New shock wave technology makes waves in advancing noninvasive treatment options

Subscribe to The Vet Blast Podcast on Apple Podcasts, Spotify, or wherever you get your podcasts.

On The Vet Blast Podcast, Jennifer Vitucci, DVM, CCRT, shares how new shock wave technology provides pain treatment without sedation.

Podcast sponsored by PulseVet, a Zomedica company

Read below for a full transcript

Adam Christman, DVM, MBA: Hey everybody, welcome back to The Vet Blast Podcast. And you know, if you're like me, I don't know too much about shockwave technology, and I'm so excited that we're gonna be learning more about it. And joining us is Dr. Jennifer Vitucci. How are you doctor?

Jennifer Vitucci, DVM, CCRT: I'm good. How are you? Thank you so much for having me today.

Adam Christman, DVM, MBA: Yeah, good to see you and good to hear from you. And this podcast is brought to you by our friends by PulseVet, a Zomedica company, and a little bit about our friend Dr. Vitucci. She graduated from...graduated magna cum laude nonetheless, from John Carroll University with a biology degree. She obtained her veterinary degree from The Ohio State University in 2007. After graduation, she moved to the St. Louis, Missouri area, and practiced at a small animal general practice for 2 years before purchasing County Animal Hospital with her husband in October 2009.

Dr. Vitucci began her rehabilitation training in 2019 and obtained her canine rehabilitation therapist certification through the Canine Rehab Institute in 2021. Synergy Veterinary Rehabilitation opened with County Animal Hospital in 2019. After selling their practice and moving to the Florida Panhandle, Dr. Vitucci joined PulseVet Technologies as the small animal business manager in 2021. And I can't think of a more competent person then to talk to us a little bit about shockwave therapy. So Jen, I really don't know anything about it. So what can you tell us by...just what is shockwave therapy?

Jennifer Vitucci, DVM, CCRT: Okay, so it's nothing to do with electric shock. It just has a big, scary name. So it's simply a physics term for a high-energy sound wave. So it's just sound energy. And the best example I give and I've gotten is lightning and thunder. So lightning is an electrical impulse that actually changes the pressure of the air around it, and it creates the big boom of thunder. And if you ever have a big boom of thunder near your house, you'll feel your window shake or your roof shake, and that's actually sound energy getting deposited into your house. And so that's the best explanation. It's just high energy sound.

Adam Christman, DVM, MBA: And so how did it all start?

Jennifer Vitucci, DVM, CCRT: So it started originally, they found that shockwaves could actually break up kidney stones in humans. And so they started with electrohydraulic, because there's different types of shock wave generators, and they would sort of blast it into the body into the kidney stone, break it up, and then hopefully, it would pass without having to have surgery. And they found out like, oh, it's having a lot of other effects in the body. And so then it sort of rolled from there into more other musculoskeletal therapies.

Adam Christman, DVM, MBA: I almost think of lithotripsy, that's currently being used, too, right?

Jennifer Vitucci, DVM, CCRT: Correct. And they still use it for lithotripsy, actually. It's not the same device, right? That's like a very small focal area, high energy, because they don't want to damage the surrounding tissue. So they just, like, it's a little laser pointer right at the kidney stone, and they'll break it up that way. So you will still have that treatment if you have kidney stones right now.

Adam Christman, DVM, MBA: Right? And in this instance, was shockwave technology, how does it work?

Jennifer Vitucci, DVM, CCRT: So what actually happens is we take...we focus that shockwave energy, right? So when I'm talking about the lightning and thunder, it's unfocused, just in the air. And so we take it, and we're going to focus it into the body. And when the sound energy goes into the tissue, it gets deposited at this area of either a density change, or what we call acoustic impedance. And so what that actually means is like a bone tendon interface, or microscopically at the cell surface, and when the sound energy hits the cells, it actually squishes them a little bit.

So there's a compressive and tensile force, like a physical force on the cells. And in response, they create and release cytokines and growth factors for healing. And so it's a physical force on the cells, and it causes this biological response. And so they release what I like to call these happy, healthy enzymes and growth factors, that reinitiate the body's healing process, and help it heal on its own.

Adam Christman, DVM, MBA: So I could just think of so many different things now that you just said that I was like, Oh, my gosh, we're gonna talk about indications in a second. But, so how has this evolved and in its use?

Jennifer Vitucci, DVM, CCRT: Correct. So when we started, right, we were thinking about blasting up kidney stones. And so they use different types of generators for shock wave. So our device is electrohydraulic. So it's like a sparkplug in water. And it has a pretty big focal area and a high peak energy. So it's depositing a good amount of energy into the tissue. And they found that it was too big and it wasn't directed right at the kidney stones. And so they actually develop a piezoelectric shock wave generator, which has this very small focal area and high energy.

So I always think of that as like the laser pointer and electrohydraulic as the flashlight. And so if you're thinking about different indications, right, in our small animal patients, or also in the equine. You know, if you're pointing flashlight vs a laser pointer at it, you're gonna have different effects and different treatment protocols. And so that's...they kind of just started figuring out as it got bigger and more energy, what was happening, and the different results they were having. And so they started using it pretty frequently on the eqine side, like for the last 10 or 15 years, the electrical hydraulic devices, but it was a little uncomfortable. And so the forces...and they used it in small animals, but they had to be sedated. So the biggest change in the last year for shock wave is a new reflector shape in our Trode that has actually lowered the peak energy and made it much more comfortable.

So we don't need to sedate the small animals anymore. And so it's kind of now opened it up, right? We used to use it before, but sedation is always a little bit of a hurdle, right? Like we don't know; it's a little bit more difficult; we have to have more people. And so now without sedation, like you were saying, it's like, oh, my gosh, what can we use this for, right? So that's kind of been the evolution over the last 30 years. And they also use it in humans for tennis elbow, plantar fasciitis, [and] diabetic foot ulcers. So it's kind of used in all aspects of medicine right now.

Adam Christman, DVM, MBA: It's incredible. So I know...so tell me a little bit about what PulseVet does. So they have this later, or latest technology and XTrode to tell us a little bit about that.

Jennifer Vitucci, DVM, CCRT: Correct. So the newest Trode...that's what we call them, where the energy comes out. It actually makes it...it changed the reflector shape and the membrane, so that when it comes out, the peak energy is lowered, and the focal area is expanded a little bit from where it was before. And so that has been released for about a year and been catching on steadily, just so much easier. The nice part about electrohydraulic and the X-Trode and PulseVet is the treatments only take about 3 minutes per area. And you only have to do the treatments 1 to 3 times either for full healing, or in a 12-month period, for like chronic pain or other indications. So it's just kind of changed noninvasive therapy options for a lot of different things in small animal.

Adam Christman, DVM, MBA: Yeah, that's incredible. I mean, I could, just like I said, so I'm thinking of all these different indications I would love, and I'm sure our listeners want to know, too. So what are some of these indications that can benefit from the shock wave therapy?

Jennifer Vitucci, DVM, CCRT: So tendon and ligament injuries, right? So I'm thinking bicep superspinatus injuries, Achilles tendon injuries, [and] partial cruciate tears are a huge one that are not candidates for surgery, right, for whatever reason. They do really, really well. Osteoarthritis and chronic pain because it's going to help with pain and inflammation. Wound healing, so we're increasing blood flow and stimulating those wounds, so lick granulomas, and like big, you know, nasty wounds, right? Like, I'm talking degloving injuries, things that are going to be healing by second intention. And then bone healing. So fractures, delayed unions, post TPLOs, post TTAs. All of those can benefit from the use of shock wave.

Adam Christman, DVM, MBA: And I'm thinking to myself, this sounds like... everything you're just saying just sounds like a service item, a service item, a service item, which is amazing in veterinary medicine. So I'm just thinking to the practice owners, this got to be such a great use and indication to so what are your thoughts on that? How does the practice benefit from adding shockwave therapy to their clinics?

Jennifer Vitucci, DVM, CCRT: Well, we all know that practice has changed, right? I mean, it was starting to change as we, you know, all of the sort of medications, especially something like a nonsteroidal, or, you know, things that they're on full time. A lot of people don't get those from their vets anymore, right. It's just more convenient for them to get them from other locations. And so they're not coming in for that. And then the other one with COVID and staffing and curbside is we don't have time, right? Time and people are such a commodity right now that veterinarians are struggling with, and so this helps with both those problems, right?

It's a service item, so they have to come in. It's a treatment only we can do, we only sell to licensed veterinarians, and it's quick and easy. So we jokingly say it's point and shoot, right, so you can train your staff how to do it. It only takes a couple minutes per area, as opposed to some other noninvasive modalities, right, that take 15 minutes, 20 minutes, a couple members of the staff, they're coming back very frequently. Like this is in and out, and they're done and we're, we're healing them. It's helping.

Adam Christman, DVM, MBA: Yeah, well expand a little bit on that. So walk me through that. So I'm a pet parent. I'm able to go into the clinic, let's just say, and I have my dog. And what does a typical shock wave treatment involve?

Jennifer Vitucci, DVM, CCRT: Yes. So it is delivered superficially, right. So we're gonna...we have a trode head, we need to make good contact with the skin, and we're going to use ultrasound gel to transmit the sound tissue, okay? The sound energy, I mean. And if you're a big, hairy dog owner, sometimes we need to shave because we need to make good contact. And we deliver a certain amount of pulses, right, a certain amount of energy. And it's going to stop automatically on our device. We want to think 360 degrees 3D, right. So we want to get all around that joint or all around that painful area. And it just...we move around [and the] patient's comfortable. It's loud, it's sound energy, that's true. But our lives are loud. So they're very used to that noise. And after we can deliver 480 pulses per minute, and the typical treatment is about 1000, pulses or less.

So 2 and a half minutes, you're done, and then we repeat those treatments, about every 2 weeks. So the most you would need is 3 treatments, and those are for your tendons and ligaments, right? We have a lot of healing to do, so we need a lot of increased blood flow [and] a lot of time, vs sometimes with pain, like lower back pain, it's just 1 or 2 treatments a couple of weeks apart, and then we sort of manage as needed. But often those results will last 10 or 12 months before you need to repeat a treatment.

Adam Christman, DVM, MBA: That's impressive...so 10 to 12 months. Wow. After that, I'm thinking to myself to as someone to ensure a compliance, you probably would want to have the parents like prepay for the package. Do you find that in your experience? That helps?

Jennifer Vitucci, DVM, CCRT: Yes, so a lot of times if you think, "Oh, we're gonna do 2, we'll just prepay." And then that way, you know, it's kind of like an included recheck, right. When you come back in 2 weeks, we'll do a recheck and we'll repeat the treatment.

Adam Christman, DVM, MBA: Right.

Jennifer Vitucci, DVM, CCRT: But then we only have to come back twice, you know. Sometimes other things we're like on 8 or 10 times and compliance gets real low.

Adam Christman, DVM, MBA: Yeah, tends to dwindle...definitely tends to dwindle. But you know, this is what I love, Jen, about our profession is like how it's constantly evolving. Cool things are in our hands, you know, cool things. For our listeners, this is awesome. This is what makes practicing exciting and fun. And you know, where do you hope to see shock wave going in the future in our profession?

Jennifer Vitucci, DVM, CCRT: We really hope that it becomes standard of care on the small animal side, as it is on the equine. You know, if you do lameness, or muscular skeletal work on the equine side, you have a shock wave. Everyone knows about it; That's what you do. And that's what we hope on the small animal side, that it becomes for certain indications and pain, that like this is the treatment of choice, you know?

Adam Christman, DVM, MBA: Yeah, it really is. I think it sounds like it should be the treatment of choice for what we're doing with our fur babies and everything. So this is fantastic. So thank you so much, Jen for your time and expertise. Where can we learn more about this?

Jennifer Vitucci, DVM, CCRT: If you head over to our website, www.PulseVet.com, we have links to all of our research articles; we have videos of treatment; we also have some free CEE webinars, all about the technology and mechanism of action; as well as a bunch of case studies about how our doctors are using this in practice with really good success.

Adam Christman, DVM, MBA: You said mechanism. You had me at mechanism of action, you know, us veterinarians, we love to nerd out on that.

Jennifer Vitucci, DVM, CCRT: Now I know you're tuning into that.

Adam Christman, DVM, MBA: I love it. Well, thank you so much for your time, and thank you to PulseVet, a Zomedica company for sponsoring today's podcast. Thank you so much, Jen.

Jennifer Vitucci, DVM, CCRT: Thank you so much for having me. I really appreciate it.

Adam Christman, DVM, MBA: Oh, my pleasure. And to our listeners. Thank you so much for tuning in. Continue to do great work out there and please stay safe and continue to stay pawesome.