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ESWT update

Posted by john h on 9/02/00 at 19:14 (026988)

it has been just over a week since by orbasone treatment in both feet. my feet are both better than before treatment. much to early to say if i am just in a remission mode or the treatment is working. i will take it either way. my pain level for the past 2 days has been around a 2 down form the usual 5. i continue to wear birks. walk only when necessary and do very mild stretching. alternate each night with my night splint and pray a little. for what ever reason the foot that had the pf surgery is slightly better than the other foot. i am probably on my feet 6-8 hours each day. there is no question the orbasone reduced tension/inflamation. will it last is the question. i can begin to understand why a 2nd or 3rd treatment might well be appropriate with this technology.

Re: ESWT update

Dr. Zuckerman on 9/02/00 at 19:35 (026992)

In my experience I have found that a 2nd, 3rd 4th treatment is benefical so long as you get improvement with the previous treatment.
This is a high energey treatment. If I only the healthronic people would get me the information about the joules/mm2 I could probaby improve the outcomes of the ossatron treatments as well as the orbasone treatment. I also have some ideas with the no relief at all after the first treatment . If anyone has influence with healthronic i would love to get this information that i need it would save me some time. As you know the ossatron has more time out in the USA market. I just did last week two patients that got no relief from the first treatments and now dramatic relief after the second. I changed the anatomical focus of energy. I believe this is the reasons the first didn't help.

Re: energy levels

Scott R on 9/02/00 at 20:50 (026997)

If the volume of liquid used in the heads is similar and the head housings aren't too different, and if the arm does not vibrate so as to increase the noise, then a sound meter placed at a specific distance from the device should give an accurate measure of the relative amounts of energy being applied from one machine to the other. But this doesn't address how they are focused.

Re: energy levels

Dr. Zuckerman on 9/02/00 at 21:16 (026999)

That still doesn't help me out. I have no idea the size of the ossatron., head and volume of fluid I can't understand why the FDA didn't want to know this question. What is the amount of joules/mm2 at the focal point of treatment. This is the most important comparision and method to research the treatment of pf with ESWT. Dornier talks about what the energy level is 0.08 joules/mm2.

I would like to have this answer . It we are going to get serious this is important. Healthronics knows this and should be willing to tell the treating doctors and patients this information. Without this information the kv and shocks are worthless parameters. I have asked
Healthronic this question at their booth at trade shows and there is a blank look on their faces. The FDA report was impressive but it amazes me that this was allowed to go unanswered and never asked. You can't teach or talk about ESWT without this information about the machine. This lack of cooperation is not helping any pateints on heelspurs.com. I will improve this technology but it ashame no one wants to help Dr. Z ( healthronics.) What the !@@@# did I do but want to help patients.

Re: energy levels

john j on 9/03/00 at 09:39 (027027)

joules of course is a measurement of work done (1 joule in 1 second is equal to 1 watt or one joule of energy equals .74 ft pounds). schock waves can travel faster than the speed of sound and depending on the medium the shock wave is passing thru will result in the force at the focal point. since all of our feet are of different thckness (moisture of the tissue could also effect the wave). 20kv at the machine may result in 16 joules on johns foot at the focal point and 20 joules on wendy's foot at the focal point. treating a shoulder on knee or some other deeper tissue will further complicate the issue as you will penetrate muscle,fat, nearby bone,etc which will all effect the shock wave in a different manner. a huge football player and a petite wendy would need entirely different settings. i would think in a lab under controlled conditions you can relate KV's to joules on a chart but in the real world of bodies it is going to vary from person to person. shock waves dissipate very rapidly and very according to the medium they pass thru. experience by the doctor and statistics should play an important part in the procedure.

i disavow the reliability of all i have just posted but some of it is very much factual

Re: energy levels

john h on 9/03/00 at 09:40 (027029)

of course john j should have been john h

Re: energy levels

john h on 9/03/00 at 11:36 (027037)

in my post i should have said energy at the focal point of .30 joules or whatever depending on the medium it is passing through. dr z: i did not look at your control panel but can you set anything other than KV?

Re: energy levels

Dr. Zuckerman on 9/03/00 at 13:29 (027046)

You can set kv. You can set the frequencey of the pulses, which is the rate over time. The point that I am trying to make is that I understand every foot is different, but it would be nice to know what the joules/ mm2 that the ossatron tries to produce at he focal point of treatment. I would like to know what the joules /mm2 is at the focal point point of treatment not treatting a non-union. I just want ot be able to gather as much information as possible on every machine doing ESWT. The only one that doesnt or won't give me the joules question is the ossatron. They do know this informaotion . It will be important for an operator to understand joules. its effect on tissue and its effect on bone.

Re: energy levels

Dr. Zuckerman on 9/03/00 at 13:33 (027049)

I was hoping it would be john W. Anyway so long as there are different feet and different areas and causes of pf my quesiton won't be important at this time. There is a clinical method that i use to determine what amounts of kv or joules to use at the focal point anyway.

Re: energy levels

john h on 9/04/00 at 13:17 (027155)

since lipotripsy has been around a long time i will start searching that area. a kidney stone in the kidney would seem to move after each blast it would seem and the machine would have to be refocused after each shock wave. additionally the stone would break into every increasing smaller particles and i guess you would have to go after each particle until you reduced it to dust. perhaps a lithotriptor is not focused so narrowly. i, unfortunately, had this procedure about 5 years ago but of course was under a general a. i do know for about 4-5 days i was really tired after that procedure

Re: ESWT update

Dr. Zuckerman on 9/02/00 at 19:35 (026992)

In my experience I have found that a 2nd, 3rd 4th treatment is benefical so long as you get improvement with the previous treatment.
This is a high energey treatment. If I only the healthronic people would get me the information about the joules/mm2 I could probaby improve the outcomes of the ossatron treatments as well as the orbasone treatment. I also have some ideas with the no relief at all after the first treatment . If anyone has influence with healthronic i would love to get this information that i need it would save me some time. As you know the ossatron has more time out in the USA market. I just did last week two patients that got no relief from the first treatments and now dramatic relief after the second. I changed the anatomical focus of energy. I believe this is the reasons the first didn't help.

Re: energy levels

Scott R on 9/02/00 at 20:50 (026997)

If the volume of liquid used in the heads is similar and the head housings aren't too different, and if the arm does not vibrate so as to increase the noise, then a sound meter placed at a specific distance from the device should give an accurate measure of the relative amounts of energy being applied from one machine to the other. But this doesn't address how they are focused.

Re: energy levels

Dr. Zuckerman on 9/02/00 at 21:16 (026999)

That still doesn't help me out. I have no idea the size of the ossatron., head and volume of fluid I can't understand why the FDA didn't want to know this question. What is the amount of joules/mm2 at the focal point of treatment. This is the most important comparision and method to research the treatment of pf with ESWT. Dornier talks about what the energy level is 0.08 joules/mm2.

I would like to have this answer . It we are going to get serious this is important. Healthronics knows this and should be willing to tell the treating doctors and patients this information. Without this information the kv and shocks are worthless parameters. I have asked
Healthronic this question at their booth at trade shows and there is a blank look on their faces. The FDA report was impressive but it amazes me that this was allowed to go unanswered and never asked. You can't teach or talk about ESWT without this information about the machine. This lack of cooperation is not helping any pateints on heelspurs.com. I will improve this technology but it ashame no one wants to help Dr. Z ( healthronics.) What the !@@@# did I do but want to help patients.

Re: energy levels

john j on 9/03/00 at 09:39 (027027)

joules of course is a measurement of work done (1 joule in 1 second is equal to 1 watt or one joule of energy equals .74 ft pounds). schock waves can travel faster than the speed of sound and depending on the medium the shock wave is passing thru will result in the force at the focal point. since all of our feet are of different thckness (moisture of the tissue could also effect the wave). 20kv at the machine may result in 16 joules on johns foot at the focal point and 20 joules on wendy's foot at the focal point. treating a shoulder on knee or some other deeper tissue will further complicate the issue as you will penetrate muscle,fat, nearby bone,etc which will all effect the shock wave in a different manner. a huge football player and a petite wendy would need entirely different settings. i would think in a lab under controlled conditions you can relate KV's to joules on a chart but in the real world of bodies it is going to vary from person to person. shock waves dissipate very rapidly and very according to the medium they pass thru. experience by the doctor and statistics should play an important part in the procedure.

i disavow the reliability of all i have just posted but some of it is very much factual

Re: energy levels

john h on 9/03/00 at 09:40 (027029)

of course john j should have been john h

Re: energy levels

john h on 9/03/00 at 11:36 (027037)

in my post i should have said energy at the focal point of .30 joules or whatever depending on the medium it is passing through. dr z: i did not look at your control panel but can you set anything other than KV?

Re: energy levels

Dr. Zuckerman on 9/03/00 at 13:29 (027046)

You can set kv. You can set the frequencey of the pulses, which is the rate over time. The point that I am trying to make is that I understand every foot is different, but it would be nice to know what the joules/ mm2 that the ossatron tries to produce at he focal point of treatment. I would like to know what the joules /mm2 is at the focal point point of treatment not treatting a non-union. I just want ot be able to gather as much information as possible on every machine doing ESWT. The only one that doesnt or won't give me the joules question is the ossatron. They do know this informaotion . It will be important for an operator to understand joules. its effect on tissue and its effect on bone.

Re: energy levels

Dr. Zuckerman on 9/03/00 at 13:33 (027049)

I was hoping it would be john W. Anyway so long as there are different feet and different areas and causes of pf my quesiton won't be important at this time. There is a clinical method that i use to determine what amounts of kv or joules to use at the focal point anyway.

Re: energy levels

john h on 9/04/00 at 13:17 (027155)

since lipotripsy has been around a long time i will start searching that area. a kidney stone in the kidney would seem to move after each blast it would seem and the machine would have to be refocused after each shock wave. additionally the stone would break into every increasing smaller particles and i guess you would have to go after each particle until you reduced it to dust. perhaps a lithotriptor is not focused so narrowly. i, unfortunately, had this procedure about 5 years ago but of course was under a general a. i do know for about 4-5 days i was really tired after that procedure