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The dvm360® anesthesiology and pain management page is a comprehensive resource for clinical news and insights on the latest in veterinary anesthesia and pain management. This page consists of videos, interviews, articles, podcasts, and research on the advancements and developments of therapies for anesthesiology, pain management, and more.

Canine osteoarthritis is a complex disease that impacts quality of life for many of our canine patients. Part 2 of this podcast series will highlight why effective management requires development of a baseline treatment plan that is customized to the individual patient and includes a plan for managing flare-ups. A systematic, evidence-based approach will be presented that can be implemented in general practice.



Recognize the importance of a customized treatment plan; that one-size does not fit all for canine osteoarthritis

Appreciate the ebb and flow of osteoarthritis with periods of calmness followed by periods of flare-ups

Appreciate the multimodal management of osteoarthritis 

David L. Dycus, DVM, MS, CCRP, DACVS joins Adam Christman, DVM, MBA, to explain treatment for osteoarthritis and the need for individualized patient plans.




Podcast CE: A Surgeon’s Perspective on Current Trends for the Management of Osteoarthritis, Part 2

Canine osteoarthritis is a complex disease that impacts quality of life for many of our canine patients. Part 1 of this podcast series will focus on the epidemiology of this disease, the importance of a proactive approach to diagnosis, and will introduce a standardized staging tool to be utilized in general practice.



Recognize that osteoarthritis affects the entire joint

Appreciate that canine osteoarthritis impacts many younger dogs and is not an “old-dog” disease

Understand the importance of a proactive approach utilizing the Canine OsteoArthritis Staging Tool

David L. Dycus, DVM, MS, CCRP, DACVS joins Adam Christman, DVM, MBA, to discuss a proactive approach to the diagnosis of osteoarthritis and the best tools for general practice.


Podcast CE: A Surgeon’s Perspective on Current Trends for the Management of Osteoarthritis, Part 1

 dives into the world of animal pain and behavior with guest Michael Petty, DVM. Petty joins host Adam Christman, DVM, MBA, to discuss how pain can cause significant changes in an animal's behavior. 

From litter box avoidance in cats to social withdrawal in dogs, this episode explores common examples of pain-induced behavioral shifts. Petty also emphasizes the importance of veterinarians considering pain as a potential culprit behind behavioral problems and offers tips for educating pet owners about this crucial link.

: Do you think that the pendulum has shifted in terms of the pet parents perspective on knowing that animals experience pain? And when they're getting older, there is to your point of arthritis and other ailments.

I tell you, the pendulum is a very, very slow swing that way, both in professionals and the caregivers of animals. No one wants to think that their pet is in pain. And so they often write this stuff off as, 'oh, my dog is old, my dog is just...fill in the blank.' And as veterinarians, if the owner doesn't bring it up to us, in these days, everyone's got a tight, tight schedule. Maybe it's at the back of your mind, and maybe it isn't, but you might have a tendency to not really ignore that behavior or you might have a tendency to ignore the behavior or ignore some of the subtle signs, or even take the time to do a proper pain exam on a dog that might need it. For example, a dog that's prone to hip dysplasia, a breed like a golden doodle, and the dog 6-years-old years old, it's time to take a look.

Adam Christman, DVM, MBA, and Michael Petty, DVM, discuss chronic pain in pets and how it can affect their behavior 

I know that dog has chronic pain, now let's convince the owner

This episode of The Vet Blast Podcast is all about fish anesthesiology. Gianluca Bini, DVM, MRCVS, DACVAA, shares his insights and expertise in aquatic medicine.

Below is a partial transcript. Listen to the full podcast for more.

: The fish anesthesia device, which is literally like a little tank where there is water underneath.... There is a little pump that pumps there. It has a little tube that pumps the water and it's recirculating that water and then there is sort of like a grate where we place a towel, which is wet. The fish lays on the towel and the tube coming from the palm goes in the fish mouth so that the water constantly recirculates from the tank to the fish mouth and then it comes out of their gills. And so it passes through their gills so that you know they have an uptake of the oxygenated water and the water with the anesthetic. And so that guarantees you that the fish constantly have supply of oxygenated water and an anesthetic. And that's usually done for more prolonged procedures.

An boarded anesthesiologist and aquatic medicine expert walks through his approach to fish anesthesiology

How do you even anesthetize a fish anyway?

In recognition of Animal Pain Awareness Month, both the founder and the immediate past president of the International Veterinary Academy of Pain Management (IVAPM) join The Vet Blast Podcast to discuss the importance of managing pain in patients.

Charles E. Short, DVM, PhD, DACVA, DECVAA

: I am so delighted that over the past 20 years, to see how [pain management] has grown, to see how younger veterinarians are bought into the concept. It is spreading in such a remarkable way, and it is so gratifying. And I'm so thankful that young veterinarians are addressing it and are showing so much compassion for their patients, whether they are large animals or small. 

: I think that it's wonderful because with research and with technology, we have better ways to treat pain in humans and in animals. And you're gonna see that expand because that everybody sees the remarkable strides and things like monoclonal antibodies...But I also think that stepping back, the future is that it's going to be the no. 1 priority in our patients, and that it's going to be at the forefront, and it will continue to be recognized as critical for success in medicine.

Leaders at the IVAPM discuss the importance of pain management in veterinary medicine

Why pain management is key to success in veterinary medicine

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

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?

I'm good. How are you? Thank you so much for having me today.

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?

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.

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.

I almost think of lithotripsy, that's currently being used, too, right?

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.

Right? And in this instance, was shockwave technology, how does it work?

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.

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?

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.

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.

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.

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?

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.

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?

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.

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?

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.

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?

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.

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.

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?

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?

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?

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.

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

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.

Thank you so much for having me. I really appreciate it.

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.

In this episode of The Vet Blast Podcast, Jennifer Vitucci, DVM, CCRT, discusses innovations that allow small animals to benefit from shock wave technology without the need for sedation

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