By Tanya Randall

RTL Intro webRL Vet, the newest generation of regenerative laser therapy, is saving lives and performance careers.A crisp, north wind blew as an early arctic front made its way across central Texas in mid-November 2014. One of the year’s brightest, and richest, futurity stars KN Fabs Gift Of Fame was enjoying some morning turnout time in her sire Frenchmans Fabulous’ pen at Kenny Nichols’ before the JB Quarter Horses Futurity in Waco, Texas.

That afternoon, J-Lo’s rider, trainer and co-owner Kelsey Lutjen called Nichols in a panic. J-Lo was three-legged lame. Lutjen’s and Nichols’ initial thought—initial hope—was that it was a hoof abscess. They met with Dr. John Janicek, a boarded surgeon at Brazos Valley Equine Hospital in Salado, Texas, at the event.

“It was a really unusual presentation,” Janicek recalls. “She was a little tender at the top of the cannon bone on the back of the left front leg when you palpated the area. I really couldn’t see anything on X-rays or ultrasound, so I called Dr. Jake Hersman at Animal Imaging. I needed an MRI of the knee and proximal (top) cannon bone, because there was something there and I just couldn’t find it.”*

Images from Animal Imaging in Las Colinas found an unusual injury.

“They found a deep digital flexor (tendon) tear in a really abnormal location, up high, actually where the cannon bone and carpus (knee) come together,” Janicek says. “There were actually three diagnoses with the main one being the deep digital flexor tear. She also had a small area of change on the back of the radius and a small area of sclerosis (abnormal bone) on a carpal bone.”

The probability of traditional treatment options like Platelet Rich Plasma (PRP) working to full efficacy was decreased by the abnormal location.

RTL01 webNearly 14 years in development, the RLT is a modified—and very powerful—surgical laser. Photo courtesy of Equicare. “Typically, we’ll use an ultrasound to guide a needle directly into the lesion and inject PRP, but this lesion wasn’t accessible,” says Janicek. After discussing J-Lo’s case with his Brazos Valley colleague Dr. Beau Whitaker, a certified equine rehabilitation specialist, the RLT Vet Laser therapy was considered the best course of action. “The laser was one of the first things that we thought of that might be beneficial in a case like this, just because of the unusual location and difficulty of getting to it.”

The Next Generation
Laser therapy isn’t a new modality, but technological advances are making them more and more powerful, and most important, more effective.

Lasers provide photon therapy, meaning they use light energy to treat damaged tissues.

“Photons are very natural, but we have to have a way to deposit them,” explains R.J. Poston, general manager of regenerative medicine at Sound, the veterinary imaging and diagnostic company that sells the RLT Vet Laser. “The sun is very powerful, but it’s so dispersed it really doesn’t penetrate beyond the skin. So what we do is concentrate photons safely into a hand piece through a fiber optic. Depositing photons into the tissues causes healing to start at the cellular level.”

The key to laser therapy is the ability to focus millions of powerful photons in an injury to foster healing without causing problems to the surrounding tissues.

“It’s like watering a garden,” Poston says. “The water is the photons and the soil is the tissue. What I have to do is use the proper protocol—the right amount of water and the right water hose to disperse it evenly, so it soaks down to the roots without damaging the soil.”

RTL03 webThe RLT Vet Laser is a modified surgical laser and is one of the most powerful therapeutic lasers on the market. Photo Courtesy of Sound. With the laser delivering the correct amount of photons to the correct location, damaged tissues will undergo photochemical, photomechanical and photothermal responses. In other words, a laser is using light energy to flip biological and chemical switches that foster the body’s own healing response to injury.

Focused energy from a laser improves the quality and speed of healing because it helps reduce pain and inflammation, plus increases the formation of new tissues, blood flow and cell metabolism, all of which reduce scar tissue and help produce normal fiber patterns within damaged tissue.

RLT Vet Laser
The Italian developed RLT Laser is the most powerful therapeutic laser on the market, with just the right specifications giving it the ability to penetrate deep into tissues, even through the hard keratin of the hoof capsule.

“All lasers work…more or less,” says Poston. “If you want to remove a little fluid, and some inflammation, maybe give a little pain relief, heal some wounds, other low powered lasers can be good for that. What separates the RLT from any other laser is its power, wavelength and pulsing mechanisms, which result in the repair and regeneration of tendons, ligaments and the removal of scar tissue.”

Nearly 14 years in development, the RLT is a modified surgical laser. Rather than cutting and removing as a surgical laser would, the RLT delivers healing energy to a focal area. Unlike surgical lasers, which only doctors can use, the RLT is safe for technicians to use as long as they’ve had training.

In 2012, renowned veterinarian and boarded equine radiologist Norm Rantanen was the first to use the RLT in the United States. As a last ditch effort to save a Quarter horse gelding from euthanasia, the RLT was used to treat a severe deep digital flexor tendon injury within the hoof capsule.

“This horse came in 5 out of 5 lame, meaning he could hardly walk,” notes Poston. “He had a necrotic deep digital flexor tendon within the hoof capsule. They got permission to laser the horse, and in two days, the horse was walking much better. The analgesic affect was very nice…it took away the pain; however, they kept lasering the horse because he was getting better. When they did a follow-up MRI, they noticed that the tendon was regenerating in a spot that was very hard to get to.”

Compared to other lasers, the RLT is a beast. It delivers a million times more power to deep injuries than do conventional surface wound healing lasers. “Horses have a slower cellular metabolism than you or me, or a cat or a dog,” says Poston, “so they need more energy to the injured tissue. The RLT is the only laser that can safely deposit a high level of energy without destroying or damaging the tissue like a surgical laser.”

In Practice
Whitaker, who took the lead on J-Lo’s treatment, had been using the RLT for about year, and like many people, he was a little skeptical of it at first.

“There are so many things out there that claim to heal tendons, joints or whatever injury your horse has; you have to be really skeptical of those things,” says Whitaker, who after visiting with other veterinarians got to get his hands on the RLT belonging to Mike Cour of Equicare, a rehabilitation center in Lampasas, Texas. “I used it for five or six months. I wanted to see if it really worked. I became a believer in it. We’ve seen some pretty amazing results with it.”

RTL02 webThe RLT Vet Laser delivers a million times more power to deep tissue injuries than do conventional surface wound healing lasers. Photo courtesy of Sound. Whitaker has used the RLT on a variety of injuries, mostly tendon and ligaments, but he’s also used the laser on some cases of degenerative joint disease (DJD).

“It’s a non-invasive alternative on some horses as far as those that aren’t responding to joint injections in certain area,” Whitaker said. “We had a barrel horse with DJD in the lower hock. Injections weren’t really affective anymore. He was really bad on flexion. They lasered him for two weeks, and when I re-flexed him, it made his flexions completely normal.

“We’ve worked on a racehorse that has some capsulitis in a fetlock. That horse has gone from crippled to almost sound. He hasn’t gone back to racing yet; he’s still being treated.”
The research to backup what Whitaker is seeing first hand is still forth coming.

“There’s not a whole lot of research out there to show exactly what the laser does,” says Whitaker, who mentioned a currently ongoing Italian study that’s measuring the efficacy of the RLT on cartilage repair in the human knee, “but there have been some in recent years that show it does improve the quality repair of tendons and ligaments. It does help regenerate collagen and align the fibers better.”
With J-Lo, the regeneration of tendon fibers was exactly what veterinarians were hoping for.

A Fabulous Gift
With Janicek and Whitaker collaborating, along with a tip of the hat from Dr. Cliff Honnas at Texas Equine Hospital in Bryan, Texas, a treatment plan was developed for J-Lo.

In addition to the RLT, J-Lo was given systemic OsPhos, a sodium biphosphonate drug used to treat abnormal bone, for the area of sclerosis on one of her carpal bones, and PRP was injected into the carpal canal, the tunnel where the tendons run behind the knee, which was the closest veterinarians could get to the actual lesion.

RTL04 webAfter the injury to KN Fabs Gift Of Fame’s deep digital flexor tendon was located via MRI, ultrasound was used to monitor healing. The lesion is circled in this image. Photo courtesy of Kenny Nichols.Equicare was responsible for administering the daily rehabilitation regimen and the RLT.

“J-Lo had 30 laser treatments,” Whitaker says. “Initially, we were doing that plus hand walking and cold, salt water spa therapy. As she improved in soundness—once we had her jogging sound in a straight line—we started her on the aquatred. Every other day, she would get laser therapy, followed by saltwater spa therapy. She was on the aquatread, five days a week with increased intensity with the water jets on that.

“I would go once a week to monitor her therapy and her progress. I’d ultrasound it and make sure it looked good and confirm that the laser settings were good with the healing that was occurring.”
In March, just four months after the initial injury, J-Lo had a repeat MRI, because Nichols wanted absolute confirmation of the mare’s soundness.

“We were amazed with her progress,” says Nichols, who co-owns the mare with Lutjen and Dale Barron. “We were originally going to do the follow up MRI in February but with all the bad weather we had to wait until March. It was just amazing how our horse is healed. She’s sound.”

Now, the only thing keeping J-Lo from returning to the arena is her second job—as an embryo donor. Although they had initially planned to go back to riding her right away, J-Lo is scheduled to have three, possible four embryo flushes. With that arduous schedule, it was decided to wait a little longer to return her to arena.

“She’s sound and good to go,” says Nichols, who hopes to have foals by A Streak Of Fling, Darkelly and Ivory James, and possibly Trippin On Fame, next spring. “She’s kicked out in the pasture, where most horses in her situation would still be in a stall. You would never have a clue that she had something wrong with her.”

MRI webThe MRI image on the right, taken in November 2014, shows J-Lo’s initial injury to the deep digital flexor tendon. The MRI on the left, which was taken in March 2015, shows healing after RLT Vet Laser treatment and therapy. Photos courtesy of Kenny Nichols.

Collaborative
Janicek says J-Lo’s recovery was “a well-orchestrated effort using different treatment modalities” to get different lesions to heal. However, the most pressing injury—the deep digital flexor tendon tear—owes a lot of its recovery to the laser.

“I think the laser had a good part in her healing,” he says. “Her lesion would have been difficult to access with a needle; it was such a small focal area in an atypical location.”
What also aided in her recovery was the rehabilitation program with the therapies, a process that’s advocated along with any RLT use. Since the laser provides pain relief and quicker healing, it’s best to foster the repair by slowly bring the horse back to form.

“We want quality healing, not necessarily faster healing,” Poston says, even though that is part of the advantage to laser therapy. “When we put a horse in the program, they get 20 to 30 treatments and rehab. They slowly work them back into competing.”

With the RLT, says Poston, it’s all about the results that time-off alone cannot deliver.

“Lesions will fill in, but it’s how the lesion fills in that’s very important,” he says. “If you’re putting a band-aid on a lesion, they’re probably going to reinjure it, maybe even more severely. That’s why we talk so much about quality healing, not so much faster healing. There’s a big difference between treating a horse with RLT and just giving them time. With the RLT, you’re going to have much better collagen repair; the fiber pattern is superior. The old guys have a saying, ‘You’re only as strong as your scar.’ We want that tissue as good as it was before.”

SIDEBAR
How could you miss that?
We’ve all been there. We leave a barrel race, knowing our horse isn’t right. We get a mid-week appointment with our veterinarian. Yet, much to our dismay, nothing shows up, or the soreness appears minor and should get better with a little time. With no improvement a week or so down the road, we’re looking for another veterinarian, because our usual one couldn’t find anything, and now the horse is worse. Lo and behold, the new veterinarian finds something.

The inflammatory response and developing injuries are the bane of both horse owners and veterinarians alike. Sometimes it just takes a while for lesions to present themselves because they’re in the process of occurring.

“Horses may seem to just stumble or “buckle” when running, only to become very lame a few hours later,” says Dr. Beau Whitaker of Brazos Valley Equine Hospital in Salado, Texas. “This can partially be due to adrenaline numbing the pain at the time of the injury and more often due to the progression of inflammation during the acute stages of the injury causing pain.”

Take the injury to KN Fabs Gift Of Fame, for instance. When Dr. John Janicek of Brazos Valley Equine Hospital first saw the mare the injury was very acute. Even though she was very painful, and a generalized area could be pinpointed, radiographs and ultrasound images were inconclusive, so more advanced diagnostics were needed.

“In order for lesions to show up on radiographs, 60 percent bone loss must be present,” Janicek says. “In comparison, only 30 percent and 20 percent bone loss is all that’s needed to be detected using computed tomography (CT Scan) or magnetic resonance imaging (MRI), respectively.”

The inflammatory process can result in lesions in tendons and ligaments appearing very differently on ultrasound immediately after an injury than they will several days to several weeks later, adds Whitaker.
“Inflammatory cells and inflammatory mediators are sent to the area as part of the body’s response to the injury,” he explains. “These cells and mediators as well as destructive enzymes released into the lesion may change the appearance on ultrasound of the fibers over several days. If a lesion is not apparent in an acute case, it may be wise to image the area again several days later.”

Tanya Randall is an avid barrel racer and veteran contributor to Barrel Horse News. Email comments on this article to [email protected]

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