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Not trying to be mean but Duane E doesn't know

Posted by Dr. Zuckerman on 7/01/00 at 15:31 (022746)

I was going to let this go but I can't . After all or the techical ??!@## Duane can't tell me the most important information that could help all of the tough cases undergoing ESWT. What was your pressure and joules/mm2 used when you Duane how ossatron treatments in Canada. Would it be very very helpful to know what setting are being used for your treatments. I will repeat again Dr. Zuckerman uses 0.6-0.8 joules/mms at the focal point of energy ( the center of where all of the pressure is being used. I can't understand this silence when you gave me alot of heat about this being so important. Well it is important to any patient undergoing ESWT. You can't trademark treatment settings. It's unethical and immoral. I can believe that you would have orthotripsy (trademark word) without knowing what was done to you. If I sound angry I am . In addition I recommend to Scott to take the information off the board about comparison of machines because it is useless if you can't know what specific mpa and joules/mm were used at the focal point.
posted to the eswt board . . . keyword:

Re: Not trying to be mean but Duane E doesn't know

Scott R on 7/01/00 at 20:21 (022750)

Dr Zuckerman,
You wrote 'I recommend to Scott to take the information off the board about comparison of machines because it is useless...'

There is a file on my ESWT page that compares the machines. I was told by someone 'in the know' that the comparisons are flawed from lack of standard measuring methods, but I think that file is worth keeping even if it has errors. But if you were referring to something posted in the board, I pretty much can't and probably shouldn't delete anything from the message board unless it's completely off-topic and abusive to the functioning of the board, abusive advertising, illegally offensive** , or clearly proven to not be true while at the same time potentially causing harm to someone/some company.

** email me if you need to know what qualifies as illegally offensive.
posted to the eswt board . . . keyword:


Re: Not trying to be mean but Duane E doesn't know

Dr. Zuckerman on 7/01/00 at 21:02 (022753)

I am talking about the ESWT page that compares the machines. It should only compare treatment for heel spur, pf. This is I think what we are talking about. I don't see what purpose it serves because it is confusing to the average person including me.
posted to the eswt board . . . keyword:

Re: Not trying to be mean but Duane E doesn't know

john h on 7/01/00 at 21:48 (022757)

dr z:: i would think the settings used for the ossatron should be a matter of public record once the meeting with the fda is complete and the results of the studies are released. i would assume in the ossatron studies all patients were treated with the same settings?
posted to the eswt board . . . keyword:

Re: Not trying to be mean but Duane E doesn't know

Pauline on 7/02/00 at 06:40 (022760)

So technical is good, but do you both miss the point? In the end
patients will spend money on both treatments depending on what treatment their CHOSEN Dr. can provide. Like everythng else if patients are truly interested in the differences in these machines
they should gather the information from the companies that make them and not from the people that use them. They can then compare the
equipment, talk to their CHOSEN Dr. about his machine, his results after treatment and especially to his patients who have had the treatment. They must keep in mind that in the health game, there
are always many outcomes.

I'm sorry technical differences have become such a major problem. I would say to Duane E., character does matter and you can't save the
world from itself. The truth is always somewhere in the middle and it is up to the individual undergoing ESWT to find that out for himself. Even with all the warning labels people still smoke----because they CHOOSE TO DO IT. It's more profitable to sue the tobacco companies afterward.
posted to the eswt board . . . keyword:


Re: Not trying to be mean but Duane E doesn't know

Dr. Zuckerman on 7/02/00 at 07:39 (022763)

I truely believe that the ESWT page of machine comparision may have created Duane's thinking. Take a look at this page and see what you think. In addition I do have the information from healthronics but I was told that the focal point of energy range which states 2-35 joules/mm2 can't be correct. To compare this to tobacco companies is not a great analogy . There is vast amount of literature on the safey of ESWT, but a small amount on the sucess of the treatments. This all started with Dr. Zuckerman talking about kv instead of joules and pressure and this was what I read thru healthronics. Duane opened my eyes to compare with joules and pma which would be very helpful in the future for comparison of treatment sucess when publishing in journals. So I do thank Duane for this approach to thinking however no one wants to talk about it
posted to the eswt board . . . keyword:

Re: Not trying to be mean but Duane E doesn't know

john h on 7/02/00 at 10:22 (022769)

It would seem to me that for each machine there should be an optimum setting from which all doctors should start from. this optimum setting would have been established by FDA or manufacturer based on treatement results. Doctors could obviously vary the settings depending on each individual patient. one patient may weigh 104 lbs and have small thin skinned feet while another 300lb offensive lineman may have very thick feet. information should be shared openly as to results and settings. in flying an aircraft there is a very detailed checklist and manual for each an every aircraft. professional pilots follow these religiously. of course there is individual technique in flying the aircraft but as to how to operate it there is no variation. if i fly an F-4 in little rock and go to France i will a different F-4 in exactly the same manner with exactly the same procedures. i hope there is detailed operating instructions with each of these EWST machines with recommended settings. if each an every doctor uses whatever settings he choses based on his individual limited experience then this does not seem to be in the best interest of the patients.
posted to the eswt board . . . keyword:

Re: Not trying to be mean but Duane E doesn't know

Dr. Zuckerman on 7/02/00 at 11:11 (022772)

I agree. There is an abstract with one year post-op results on this site. It uses 0.3joules/mm2 as the treatment parameter setting. I am using 0.6-0.8 for my treatment. The PHD who taught me told me to use the orbaone gave me these settings to use. This is the same setting for every treatment including the arm, shoulder, and foot. The only time I used less was for peroneal brevis tendonits. The reason was the superficial insertion of the tendon into the bone.I do know there were different changes in the treatment in Canada during various times. Why I don't know. There are so many variables with ESWT treatments , patient selection. impedence differences from pateint to patient. The problem with having doctors do treatment studies and reporting results is the subjective nature of results. So I guess time will bring out the good, the bad and the ugly. So far in my experience that is no one worse off. I can't way that with foot surgery.
posted to the eswt board . . . keyword:

Re: Not trying to be mean but Duane E doesn't know

Dr. Zuckerman on 7/02/00 at 11:19 (022773)

I do have a detailed written manual now for the orbasone but it deals with operation, settings and what is mpa and joules are produced for each kv setting. It doesn't tell you the setting to use. I have found that with x-ray equipment the same thing holds true. I learned from my eperience which x-ray setting is best for what part of the foot anatomy I want to examine and determine the pathology for that specific bone. So good manuel, good machine but no experience when flying in bad weather is in the book. Right now the settting 0.6 is used to start with I will increase depending on my hands on palpation of the entire area during the procedure and the sound of the shock wave entering the foot. The pressure waves due vary at times and if the sound changes for any length of time then I will increase the kv . I want to beable to feel good vibration into the area of treatment and depth of treatment. I also like to feel shock waves expanding into the pf distal, medial, lateral to the site of treatment. I want to know if the shock wave is into the area and if it is ther will be vibration of the pf just like a muscle contraction
posted to the eswt board . . . keyword:

Re: Not trying to be mean but Duane E doesn't know

Scott R on 7/01/00 at 20:21 (022750)

Dr Zuckerman,
You wrote 'I recommend to Scott to take the information off the board about comparison of machines because it is useless...'

There is a file on my ESWT page that compares the machines. I was told by someone 'in the know' that the comparisons are flawed from lack of standard measuring methods, but I think that file is worth keeping even if it has errors. But if you were referring to something posted in the board, I pretty much can't and probably shouldn't delete anything from the message board unless it's completely off-topic and abusive to the functioning of the board, abusive advertising, illegally offensive** , or clearly proven to not be true while at the same time potentially causing harm to someone/some company.

** email me if you need to know what qualifies as illegally offensive.
posted to the eswt board . . . keyword:


Re: Not trying to be mean but Duane E doesn't know

Dr. Zuckerman on 7/01/00 at 21:02 (022753)

I am talking about the ESWT page that compares the machines. It should only compare treatment for heel spur, pf. This is I think what we are talking about. I don't see what purpose it serves because it is confusing to the average person including me.
posted to the eswt board . . . keyword:

Re: Not trying to be mean but Duane E doesn't know

john h on 7/01/00 at 21:48 (022757)

dr z:: i would think the settings used for the ossatron should be a matter of public record once the meeting with the fda is complete and the results of the studies are released. i would assume in the ossatron studies all patients were treated with the same settings?
posted to the eswt board . . . keyword:

Re: Not trying to be mean but Duane E doesn't know

Pauline on 7/02/00 at 06:40 (022760)

So technical is good, but do you both miss the point? In the end
patients will spend money on both treatments depending on what treatment their CHOSEN Dr. can provide. Like everythng else if patients are truly interested in the differences in these machines
they should gather the information from the companies that make them and not from the people that use them. They can then compare the
equipment, talk to their CHOSEN Dr. about his machine, his results after treatment and especially to his patients who have had the treatment. They must keep in mind that in the health game, there
are always many outcomes.

I'm sorry technical differences have become such a major problem. I would say to Duane E., character does matter and you can't save the
world from itself. The truth is always somewhere in the middle and it is up to the individual undergoing ESWT to find that out for himself. Even with all the warning labels people still smoke----because they CHOOSE TO DO IT. It's more profitable to sue the tobacco companies afterward.
posted to the eswt board . . . keyword:


Re: Not trying to be mean but Duane E doesn't know

Dr. Zuckerman on 7/02/00 at 07:39 (022763)

I truely believe that the ESWT page of machine comparision may have created Duane's thinking. Take a look at this page and see what you think. In addition I do have the information from healthronics but I was told that the focal point of energy range which states 2-35 joules/mm2 can't be correct. To compare this to tobacco companies is not a great analogy . There is vast amount of literature on the safey of ESWT, but a small amount on the sucess of the treatments. This all started with Dr. Zuckerman talking about kv instead of joules and pressure and this was what I read thru healthronics. Duane opened my eyes to compare with joules and pma which would be very helpful in the future for comparison of treatment sucess when publishing in journals. So I do thank Duane for this approach to thinking however no one wants to talk about it
posted to the eswt board . . . keyword:

Re: Not trying to be mean but Duane E doesn't know

john h on 7/02/00 at 10:22 (022769)

It would seem to me that for each machine there should be an optimum setting from which all doctors should start from. this optimum setting would have been established by FDA or manufacturer based on treatement results. Doctors could obviously vary the settings depending on each individual patient. one patient may weigh 104 lbs and have small thin skinned feet while another 300lb offensive lineman may have very thick feet. information should be shared openly as to results and settings. in flying an aircraft there is a very detailed checklist and manual for each an every aircraft. professional pilots follow these religiously. of course there is individual technique in flying the aircraft but as to how to operate it there is no variation. if i fly an F-4 in little rock and go to France i will a different F-4 in exactly the same manner with exactly the same procedures. i hope there is detailed operating instructions with each of these EWST machines with recommended settings. if each an every doctor uses whatever settings he choses based on his individual limited experience then this does not seem to be in the best interest of the patients.
posted to the eswt board . . . keyword:

Re: Not trying to be mean but Duane E doesn't know

Dr. Zuckerman on 7/02/00 at 11:11 (022772)

I agree. There is an abstract with one year post-op results on this site. It uses 0.3joules/mm2 as the treatment parameter setting. I am using 0.6-0.8 for my treatment. The PHD who taught me told me to use the orbaone gave me these settings to use. This is the same setting for every treatment including the arm, shoulder, and foot. The only time I used less was for peroneal brevis tendonits. The reason was the superficial insertion of the tendon into the bone.I do know there were different changes in the treatment in Canada during various times. Why I don't know. There are so many variables with ESWT treatments , patient selection. impedence differences from pateint to patient. The problem with having doctors do treatment studies and reporting results is the subjective nature of results. So I guess time will bring out the good, the bad and the ugly. So far in my experience that is no one worse off. I can't way that with foot surgery.
posted to the eswt board . . . keyword:

Re: Not trying to be mean but Duane E doesn't know

Dr. Zuckerman on 7/02/00 at 11:19 (022773)

I do have a detailed written manual now for the orbasone but it deals with operation, settings and what is mpa and joules are produced for each kv setting. It doesn't tell you the setting to use. I have found that with x-ray equipment the same thing holds true. I learned from my eperience which x-ray setting is best for what part of the foot anatomy I want to examine and determine the pathology for that specific bone. So good manuel, good machine but no experience when flying in bad weather is in the book. Right now the settting 0.6 is used to start with I will increase depending on my hands on palpation of the entire area during the procedure and the sound of the shock wave entering the foot. The pressure waves due vary at times and if the sound changes for any length of time then I will increase the kv . I want to beable to feel good vibration into the area of treatment and depth of treatment. I also like to feel shock waves expanding into the pf distal, medial, lateral to the site of treatment. I want to know if the shock wave is into the area and if it is ther will be vibration of the pf just like a muscle contraction
posted to the eswt board . . . keyword: