Examine the preparation and application of shockwave therapy on a patient, highlighting the importance of proper hair coat management and safety measures
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Adam Christman, DVM, MBA: So, I understand it doesn't take long, I know we get questions about this, like, how does it work from beginning to end, including the ultrasound transduction gel? So what does that look like to the practice?
Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: Yeah, good. I might differ a little bit in advice that maybe other people give, but I'll tell you what I think is the best way to prepare for a successful treatment is the sound wave energy. And we have other things that we use every day in veterinary medicine that are sound waves based, and the big one that almost every veterinarian has been trained on is diagnostic ultrasound. Yeah. So that's sound wave energy. So I will ask my interns and residents, I'm like, okay, what do you do to get a really clear image when you're doing diagnostic ultrasound? And they're like, oh, well, we shave the patient, we apply gel, and then we make good contact, right, with your transducer. Same for this. Now, a lot of people are not shaving in order to do shock wave. I think if you have a very thin coated dog and you apply a lot of gel, because the thing that happens, same as with diagnostic ultrasound is you're going to get impotence, right? So sound travels really nicely through water and gel, not so great through air. So if you deliver these sound waves in a coat that's dry, there's going to be a lot of air caught in between that plus the thick hair. And it's not that it would be ineffective, but just think about what is that image going to look like if it was diagnostic ultrasound? It's going to be blurry. It's not going to have as high a resolution. So and what that means is not as much of the sound waves are getting through. But it's basically the same prep time that when you're doing like a fast scan or like an A scan or T scan and an ER, I mean, how quick is that? Shave. Blip. Done. That's the thing. And this is literally takes minutes to deliver the therapy. I personally do recommend shaving because you're just getting rid of that impotence. But I do have a lot of colleagues that don't shave and they feel that they're getting great results. I just caution, make sure it's a really thin hair coat. I have seen some radiologists not shave and then they just bathe with a lot of alcohol and a lot of gel and just make sure you have really good contact.
Adam Christman, DVM, MBA: Excellent. Well, I understand that we have a patient that we're going to be using and it's actually Dr. Oliver is going to be my son, my first son, Capone. He's a five-month-old standard wirehair dachshund puppy. So we figure we give it a try so he could demonstrate it so he can kind of hear the noise and see what that looks like from your perspective as well as yours to do so and I just can I just say yes, that when I found out that Capone was going to be here. I mean Capone's a celebrity and I'm like secretly in love with him and the fact that I get to meet him in person and do shockwave on him, it's like a dream come true. Mark that off your bucket list.
Leilani Alvarez, DVM, DACVSMR, CVA, CCRT: So if we have Capone, we have our machine. There's a couple of things so you can do manual or there's actually presets and on the presets, you know we would choose the dog he's be a small dog, but I I'm at kind of a traditional list and I like to just do my manual. And this allows you to choose a 6 is the highest level of energy. You might want to try with maybe e 3 that's a lower amount of energy and I'm let's just try like 200 pulses so I suggest we do maybe Capone's like really nice look at this, you know, I love muscle. Yeah, yeah, yeah, he's got really one. Thank you so proud. So what we're going to do is it's really important because this has that fluid media and we want to shake it up so we're going to give it a good shake shake shake shake. Okay. And then we're going to do gel on here. And then again if if we were really treating him for a condition his coats pretty thick so I probably would shave him. Okay, but we're you're so gorgeous. We don't want to do that so we're just going to just going to do you right here. And the biggest thing that I find in patients when they haven't had this is the sound can be a little alarming on putting earplugs can be nice. It can just be cotton balls and sometimes that can be a really effective strategy. I'm just going to try to get the settings. Okay, so that's really cool as we have this little thing here and once that's activated, I can just press my finger here and it should work. So I have treats here, but I'm going to give them to you. Okay here we go Mr. I'm going to make a little sound.