasers work fantastic to use the physiological windows of the specific meridian points. Some of these meridian points seemingly have nothing to do with direct neurological indicators, but yet if you were a traditional Chinese medical doctor, these would be the points that were used. So lasers are the greatest integrating tool we can ever bring into our practice and even using the meridian system in combining with our neurological understanding of the body, it works great to pull the two together.
So at this point, this concludes just the basic information of how basic and simple lasers are to use. And if there’s any questions out there, we can start taking them at this time.
Daniel: Well, thank you, Jerome. This has been extremely informative, and I was certainly impressed to see the wide range of applications of therapeutic laser in the practice. We’ve been collecting some questions from the audience, and I’d like to go ahead and get to those now. One of our viewers asks, “Is it safe for low-level lasers to be used on infants and children?”
Jerome: That answer would be yes. And again, as we’re talking specifically low-level lasers. Now, one of the things I always really recommend to chiropractors if I would ask you the question when is it safe to adjust an infant or a newborn. Many people would say immediately at birth, or one day after, shortly. Just pretty much instantaneous in the birthing process. And if you are comfortable working on kids already with your skills as a chiropractor, absolutely. Low-level lasers would be 100% safe to work on kids. Now, if you’re not really skilled at working on kids already, not that the laser is not safe to work on that person. But I do think just people’s comfort level and what they naturally do as a clinician should be involved with that.
So looking at the kids, sometimes doctors will ask me some concerning diagnoses that they have never even treated that type of patient in a practice before. And they’ll be like does lasers work on Lou Gehrig’s disease. I’ll be like, well, have you ever treated Lou Gehrig’s disease? And if they say no, I’m like you know, let’s just kind of focus on some things that you already do consistently well in your practice. But you have some people that are kinda stuck and plateaued in a particular situation. And let’s start helping them first. But definitely, kids and infants, lasers are so safe, especially if you already have a pediatric-based practice and you understand some of the common conditions working with children and help strengthening the nervous system, increasing circulation, boosting the immune system. Absolutely lasers are for you.
Daniel: Very good. We have another question for you. And this of course really applies directly to chiropractic. How can a laser be used to help clear subluxations?
Jerome: That’s a great question, because sometimes people misinterpret lasers as it doesn’t fit within the philosophy of chiropractic. But I think again, physiologically there’s an absolute direct correlation. So we’ve kind of alluded to in the webinar already that stress, and especially stress to the nervous system chiropractors have always said it’s physical, chemical and emotional. And so when we look at a physical stress in this instance, being the subluxation no matter what causes it, subluxations absolutely do cause neuro degenration at this specific area, as well as it does cause neurological stress and degeneration through the entire nervous system.
So where their physical stress is at, whether it’s degeneration on x-ray or just sore inflammation and that hyper sympathetic response, by lasering that area, and absolutely I would adjust and follow up with the laser to understand that physical stress, that physical injury, that neurological injury, that mitochondria injury that’s been involved by that subluxation. So I would tell chiropractors would you rather adjust somebody that has 45% of the mitochondria working or would you rather adjust somebody that has 70% of the mitochondria working? All else being normal, you will always get better results the more mitochondria you have. And that goes for all of us on that webinar.
Daniel: Very good. We have a really interesting question here that I’d certainly like to know what the answer is. How can you use lasers with respect to benefits that…I’m sorry, with respect to patients that require surgery?
Jerome: All of us, we have helped people avoid surgery. I know everybody could probably write a whole “Chicken Soup for the Soul” testimonial book on that. But we do attract people that also need surgery at some point. They’ve just waited too long before they can come in to us. Now Erchonia has achieved specific FDA clearances in the plastic surgery realm. And one of the FDA clearances related to a plastic surgeon who has mapped out very specifically if you laser pre-surgery there is an entire level of healing you will never get back in the post-healing process. So it’s always great if people come to you, you get their body as strong as possible.
And I do, I get people that right out of the gate that I tell ’em it’s like wow, you are a candidate for surgery. And we’re gonna do everything we can to avoid this, however, the one thing I can promise you, and yes, I even use that word, cuz I’ve done it so many times. One thing I can promise you, if you have to have surgery you will have a night and day different outcome, based upon us preparing your body, getting you stronger, getting you biomechanically sound, and using the laser to actually load the cells with energy. It was very, very clear in Dr. Rodrigo Enere’s [SP] research in terms of patient benefits that related to pre-lasering.
And then, of course, the post-laser benefits. So the laser is also FDA cleared for the Baker scale, which is a scarring scale that’s commonly used in plastic surgery. And even people who suffered scarring who never had low-level laser used on them it actually would change and improve even chronic scarring in the fact of textures, even long, long after the surgical process was there.
So it is, it’s just that metabolism that lasers help in that healing process. And so we have extra lasers in our clinic, and even some people in the community that unfortunately we’ve never even got to see as chiropractic patients, but we have lasers rented out to people all the time for pre and post-surgical wound healing. And it never surprises me, but we get the stories all the time. “My surgeon can’t believe how fast I’m healing.” Doesn’t surprise me, but you just do what you can with people, and that’s gonna be a common response.
Daniel: Hey, we’ve got a couple more questions, and we do have time to get to them. And some of these are really quite good. Can I ask you this one? Do we need to laser directly to the skin, or can we laser through the clothing?
Jerome: Yeah, another great question. And when you talk about the light therapy market, such as infrared, light-emitting diodes, those require to be directly on the exposed area of treatment and yes even touching the surface. So in terms of using an infrared, it’s not coherent, it’s invisible. And if it’s not touching the surface area you’ll get a dissipation of the photonic energy and obviously decreasing efficiency. Light-emitting diodes have nowhere near the penetration power or efficiency that lasers have. So once again, they need to be directly on the skin.
Now, I prefer to treat skin on skin, however, when using true lasers a photon is the smallest particle known to man. And the waves are coherent. And in seminars I show people where I can treat people through a chair and get ortho-neuro indicators to change in seconds. I would never treat somebody like that in the clinic necessarily, but it does give an example of the AMA [inaudible 00:42:40] guidelines of pre and post-testing and validation for treatment. And yes, I can treat you through a chair with a laser, and even see neurological indicators change.
Now, that being said, if I can just lift up a shirt, or I would never try to convince a patient if they say I don’t believe that goes through clothes. I say great, next time you come in just wear something more comfortable that we can expose the area because I prefer to treat skin on skin as well. So I just never let that get in the way of somebody’s healing or benefits. And I don’t try to convince them outside of what is obvious.
Daniel: Gotcha. Here’s another one. I think that most DCs are going to have a certain number of patients who have metal implants. Can you use lasers safely over areas that have metal implants?
Jerome: Now with low-level lasers there is no heat. There’s no photothermal. And I wouldn’t say this is even a grey area. There is not a….from what’s written in a manufacturer’s book, I do not work for any laser company, even though I am a clinician and I lecture on lasers. So even if in certain manuals from a manufacturer, even if it’s low-level lasers, maybe it would say in there you can’t use with pacemakers and you couldn’t use with implants or something like that. But as a clinician, I can tell you because I’m not a manufacturer, that we will get people that have actually had a lot of pain and inflammation post-implantation. And it’s almost like the body’s having an allergic response and almost kind of rejecting the implant, even if it’s titanium. And it’s been pretty astounding that even just lasering people after the surgery, even if it’s been weeks of inflammation. Literally, almost some it’s instantaneous, some it’s a couple days where literally it will decrease that inflammation and lack of healing process after the surgery. So I would say it is, it’s incredibly safe.
I would never try to convince somebody that this works. Nobody has ever gotten sued for these reasons, but I always tell people, people are crazy out there. You just have to defend yourself properly. So if somebody didn’t think this could help them, and even if I had some relationship with them, I’m like no, no lasers can really help you, everything you’re going through. And if they had some other adverse effect that had nothing to do with something you did, like a post-surgical infection and they blamed you for it and they says, “I didn’t want that laser in the first place and they just kinda forced it upon me.” You would have to defend yourself that you were practicing within your scope of practice.
So I always tell people keep it within your license. Your different state borders are different. You just have to take those things up with the scope of your practice. Don’t necessarily try to convince anybody, but me as a clinician telling you, no. It’s incredibly safe. There’s nothing low-level lasers could do to create concern with a metal implant. And that does not go for [inaudible 00:45:42] and higher-powered products at all.
Daniel: Very good. This one, I don’t know if you’ll be able to answer it, but it’s clear that quite a few people in our audience are already using laser and they were coming for tips and ideas. One doctor writes in, “We’re challenged by billing for laser. The new AMA regulation 2014 pushed for 15 minutes to be a billable segment, and there have been articles stating possible detriment from extended time.” I believe that’s with respect to use of laser. Are there any concerns in terms of billable sessions combined with laser treatment times?
Jerome: Well, I personally am a fan of cash. And I think when people are somehow really overly concerned about where insurance has gone, I didn’t buy my patients insurance. I don’t even know why I should accept the patient’s insurance, other than if it meets a certain qualification. And what we do is so powerful and valuable. So I guess nobody goes to their hairstylist and asks them for insurance. The fitness industry is the largest cash health industry on the planet. Insurance doesn’t pay anybody for personal trainers and performance coaches and strength coaches and gym memberships. So I think we, as chiropractors, should be leading the entire cash income because of the value we have for people in terms of our cash system and services.
So I think lasers are ideal to charge cash for. There are insurance plans that will pay for laser. And that’s your choice as a practitioner to accept those things. I always think some people underestimate the value that they have out there, and what we really do. And as we start looking at the change of market, instead of being concerned are lasers covered by insurance, the reality is across the board everybody’s deductible is higher. So no matter if you go to an MD, a DO, a PT, a chiropractor, you have to meet your deductible. So to have more quality, cash services that people get in order to spend to meet their deductible is really where things are at right now. And of course, the adjustment speaks for itself and unfortunately not everybody’s aware of it like we are. But to use lasers as a cash incentive for valuable services, especially combined with chiropractic, I am personally very cash-driven and motivate my patients to be too.
Daniel: Understood. And with that answer, you actually have addressed two other related questions. And that brings us to the end of our question and answer period. Thank you for those patient explanations.