2 Joules/sq. cm. -- doable from red Luxeons?

[hank]

I'm looking to provide a really bright 650nm light source a kid in the hospital having chemotherapy can use on ulcers in the mouth. There are several children's cancer hospitals using that kind of light successfully for this problem. This hospital where this kid is doesn't do it yet. I've given them printouts of the research (see links below).

Meanwhile they say "we'll read up on it, go ahead and get a bright light source yourself, it can't hurt the kid, and if it helps reduce the ulcers that's good."

I'm wondering how close I can come with red Luxeon or other high-brightness red 650nm LEDs -- I know it won't be very close --- to the medical red laser system used in this study.

Right now they're on the recovery side of the last chemo treatment, and have a regular red laser pointer and will soon have a regular Luxeon red flashlight mod to use, and it may help with skin healing even now.

 

[hank]

I'll give them the standard mod red Luxeon most CPFers know about this week.

In a few weeks, before the next round of chemotherapy starts, I'd like to give them the brightest 650nm light that can be aimed inside a child's mouth.

So it can't be a big Mag mod -- it'd need to be the brightest 650nm or so LED source possible to cram into a small aperture, well heatsunk, flashlight. A superbright M@g AA, basically, or something like that.

Here's the idea ---

The light works BEFORE and during the chemotherapy --- apparently it perks up the new skin cells being formed, and helps them resist the damage the chemotherapy does. Usually, a week after the chemo, ulcers happen -- and it's really hard for kids to eat then until they resolve in another week or more.

The measured brightness at the skin was 2 Joules per square centimeter.

http://www.springerlink.com/content/910406505t28l259/

I found one other study here:

http://bloodjournal.hematologylibrary.org/cgi/content/full/109/5/2250

(full text of that one is available, for anyone interested -- the statistics are awesome, it's very, VERY effective helping with this very serious side effect of chemotherapy)

"Remarkably, the hazard ratio (HR) for grades 2, 3, and 4 OM was 0.41...and for grades 3 and 4 it was 0.07.... 5.3% of the laser group presented with ulcers of 9.1 cm2 to 18 cm2, whereas 73.6% of the control group presented with ulcers from 9.1 cm2 to 18 cm2 (P = .003).... use of upfront LPLT in patients ... is a powerful instrument in reducing the incidence of [mouth ulcers] and is now standard in our center."


They achieved twice the brightness:
A diode InGaAlP was used, emitting light at 660 nm, 50 mW, and 4 J/cm2

That's 10x the power of the usual red laser pointer's maximum allowed 5mW

But I'm sure just using it longer will help.

Anyone technical enough to help me understand what sort of homemade light might come anywhere near 2 or 4 Joules/square centimeter?

A little bent-plastic waveguide might serve to bring it all into the mouth -- but an ordinary wide bright spot should be plenty.

=============
Note there is at least one prior article on LED light and health -- red and infrared and blue all have their medical uses. I'll crosspost a reference when I retrieve that, but am posting this one to be specific about this one use.

 

[2xTrinity]

The measured brightness at the skin was 2 Joules per square centimeter.

...

Anyone technical enough to help me understand what sort of homemade light might come anywhere near 2 or 4 Joules/square centimeter?

Joules is measure of energy. Brightness is usually a measure of power in watts (joules/second), along with some sort of weighting factor. In the case of this therapy, the relevant figure is just the unweighted power in mW/sq-cm.

This means with a light that is 1/10th the brightness, you simply run it for 10 times longer and you have the same joules/sq-cm. It's the same way film exposure times are determined.

Most LuxIII red LEDs can draw around 3 watts, and I'll assume maybe just under 20% radiant efficiency, or 500mW of red light. It seems to me based on what you've said, if it really is as simple as the article is suggesting, the most efficient approach would be NO optic, just a uniform flood of red light inside the mouth, run for 1/10th as long as total time they were sweeping the red laser around.

One thing to remember though is that Lux III red LEDs are more like 630nm, I don't know if 650nm is carefully selected for some biological reason, or because red laser diodes conveniently happen to emit at 650nm, so they tested there. I also don't know if the light being coherent (laser light) is biologically significant.

Note there is at least one prior article on LED light and health -- red and infrared and blue all have their medical uses. I'll crosspost a reference when I retrieve that, but am posting this one to be specific about this one use.

It seems like if any one of these colors had a beneficial purpose, why not sit under a broad spectrum source with the UV filtered out, it should be like doing ALL the therapies at once

 

[hank]

I am sure they want to stay away from the higher energy shorter wavelengths to minimize damage since these patients already have open ulcers in the mouth and the idea is to heal them -- a lot of medicines are photosensitizers, and the people getting this kind of treatment get a whole range of medicines.

I've seen a variety of wavelengths specified in the red range, I"m sure they use what they have and report the results. Everything I've seen so far says there's no risk with the red range, so it's what I am looking at building for amateur hour. Other colors have been tried for skin healing, with various results. Google Scholar is a good place to look, for example http://scholar.google.com/scholar?q=light+skin+wavelength+healing

 

[hank]

Re: 2 Joules/sq. cm. -- red Luxeons? AND, yellow flood headlight?

Back from some long days at the hospital.

Anyone know if there is a 3-watt LED I can perhaps swap into something like a Brinkmann 3-watt (3xAAA, on sale at Target)?

Best use of this is probably going to be to actually shine through the youngster's cheeks from the outside --- which ought to get plenty of light to the skin ulcers on the inside of the mouth.

Need this in 2-3 weeks to begin using before the next round of chemotherapy starts, if possible.

Is anyone building plain bright BRIGHT red LED lights these days?

----------------
An aside from sitting in at the hospital -- the staff are trying REALLY hard not to wake up the kids at night when they change IV lines, take vitals, etc.
So they quit using their overhead fluorescents.

Unfortunately their Admins got them some extremely bright blue-white LED cap lights and headlights that are just blazingly bright blue-white, enough to wake an adult across the room!

Nobody makes a yellow LED headlight -- or a very wide floody LED headlight --- that I can find. But now I'm looking for those too.

 

[Jarl]

Re: 2 Joules/sq. cm. -- red Luxeons? AND, yellow flood headlight?

Wide floody headlight is a zebralight H50. Bit expensive, but good.

As for red lights, there's a red rebel emitter, not sure about any stats though.

 

[MichaelW]

Well since you said no big lamps, this is out.
http://www.batteryjunction.com/tle-6exr.html

I purchased this for my sister for night flights.
http://www.led-replacement.com/tle5k2-red.html
It was a little too bright, so I told her to pick up the NiteIze IQ switch to tone it down.

It is plenty bright (without IQ switch) on fresh AA lithiums.

 

[hank]

Rebel might do, thanks Jarl. I'll look it up.
And I'll look for 3-watt red Luxeons too, I think I recall such. Not much time right now, I'll come back to this late next week if all goes well between now and then.

The big red mag dropin is bright, but I recall those drop in brightness by half within a few seconds of use because they heat up, not enough heatsink attached to the LED when total energy delivered is the goal.

Still trying to find out what the cancer centers mentioned in the cites actually used, in case they're regular clinical tools repurposed. With luck the medical people will follow up the references before the next round and preclude my amateur efforts, but it can't hurt to proceed as though they won't til they do.

 

[hank]

This may be the best bet, though I'm just going from online info:

TLE-5K2-RED TerraLUX MiniStar2 3 Watt

3 watt Luxeon, M@g AA dropin -- small enough and light enough for a kid to hold up to illuminate the area of the mouth sores for long stretches at a time.
(So cancel my question about modding a 3w Brinkmann, this ought to equal it)

We've got about a week til the next round of chemotherapy starts, so I"m going to send the family one of these and a M@g AA and some rechargeable batteries, and then keep looking for something the same size or smaller up toward 5 watts.f

Ideas still welcome of course. This is going to be going on for months off and on.

We did hear second hand that the doctor who's handling the treatment did participate in some research along these lines and favors the idea.

 

[hank]

Following up, looked at the Rebel star -- but they don't have that in 3xred yet.
They have a Red-Green-Blue star, but I don't have the soldering ability to redo one of those to handle three of the red emitters. They promise more soon.

I did verify that even the 1-watt red sources will go deep into the body, which is what's needed.

(Try letting your eyes dark-adapt then put a red emitter against your wrist and look at how much of it goes right through your arm --that's the 'carpal tunnel' area. Wish I'd known about this when I was having trouble with that medical issue, it might've helped, who knows.)

 

[__philippe]

The self contained units in the attached references both claim to use the required 650 nm laser diodes for "healing purposes", (but at a much reduced 5mW power output.)

http://www.meridianpsych.com/store/products/vitagnost.htm

http://quantum-healing-lasers.com/pointer_pulse_laser.html

No idea of their effectiveness for the intended purpose, of course...

Cheers,

__philippe

 

[hank]

Chuckle.
"... infra red light soft laser - ... cold red light (650 nm) ..."
Someone's marketing crap at 10x the price of ordinary laser pointers, I'd say.

Back to reality, for the kid I'm trying to help out:

At point blank range -- I don't see any reason a laser red light source is any better than a big bright red LED, for skin treatment. The original discovery was from red LEDs.

I'm sure for babies getting chemotherapy one reason for using a laser is just to be able to get the light source inside the mouth (and for that they'd want something very easy to sterilize, since those kids are immune-suppressed!).

Red light right through the cheeks -- over enough time to add up to the desired 1 or 2 Joules/sq.cm -- sould work as well and be less invasive.

It'd be easy to put the flashlight in a ziplock bag and sterilize that and use it -- and it'd meet the precautions for infection control that way.

 

[James S]

Though besides the point of this thread, I have suffered from non-chemo induced mouth ulcers most of my life. Sometimes to the point of distraction and as a child not being able to eat for a while. They aren't serious or anything, but if many pile up they can be quite miserable.

In the last year I've had none, zero, zip, even when things happen like my son smacks me in the mouth with the back of his head by accident like he did the other day the injury has not turned into an ulcer like it would be guaranteed to do previously.

The solution that I'm telling everybody about is just to get toothpaste that doesn't have soap in it! I read something about this somewhere on the internet and it really is amazing. You might suggest to them to find some toothpaste that doesn't have Sodium Laureth (or laurl) Sulphate in it.

That wont help with the underlying cause here, but it might help them also to heal more quickly if they aren't washing the natural protective stuff off the mucosa on the inside of the child's mouth twice or more a day.

My local grocery carries only 1 or 2 brands that dont have it. I'm using a sensodine right now. You've got to read the ingredients, as even among the same brand some kinds have it and others dont.

I hope that between your red lights and maybe alternative tooth pastes the child will suffer a bit less!

 

[hank]

The hospital does have something like that toothpaste; I don't know what.
(I just sit in to give the parents a break, daytimes, called when needed).

The doctors are doing 99-1/2 percent of the work here and all the heavy lifting; the rest of us are just trying for any little comfort we can add.

 

[hank]

Terralux website now
[Edit -- seems to suggest, but perhaps this is not true for the RED LED]
says they have a 5-watt dropin for the M@g 2xAA light:

http://www.terraluxcorp.com/products/MiniStar2Extreme.php?PHPSESSID=27c30b3a8e8a11f2f0f77535c00e7cbc

although their "retailer" link today is to a vendor selling the older 1-watt red.

I've sent three
[Edit: not sure if there's a difference between "1-watt" and "3-watt" for Terralux red, trying to sort out whether they've used different LEDs with identical part numbers for these]

Anyhow, have sent three so far red LED flashlights (one homemade, two Terralux) to the youngster, who's back in chemotherapy again now, and has been using them; we'll know in a week if the mouth ulcers are any less bad this time around.

Here's hoping ....
-------

Edited to add -- commercially available red LED dropins for M@g AAs that I know of (not sure if these are all the same LED or different as of yet)

http://www.led-replacement.com/images/tle5k2-red.jpg

http://www.zbattery.com/TerraLUX-TLE-K2-Red

http://www.lighthound.com/index.asp?PageAction=VIEWPROD&ProdID=1531

 

[hank]

Updating

Which is which?
-- the newest of these LEDs have a hexagonal base for the emitter that you can see looking at them. The somewhat older, less expensive and maybe less bright ones have a round base. I've bought both. We've been using the newer ones, bought from led-replacement, in the lights I've built and given the kids' families.

Not medical advice!
-- This is anecdotal, see the medical studies if you want medical info. Anecdotally -- the red LEDs did seem to help with the most recent couple of chemotherapy sessions. The red light was probably used irregularly, and no idea how much, but some at least on each of the last two rounds. And the youngster had a lot less trouble with mouth ulcers these times than before. Another family borrowed the lights for their kid -- no report back on them has reached me.

A couple more families on the same unit are going to try them for their kids' next rounds of chemo.

Summing up, the advice as best I figure it out from reading the medical studies is to start using the red light a few days before the chemo starts, illuminate the mouth (works right through the cheeks, good for kids' s small mouths). Continue through the five-six-seven days of chemotherapy and afterward.

My personal hunch -- getting out into bright sunlight, with proper UV sunscreen on, could also be really good, there has to be as much red light in sunlight. But the medicines can cause sensitivity to ultraviolet, so that's iffy. The hospital I've been visiting doesn't have a sunroom and it's been cold or hot or tornado weather most of the time, not good for getting outdoors with bare skin anyhow.