Pulsed Signal Therapy - this is available at two hospitals Dr. Crowe visits. It was developed by Dr. Richard Markoll MD, PhD for the preservation and recovery of articular cartilage. Its an amazing therapy. If interested please call Dr. Crowe for more information.
Another type called targeted Pulsed Electromagnetic Field Therapy (tPEMF) is available as a portable device and Dr. Crowe uses this device and type of therapy very commonly in his surgical patients. Please go to www.assisianimalhealth.com for more information or also contact Dr. Crowe. Below is an article that he and others published in the Proceedings of the Florida VMA Annual Meeting April 2015
Use of a Targeted Pulsed Electromagnetic Field Coil in Practice
Dennis T Crowe1, Laurrie McCauley2, Deirdre Chiaramonte3, Arthur A Pilla4
1Regional Institute for Veterinary Emergencies and Referrals, Chattanooga, TN; 2TOPS Rehabilitation For Animals, Grayslake, IL; 3 NYC Mobile Vet and Assisi Animal Health, NY; 4Departments of Biomedical Engineering, Columbia University and Orthopedics, Mount Sinai School of Medicine, NY
Introduction: Non-thermal and non-invasive pulsed electromagnetic fields (PEMF) have been successfully employed in human applications since the 1970s. The primary applications have been as adjunctive therapy for the treatment of delayed- and non-union fractures, fresh fractures and chronic wounds. As the mechanism of action of PEMF has become better understood, the signals could be configured to target specific pathways. This has permitted technologic advances allowing the development of PEMF devices which are portable and disposable, can be incorporated into dressings, supports and casts, and can be used over garments or simply held over the area of the body requiring the therapy as most treatment times are just minutes long. This advancement in understanding the mechanisms of action broadened the use of non-pharmacological, non-invasive PEMF therapy to the treatment of post-operative pain and edema to enhance surgical recovery. The result is PEMF therapy is now part of the standard armamentarium of the orthopedist and plastic surgeon and is rapidly becoming an integral part surgical care. There is active research in clinical applications for osteoarthritis, brain and cardiac ischemia, multiple sclerosis and traumatic brain injury. It is only in the last decade that PEMF therapy has seen increased application to veterinary problems. This review will summarize the basic and clinical research, which led to the Assisi Loop and present clinical examples in the veterinary arena; and hopefully lead to more use of this therapeutic technology. The tPEMF Signal: PEMF signals with a vast range of waveform parameters have been reported to reduce pain and inflammation , and enhance healing . A common unifying mechanism was proposed, which involves Ca2+/calmodulin CaM-dependent nitric oxide NO/cyclic guanosine phosphate cGMP signaling, to quantify the relation between signal parameters and bioeffect . The CaM/NO/cGMP signaling pathway is a rapid response cascade which can modulate peripheral and cardiac blood flow in response to normal physiologic demands, as well as to inflammation and ischemia . This same pathway also modulates the release of cytokines, such as interleukin-1beta (IL-1β) which is pro-inflammatory , and growth factors such as basic fibroblast growth factor (FGF-2) and vascular endothelial growth factor (VEGF) which are important for angiogenesis, a necessary component of tissue repair . Studies at the cellular level showed tPEMF could modulate NO and cGMP release from challenged cells . These studies employed CaM antagonists and nitric oxide synthase NOS inhibitors which blocked the tPEMF effect, confirming the validity of the proposed mechanism. Other cellular studies showed that the master pro-inflammatory enzyme interleuken-1beta IL-1b could be down-regulated by tPEMF . This enabled the parameters of the tPEMF signal to be defined as a 2 msec burst of a 27.12 MHz radio frequency carrier repeating at 2 bursts/sec. The induced magnetic B field is 4 ± 0.4 mT and electric E field is 4 ± 0.4 V/m. This tPEMF signal can be delivered by portable battery-operated devices such as the Assisi Loop.
Animal and Clinical Studies: Blinded studies in the rat showed that tPEMF accelerated wound repair by 60%  and tendon repair by 70%  using tensile strength testing. Other animal studies showed tPEMF reduced IL-1b in cerebrospinal fluid 6 hours after post-traumatic brain injury in a rat model ; down-regulated IL-1b and upregulated IL-10 (anti-inflammatory cytokine) in a mouse cerebral ischemia model , and upregulated IL-10 within 7 days in a chronic inflammation model in the mouse . In randomized studies in the clinical setting tPEMF enhanced the management of post-operative pain and inflammation by significantly accelerating post-operative pain and inflammation reduction, and, concomitantly, reducing post-operative narcotic requirements [13-15]. Two clinical studies in humans [14,15] showed IL-1b in wound exudates of active patients was 50% of that for sham patients at 6 hours post-operative; wound exudate volume at 12 hours post-operative was approximately 2-fold higher in sham vs active patients in both studies. Reductions in IL-1b and wound exudate volume are consistent with a tPEMF effect on inflammation via CaM/NO/cGMP signaling. In an unpublished veterinary study that started in April, 2009 (Crowe and McCauley) 80 pet dogs and cats were treated with the Loop by two veterinarians. In all cases the portable device was placed over the area of pain, edema or redness for 15 minutes. Clinical changes in the patient’s demeanor, actions, breathing characteristics, visible redness or swelling or other physical signs were observed and recorded .When able a 10-point pain scale developed to compare pain before and after therapy was applied. Loops were often continued to be used in treatments after the pet was discharged from the hospital following owner instruction and asked to provide observed signs that they saw in their pets at home before and after treatment. Both veterinarians often observed decreases in pain, improvements in mobility, and decreases in edema and redness is wounds, and in some cases, quite obvious improvements. This study is described in more detail in this manuscript and a few of these patients are described later in this publication.
A few Examples of Papers Previously Published Use of Pulsed Electromagnetic Fields for Ischemic cardiomyopathy Therapy (EFFECT Trial): A Randomized, Double-Blind, Parallel, Placebo-Controlled, Prospective Trial from the Cleveland Clinic –Florida, Weston, FL and Columbia Univ., NY, NY by M. Shen, C. Casher, M Chandy, et al. Poster AHA Annual Meeting 2009. Evidenced-Based Use of Pulsed Electromagnetic Field Therapy in Clinical Plastic Surgery. Strauch B, Herman C, Dabb R, et al: Aesthetic Surgery Journal Vol 29, No 2, March/April 2009, pages 135-142
Limited Myocardial Muscle Necrosis Model Allowing for Evaluation of Angiogenic Treatment Modalities Mitesh K. Patel, M.D.,1 Stephen M. Factor, M.D.,2 Jennifer Wang, B.A.,1 Suman Jana, M.D.,3 and Berish Strauch, M.D.1 JOURNAL OF RECONSTRUCTIVE MICROSURGERY/VOLUME 22, NUMBER 8 NOVEMBER 2006 pages 611-615
ABSTRACT: The currently accepted model for creating infarcted cardiac tissue in a rat model involves ligation of the left anterior descending artery (LAD), either proximally or at the bifurcation level. This procedure requires significant technical expertise and, even in skilled hands, commonly results in a 30 percent to 60 percent animal mortality. The authors propose a new model for creating a limited area of myocardial muscle necrosis that can be effectively studied. It involves a distal electrocautery occlusion of the LAD terminalbranches and coagulation of the surrounding muscle. The model is consistently reproducible and decreases the morbidity of the study animals. It provides a cardiac muscle necrosis model not dependent on survival, while allowing study of the post injured state of the muscle and surrounding scar. This allows researchers to evaluate neovascularization and healing of the scar and peri-necrotic muscle, to assess improving blood flow with treatment by techniques designed to improve and stimulate angiogenesis, and to measure the outcome of stem-cell transplants for potential clinical use. KEYWORDS: Myocardial necrosis, rat, electrocautery,
Protective Effect of Low Frequency Low Energy Pulsing Electromagnetic Fields on Acute Experimental Myocardial Infarcts in Rats Alberto Albertini,1 Patrizia Zucchini,2* Giorgio Noera,3 Ruggero Cadossi,2 Carlo Pace Napoleone,3 and Angelo Pierangeli3 1Hospital S.M. Misericordia of Udine, Udine, Italy2Department of Medical, Oncological and Radiological Sciences, University of Modena,Modena, Italy 3Department of Heart and Great Vessel Surgery, University of Bologna, Bologna, Italy Bioelectromagnetics 20:372–377 (1999)
ABSTRACT: This series of experiments assessed the effect of exposure to low-frequency pulsing electromagnetic fields (PEMFs) in 340 rats with acute experimental myocardial infarcts. The left anterior descending artery was ligated with suture thread, and the rats underwent total body exposure to PEMFs until they were killed. Twenty-four hours after surgery, the necrotic area was evaluated by staining with triphenyltetrazolium chloride. A significant reduction of the necrotic area was observed in the animals exposed to PEMFs compared with the nonexposed controls. Exposure for up to 6 days does not appear to affect the area of necrosis, although in exposed animals an increase of vascular invasion of the necrotic area is observed: 24.3 % as against 11.3 % in controls. No effect on the necrotic area size from exposure was found when the left anterior descending artery was occluded for 60 min, followed by reperfusion. The results reported showed that exposure to PEMFs was able to limit the area of necrosis after an acute ischemic injury caused by permanent ligation of the left anterior descending artery. These data are in agreement with the protective effect of PEMFs observed on acute ischemia in skin free flaps in rats and in cerebral infarcts in rabbits. Bioelectromagnetics 20:372–377, 1999.
Myocardial function improved by electromagnetic field induction of stress protein hsp70 Journal of Cellular Physiology Early View (Articles online in advance of print) Published Online: 29 Apr 2008 Isaac George 1, Matthew S. Geddis 2, Zachary Lill 1, Hana Lin 3, Teodoro Gomez 2, Martin Blank 4, Mehmet C. Oz 1, Reba Goodman 3 *1Department of Surgery, Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York 2Department of Surgery, Division of Surgical Sciences, Columbia University College of Physicians and Surgeons, New York, New York 3Department of Anatomy and Pathology, Columbia University College of Physicians and Surgeons, New York, New York 4 Department of Physiology and Cellular Biophysics, Columbia University College of Physicians and Surgeons, New York, New York email: Reba Goodman (firstname.lastname@example.org)
PEMF Signals Protect Dopaminergic Neurons from Lipopolysaccharide-Induced Inflammation in Culture. Diana Casper, Eric Taub, Luna Alammar, Ann Pidel, Arthur A Pilla. Neurosurgery Laboratory, Monteiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY and Department of Biomedical Engineering, Columbia University, New York, NY
ABSTRACT: PEMF increased neuronal survival in response to post traumatic inflammation in laboratory neuronal rat cells by daily applications of the IVIVI loop. The PEMF reduced microglial activity and it increased Ca calmodulin dependent NO levels (nNOs).The PEMF also deceased Ca/CaM- independent NO levels and it also increased cGMP in the injured neuronal cells. Potential applications include Parkinson’s disease, Alzheimer’s disease, Amyotrophic Lateral Sclerosis, Huntington’s disease and possibly age related diseases.
Description of a tPEMF Treatment 1. The device is turned on by a switch, and the self-contained timer is started. 2. The loop is laid on the patient where the clinical problem is located ), directly or maintained within a few centimeters of the surface of the tissue, as the fields generated will penetrate dressings, casts, etc.. An affected part of the body, such as an appendage or neck, may also be placed also within the loop). No heat is generated by the pulsed signal. It is important that the loop be kept at least 6 inches away from metal cages sides or metal floor and metal tables, to prevent interference with the electromagnetic signal. If there is a large amount of metal within the patient it will still be effective but the metal can act as a shield from the incoming signal. Therefore the loop should be placed where the shielding will be minimized by the anatomic location. As an example, if there is a large bone plate on the lateral aspect of the femur then the loop should be placed on the medial side of the leg when providing treatments. Simply re-orient the loop so the volume of the metal in the field is minimized. After 15 minutes treatment is complete and the device is manually turned off. For further information the reader is encouraged to visit the following web site: www.assisianimalhealth.com.
Veterinary Clinical Experience with tPEMF Case Inclusion: We (Crowe and McCauley) began to document and track the small animal cases reported here after witnessing dramatic results in our own practices. Investigation began independently in April, 2009). Other investigators added treated cases as well. We treated any patient having recognized pain, edema, or redness, traumatic wound, a surgical procedure or condition thought to be involved with inflammation. This included both acute and chronic conditions. A total of 80 patients were observed with a positive response in most (70) and with a common verbal responses from both owners and veterinarian as “fantastic “and “amazing”. We present 5 illustrative cases below.
Methods and Materials: Treatment was administered both in the office, and/or by the owner after discharge home using the portable device (see individual reports, below). In all cases the loop was placed over the area where pain, edema, or redness was present and held in that location or temporarily taped in place for about 15 minutes. Clinical changes in the patient’s demeanor, actions, breathing characteristics, visible redness or swelling, or any other physical signs were observed and recorded. When appropriate, we applied a 10-point pain scale developed by McCauley to compare pain before and after therapy (Table I). As appropriate, owners were asked to report observations, and to provide a pain scale number pre- and post-treatment. These observations, as well as those made by the authors were compiled. In some cases the changes in pain scale were arrived at after only a single in-office treatment. In others patients received as many as 30 total treatments, 2 or 3 times each day for 15 days. Where multiple applications were performed the lowest and highest scale numbers were reported for the comparison.
Results: We observed a marked reduction in pain (dropping from 1 to 3.5 on the pain scale (table 1) when all pre-treatment and post- treatment scores were analyzed for 60 patients (where pain scale comparisons were able to performed). Edema was also observed to be improved (comparison photos or circumferential measurements). In some cases the results were clinically very apparent and some of these will be discussed in the presentation.
Case Descriptions of tPEMF Treatment Case 1 "Rayne,” a 15-month-old Great Dane presented with all the clinical signs of a cervical malformation - myelopathy, unable to rise without assistance, diminished proprioception, and a typical “Wobbler” disease gait. Radiographs confirmed the vertebral malformation at C4- 5, C5-6. The loop (orange) was placed over her head and positioned over the affected portion of the neck. The first 20-minute application improved coordination, and she able to rise on her own with difficulty. Pain was difficult to assess –scale not applied. The dog’s gait continued to improve according to the owner, and after 2 weeks of twice a day applications she stopped placing the loop on the dog’s neck. She has also been treated with photonic and BICOM therapy, but has had no surgery. Follow-up: The patient continued to do well for 1.5 years post-therapy. Rayne showed only a very slightly slower than normal CP, but otherwise deficits were not detectable and she ran and played without any or very little compromise. A video of this patient can be observed on the web site at www.ivivihealthcare.com.
Case 2 “Pepe” a 10-week-old Maltese presented with a severe head injury. On admission he was obtunded and had the first of several seizures. Loop treatments began approximately 12 hours post injury. A total of 7 treatments were completed, with the loop applied every 4 hours for approximately 20 minutes. The patient also received 9 sessions of Hyperbaric Oxygen Therapy. Applying the loop appeared to calm him and help him sleep. Circling behavior and torticollis to the right also seemed to lessen after tPEMF treatment. Pepe was able to rise at discharge, with less miosis and more positive menace response to light. His owners continued treatment and after approximately 2 weeks he began making significant improvement. Follow-up 4 months post treatment he was “nearly normal,” but still not able to see. Pain scale assessment: pretreatment= 5; post-treatment 0.
Case 3. “Panda,” a 6-year-old Australian Shepherd received a primary diagnosis of Metaldehyde toxicosis. While receiving acute care, Panda aspirated Toxiban. He was treated with methocarbamol, diazepam, phenobarbital, and supportive intravenous fluids. The initial hyperthermia was treated with cold application. Clinical evidence of difficulty breathing was treated with nasal oxygen bilaterally, however pulmonary failure progressed and ventilator support was required. The loop was used on both sides of the thoracic cavity and over the head for 30 minutes every 8 hours to decrease secondary edema and inflammation. Immediately following the first therapy it was noted that the patient seemed more comfortable, even when on a ventilator. Panda was weaned off the ventilator in 24 hours. After several more days of intensive care support he was discharged with good neurologic and pulmonary function. Pain scale assessment pre-treatment = 6-8; post-treatment = 0-1. Panda was doing well at a 1 year- follow-up.
Case 4 “JD” a MN Golden Retriever following a road rash injury to his nose and left frontal region. The owner had not witnessed the trauma. He also was much quieter than he is normally, according to the owners observations. He was hospitalized and observed through the week-end for a concern that he had been struck by a moving vehicle and a possible concussion had occurred. The ICU technicians stated that he was much brighter after the first tPEMF treatment (pain scale not applied) and continued to improve throughout his hospitalization. He was treated with tPEMF treatments were done for 15 minutes every 8 hours and then the Loop sent home for continued treatments . The wounds were cleaned with electrolyzed oxidized water and left open. No dressings were applied. Impression: significant healing in just 2 days compared to other wounds seen with comparable trauma and then at 5 days
Case 5 “Raffi” is a 13 year old MN Rat Terrier presented with acute respiratory distress *. It was believed that may started as tracheobronchitis and after coughing through the night he suddenly got much worse. He was cyanotic and presentation and the sounds from his upper airway were quite apparent. The airway generated sounds could be heard from across a room and both a mixture of pharyngeal and laryngeal in nature. The dog was in a panic and was noted to be difficult to manage in previous visits so all doctors and technicians were concerned that the dog could also try to bite as his past medical history indicated. After placing on a treatment table and trying to deliver supplemental oxygen to him a Loop was eased over his head so that he could ware it as a collar on is neck. Within 5 minutes the loudness of the airway sounds were greatly diminished and his tongue color became pink again. He also appeared to be breathing with less effort on inspiration. In another 5 minutes the airway sounds had just about diminished to being nonexistent and now there was no additional respiratory effort observed and he was much more calm (pain scale not applied). The patient was still making some abnormal sounds and the thought was that he could still have a foreign body somewhere lodged in his airway region so he underwent a radiographic evaluation of the cervical region and thorax and laryngoscopic and bronchosopic examination and no foreign bodies were noted. There was some mild evidence of edema and redness of the larynx on some tendency toward tracheal collapse and the possibility of aspitation on radiographs so antibiotics were prescribed. He recovered and with further airway or pulmonary clinical signs.
Case 6 “Shep” a 7 year old MN German Shepard dog that had a maxillary malignant fibrosarcoma that was operated twice for removal (once with conventional surgery and once with CO2 laser surgery) and after the tumor returned within weeks of the second surgery the area was treated twice each day with tPEMF therapy. Initially the first observation was that it appeared that the tumor growth had arrested or at least slowed down dramatically and the dog appeared to be much more comfortable (the pain scare was not applied) . In 6 weeks the owners said that thought the mass was getting smaller. This was verified on subsequent examinations. At a 6 month follow-up there was no further tumor visibly present on physical exam. The owners and stop using a loop and within six months the tumor had returned. Again the loop begano be used again for therapy but this time the tumor did not respond to the therapy. Eventually the dog was euthanized.
Case 7 "Grace" 6 yr old lab / Dalmatian cross that belonged a veterinary praticioner that uses the loop frequently. For a few weeks the dog began having neurologic signs and an MRI confirmed a large pituitary gland tumor described as 1/3 the size of her brain. The loop vastly improved her symptoms for several weeks of compulsive circling to the right, difficulty prehension of food, depression and severe pain. After applying the loop 2-3 times each day the clinical signs greatly dissipated. Her appetite returned and she appeared to feel so much better. The owner was convinced that the loop applications greatly improved the dog’s quality of life for several months. Then the clinical signs worsened and she was euthanized.
Closing Summary Our experience (Crowe, McCauley) with the Assii Loop device, both for inpatient and home treatment, suggests that this treatment modality is efficacious and cost effective for the treatment of pain, edema, and inflammation, without adverse effects. In addition, the availability of a clinic-based unit supplemented by a portable unit prescribed for use at home creates the opportunity to an excellent continuum of care. Further research is underway to analyze other outcomes and possible uses of this technology. The mechanism of action holds promise for a broad range of syndromes that have previously eluded reliable treatment. Currently the authors recommend the use of the technology in any patient with pain, edema, or disease or injury where ischemia is thought to be present. This includes many conditions that veterinarians face each day. Some of those that have been particularly been noted to see improvements following the use of the loop include intervertebral disc herniation, pancreatitis, severe wounds, fractures, post neurologic and orthopedic surgeries, ligament injuries, and chronic osteoarthritis in the hip stifle and elbow, neuropathies and myopathies.
Table I Pain Scale (Courtesy of Dr. Laurie McCauley, TOPS Vet Rehab) 0. No Pain - Alert and Happy 1. Occasional Pain - Happy most of the time 2. Mild Pain - Can be Ignored (distracted) easily 3. Mild Pain - Can be Ignored (distracted) with a bit of effort 4. Moderate Pain - Changes in breathing pattern (pants more often or more frequently when heat is not a factor 5. Moderate Pain - Pain interferes with some difficult tasks (difficulty getting on the bed) 6. Moderate Pain - Pain interferes with some easier tasks (difficulty going up or down stairs; getting into/out of the car) 7. Pain interferes with Concentration - Change in attitude (grumpy; loses patience easily) 8. Pain interferes with Daily Function of Living behaviors (difficulty getting up; difficulty maintaining a squat to urinate or defecate) 9. Severe Pain - does not want to do anything or even get up; not wanting to eat. 10. Severe Pain - Worst pain possible; moaning; crying out often; glazed look in their eye
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Acknowledgements. The author (Crowe) would like to recognize Dr. Joey Gross at Mars Hill Animal Hospital, Bogart, GA and Dr. Hilty Burr at Lake Chatuge Animal Hospital, Young Harris, GA and all the doctors and staff at the Regional Institute for Veterinary Emergencies and Referrals, Chattanooga TN for their contributions to cases studied and presented. I would like to dedicate this presentation to my colleague, Dr. Burr and his wife Susan and their dog Grace. She is listed as the 7th case in this series presented. Dr. Burr has been very supportive of the use of the Loop from the very beginning went I stated using it at their practice.
A note from Dr. Hilty Burr “I also credit the loop to minimizing the growth of an anal adenocarcinoma in a 15 yr. old Yorkie using the loop over the past 18-24 months.