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Adverse effects and contraindications


Explore the contraindications for shockwave therapy and learn more about the minimal adverse effects

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Adam Christman, DVM, MBA: And what about side effects? Any associated side effects that we should be familiar with?

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: Yes, what I would say, I'm gonna cover if it's okay both side effects and contraindications. So remember we talked about that when these sound waves go out, they basically create bubbles that then collapse. Can I ask you a question?

Adam Christman, DVM, MBA: Oh gosh, I'm nervous, yes. (laughing)

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: It's okay if you get it wrong, Adam.

Adam Christman, DVM, MBA: Okay, yeah.

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: Where in the body might it be a bad idea to have a bubble then then burst?

Adam Christman, DVM, MBA: Well, definitely not in the heart area or any vessels.

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: Yeah, vessels, exactly. So no large vessels, see, you're so smart. Okay, and any other place where like air in a bubble would not be a good idea?

Adam Christman, DVM, MBA: I also think of brain area too, but I mean, is there another area too?

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: Lungs.

Adam Christman, DVM, MBA: Oh, yeah, lungs too, of course, yeah.

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: So we don't like, you know, I would not want to put this on my chest.

Adam Christman, DVM, MBA: No, yeah.

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: And not on my patient's chest because if we introduce these bubbles that then collapse in the lungs, we have a potentially pneumothorax.

Adam Christman, DVM, MBA: Gotcha.

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: Jugular, we don't want to do that. Any large major vessel, a tiny little blood vessel's not going to be a big deal, but we don't want to basically create a thrombus. So those would be contraindications, other contraindications. I'm not going to put it over a tumor because this brings a lot of blood flow to the area. Obviously, we don't want to do that for a tumor. If an animal is pregnant, you can do it, but I would not do it on the gravid uterus.

Adam Christman, DVM, MBA: Yes, yeah.

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: And that's about it. And then as far as side effects, honestly, they're fairly minimal, but you can sometimes see a little bit of petechiation or bruising at the skin surface. You can feel, just 'cause I've done it on myself and on colleagues, you can feel it tingling, and it just, it almost feels like it reverberates, it's like away from where you're receiving it. So it's just kind of sensation stuff. It's, I wouldn't say it's like a negative side effect that has any consequential difference, but those are side effects that you might experience. I wouldn't use it on patients with coagulopathies because they potentially can interfere with that. Sound, if you're very, very sound-sensitive, some dogs are. This does generate a noise, and then that would be something to consider for as a potential side effect. I will say that I had this lovely greyhound that responded beautifully to shockwave. He actually had lumbar pain, and I was telling Dad all about it, and he's like, "Oh, he has the worst thunderphobia." So we put noise-canceling headphones on him. Dad insisted that we had to have blue pads because he was gonna have explosive diarrhea and urination because that's how he responds during thunderstorms, and the dog is also quite nervous. We started the shockwave. He just laid down and was super chill, and Dad couldn't believe it.

Adam Christman, DVM, MBA: It's amazing, yeah.

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: Yeah, so we talk about the noise sensitivity that I actually find in real clinical application. It's usually quite well tolerated. But that's it, it's very well tolerated. I would say side effects are minimal, and if they did get the petechiation or bruising, it usually resolves within 48 hours.

Adam Christman, DVM, MBA: Right, I do find that dogs know, to your point you were talking earlier, that they do know that we're helping them out, and once they initially feel it, they're like, ooh, oh, okay.

Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: Yeah, it feels good.

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