Applications, conditions, and patient considerations

Sponsored my Zomedica / PulseVet

Adam Christman, DVM, MBA: And let's talk about some applications and conditions responsive to shockwave. There are specific conditions that you probably have found that respond well, particularly to shockwave therapy. So what are some of those in your experience?

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: If I had to give a general overview of the types of things that respond nicely to shockwave, specifically electrohydraulic shockwave, it's the chronic repetitive injuries that are not responsive to surgical intervention. That's really the general category. So more specifically, you have a non-healing fracture. You have a chronic tendonopathy. So you have a biceps injury to your tendon. Tendons don't have good vascularity. This is gonna give you that massive blood flow in there. It's gonna stir up the healing. And then maybe we don't think about it as often. Things like arthritis, actually, 'cause that's a chronic condition that's not gonna respond to surgery. And then the other one I'll add in there, which is more recent, but it's one of my favorite applications of shockwave is lumbor sacral disease.

Adam Christman, DVM, MBA: Well, that I know quite too well. My patients and everything too. And so, okay, so that's interesting. So lots of great indications that we see. And it's interesting that you mentioned arthritis too because that may be something that you may not have on your radar using shockwave therapy, right? So I think that's interesting as well. And so do patients need to be sedated for shockwave therapy?

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: Back in the day, when this machine first came out, you did need to sedate them. And it's because of that high velocity, high pressure. It gives you like a little jolt in your body. And we would always sedate patients. This company came out with a new probe, and we're holding it. It's called the X-Trode. And this one actually, it's still focused shockwave. It actually still provides the same amount of energy. But instead of a very narrow beam coming straight out of this, which is, if you think about when you get like a vaccine and there's a one sharp needle going in, you really feel that versus if you had something wider and a wide pressure, it's more comfortable. So this is a little bit wider dispersion, which is better tolerated from a pain perspective. So this X-Trode needs absolutely no sedation.

Adam Christman, DVM, MBA: Wow, that's fantastic. And how do you keep them comfortable during the procedure, any recommendations when they're receiving it?

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: Oh man, I should have had prepared some videos of patients. You know what's interesting is it feels so good 'cause they get that endorphin release. I actually find patients relaxed during the treatment, and even I would be really worried about like your anxious pity. And I've had some really anxious dogs that are like climbing up the walls, and I start their shockwave treatment, and all of a sudden they're like, whoa, oh, oh. (laughing) And they tolerate it really well. Other things that you can do besides just the natural calming effect that it does have is feed them treats because you don't need to sedate them. So give them a treat, a favorite toy. I sometimes will have owners there so they can just be licking their owner's face.

Adam Christman, DVM, MBA: Right, yeah, yeah, that's great. Yeah, 'cause I've noticed that no PPE is needed for that too. So it's really nice in that regard as well. And talk to me about the treatment regimen, like how often, how long are the sessions for patients?

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: Yeah, it a little bit depends on what condition you're treating. But in general, I'm looking for two to three treatments, and they're spaced two to three weeks apart. If you look in the literature, some protocols are every three to four weeks, but my go-to is every two to three weeks for two to three treatments.

Adam Christman, DVM, MBA: Okay, and as a general practitioner, how would I decide to know, okay, this patient needs two to three weeks or two to three treatments?

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: Yeah, that's an excellent question. Typically, the greatest response is gonna be after the second treatment. So if after the second treatment, the clinical symptoms are completely resolved, I tell owners, we're good, we don't need to do another one. If we're significantly improved, but maybe it's not resolved, then I'll go ahead and do that third treatment. In some instances, particularly if you're doing a treatment for arthritis and they've had it before, it could just be a maintenance treatment, so it's just gonna be a single treatment.

Adam Christman, DVM, MBA: Okay, oh, great.