Interview with Amy Randall, DVM, MS, Diplomate ACDV about veterinary dermatology, including CO2 Laser treatment
- Aside from immunotherapy, what other types of treatments and services do you offer in your clinic?
We offer treatments for any dermatologic issues including as autoimmune diseases, hair coat problems, nail bed problems, ear issues and surgeries with laser for small mass removals. Because cats – and dogs – can get sunburned, particularly on the nose and ears, we remove squamous cell carcinoma on cats with the laser and this prevents them from having to undergo a total nose amputation. We also perform biopsies to diagnose other skin diseases.
- What sorts of ear issues do your patients come in with and what are the most common treatments you prescribe?
- My patients come in with swollen, red, painful ear infections. Some of them also have yeast and bacterial infections in the middle ear which cause problems with balance and hearing and can cause a head tilt and vomiting.
- We remove masses/growths/tumors from within the ear canals and sometimes from within the middle ear. We use a videotoscope with many different instruments, including the CO2 laser, to remove these masses.
- We restore hearing loss from the use of different ear products.
- We remove grass seeds, waxy plugs, hairs rubbing up against the ear drum and other foreign bodies from the ear canals of dogs and cats.
The most common treatments we use for the ears are topical and oral steroids and antibiotic medications which help to open the ear canals and resolve the bacterial and yeast infections. Once we have the infections resolved we will then identify the underlying cause for the infection (i.e. identify the allergy) so we can then prevent the infections from recurring.
- What do you recommend to your patients with regard to regular ear care and health?
Unless your dog or cat has allergies, for the most part the pet parent does not need to worry about regular management of ear issues. For animals with allergies we recommend using a weekly drying/cleaning solution in the ears and flushing the ears with this cleaner to help and prevent the build up of waxy debris which can then lead to infection. This also allows the pet parent to appreciate how the skin of the ear flaps look and opening of the canals. This provides the pet parent with the ability to distinguish normal versus abnormal and identify when an infection is starting before it becomes painful or really odiferous.
- What is CO2 Laser procedure and what is it used for?
CO2 stands for “carbon dioxide” which is the primary type of laser used in veterinary dermatology. It emits a beam in the infrared region with a wavelength of 10,600nm. The CO2 laser beam is absorbed by water. Because water is the main component of all living cells, the CO2 laser beam is absorbed efficiently by the targeted area with minimal thermal scattering and limited thermal damage to surrounding tissues. Cells in tissue exposed to the high-intensity beam of the CO2 laser are disintegrated by vaporization, steam production and ejection of solids. The solids that are ejected with the steam are heated to a point of combustion. The combustion of solids results in a smoke plume of carbonized material.
CO2 laser is the use of a surgical laser beam which can cut skin and vaporize tissue cells. It cuts, cauterizes and seals nerve endings as well as sterilizes the tissue during the burning or cutting procedure. It is used to remove superficial growths and masses on the skin without the need for general anesthesia. Most of the growths are sebaceous adenomas or cysts. We also are able to use the laser to remove masses from within the ear canals so the patient does not need to have the entire ear canal removed and become completely deaf. We have a laser tip which can go down my videotoscope and I can see with the scope to remove the mass in the deepest parts of the ear canals.
We also use the laser on very old patients who cannot undergo general anesthesia to remove masses on the skin which are causing them pain or discomfort. Most of the small growths do not require sutures so there is no need for e-collars.
We also use use it to remove eyelid masses without sutures and remove painful papilloma virus warts in the mouth and on the feet which do not respond to a lot of other forms of treatments. Since the laser cauterized the blood vessels as it cuts, there is very little bleeding and laser surgery is less painful due to the sealing of the nerve endings. So the patient is more comfortable post-surgery.
Specific diseases which can be treated with the CO2 laser include but are not limited to:
- Squamous Cell Carcinoma (skin cancer which occurs mainly on cats)
- Feline Bowenoid in situ carcinomas
- Canine and Feline Pigmented Viral Plaques
- Actinic Keratosis (Sun damage which can lead to skin cancer)
- Tumors on the ear pinna
- Hair Follicle Cysts which are common in between the toes of dogs
- Hair Follicle Tumors
- What sort of training did you have to provide the CO2 Laser treatment?
You take courses which are offered by the companies which sell the equipment. There are additional continuing education courses offered by other specialists and companies to improve and enhance your skills. They also teach new procedures and treatment options.
- Is the CO2 Laser treatment in lieu of another type of treatment?
It provides clients the option of mass removals without the need for general anesthesia and the longer recovery periods patients have with traditional surgery, both of which reduce the risk for older patients in particular.
- What are the benefits of the CO2 Laser treatment as opposed to more traditional surgery techniques?
In many cases, laser surgery is easier, more effective, and less harmful to the patient. In some cases, laser treatment is the only method available to achieve optimal results.
- What are the risks associated with this treatment?
As long as the doctor who is performing the laser procedure knows how to use the laser appropriately, there are very few risks. However, if the laser power is too strong and too much of the surrounding tissue is affected and sutures are needed, the sutured area can open back up. Other than bad technique, there is very little risk with this type of procedure.
- What can a pet parent expect to pay for this type of treatment?
The cost is based on the type of sedation and time it takes for the procedure. The costs vary with types of procedures but it should cost less than traditional surgery since there is no general anesthesia typically. Additionally, mass removal is much faster with the CO2 Laser than is is with traditional surgery.