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Dear David Lowry

Posted by Jonathan Kay on 10/09/00 at 18:46 (030123)

Dear David,

I have had six Sonocur treaments on my left wrist and three on my tennis elbow. I have felt some improvement but not the amount that I was expecting. I feel that my left wrist is harder to treat than my elbow and this may be why I feel that my tennis elbow has improved more than my wrist. If it will improve my tendinitis, I was interested in recieving another three treatments in my wrist and another four in my elbow. This would bring the total number of treatments to nine for the wrist and seven for the elbow. Is there any studies indicating that more is better, or is there a treatment 'threshold' after which more treatments will not be helpful.

Thank you,

Jonathan

Re: Dear David Lowry

Dr. Zuckerman on 10/09/00 at 22:04 (030133)

I just read that in feet that additional and accumuative treatment sessions does have a benefical effect .I am sure that David can give you more specific information regarding his therapy center. If you give me your address I will mail to you the sections from the New shockwave book that was published in Europe that talks about this .

Re: Dear David Lowry

Jonathan Kay on 10/10/00 at 12:30 (030172)

Dear Dr. Zuckerman,

I was having trouble with your email address. Since I would really like to see some of this information on cumulative ESWP, my mailing address is;
Jonathan Kay
376 Brock Street
Peterborough, Ontario
K9H 2R3
Canada

Re: Dear David Lowry

David Lowy on 10/10/00 at 13:38 (030180)

Experienced ESWT physicians point out a difference with higher energy
and lower energy ESWT treatment. Higher energy devices usually result in an average of 1.5 to 1.8 treatments to the affected site to achieve good results, and lower energy devices usually require approximately 2.8 to 3.0 treatments to achieve good results in chronic painful conditions. If there is absolutely no improvement after these initial treatments, then it is unlikely that additional therapy will result in a better outcome. If however , there is significant improvement after these initial treatments, then additional treatment may offer additional benefit. The patient should
wait at least six weeks or longer after the first series of treatments to consider further ESWT therapy. In some cases, the maximum effect from treatment is not realized for up to 12 weeks after the last treatment. Regardless of whether higher energy or lower energy devices are used ( both are effective) up to 20% of patients will be 'non-responders' and will not improve with ESWT treatment.

In view of this, our treatment protocol at Sonorex Therapy Centers is generally as follows:

1) The patient is scheduled for a series of three (3) treatments usually, but not necessarily, one week apart.
2) If after one (1) or two (2) treatments the patient is pain free, no further treatment is necessary.
3) After three (3) treatments, the patient should wait at least six weeks to see how he or she progresses. Most patients require no further treatment.
4) If after three (3) treatments the patient has had no improvement, then the patient is considered a non-responder and should seek alternative therapy.
5) If after three (3) treatments and a suitable waiting period to reach maximum benefit (6-12 weeks) the patient has had significant improvement but still has residual symptoms, the patient may benefit from up to two (2) additional treatments. Once again, the patient should wait at least 6 weeks after these final ESWT sessions before evaluating success or failure.
6) If the patient still has pain after a total of five (5) treatments with the lower energy device, then it is unlikely that further benefit will be obtained and the patient should seek alternative treatment.

We believe that treatment with the lower energy offers several
advantages:

1) It is much more cost-effective. In Canada, a series of three (3) Siemens Sonocur treatments is about half the charge (50%) of a single (1) treatment with a higher energy device.
2) No anesthesia is necessary, so the patient is not required to have
painful local anesthetic injections or other types of anesthesia.
3) Lower energy allows for clinical focusing of shock waves which is felt to be more precise than flouroscopy/x-ray or ultrasound. Imaging devices cannot 'see' pain, but only identify anatomical structures which may or may not be the actual site of the painful pathology.
4) Lower energy treatment ensures that ESWT treatment energy levels stay below the energy density level which can result in tissue injury. This significantly reduces the chance of bleeding (hematoma, etc) in the treated site and reduces the post treatment pain and swelling while preserving the beneficial pain-relieving and healing effects of ESWT treatment.

I apologize for this long answer, but I wanted you to know of our
experience so that you can better evaluate your response to ESWT treatment. You have had multiple treatments to two separate sites. If you have had no response or only minimal pain relief, then you will probably not benefit from further treatment. You may be one of that 20% who is a non-responder.

Regards,
David Lowy
Vice President, Canada
Sonorex Therapy Centers http://www.sonorex.com Toll Free: 1 877 766-6287

Re: Dear David Lowry

john h on 10/10/00 at 15:41 (030185)

your post david seems to reflect some of the information i read in the ESWT Book from Europe. It indicated that improvement after an ESWT treatment could continue for up to 3 months. i assume blood vessiles are still forming in the damaged area during this period.

Re: Dear David Lowry

Dr. Zuckerman on 10/10/00 at 18:37 (030214)

I have your address . Will mail to you asap

Re: Dear David Lowry

Dr. Zuckerman on 10/09/00 at 22:04 (030133)

I just read that in feet that additional and accumuative treatment sessions does have a benefical effect .I am sure that David can give you more specific information regarding his therapy center. If you give me your address I will mail to you the sections from the New shockwave book that was published in Europe that talks about this .

Re: Dear David Lowry

Jonathan Kay on 10/10/00 at 12:30 (030172)

Dear Dr. Zuckerman,

I was having trouble with your email address. Since I would really like to see some of this information on cumulative ESWP, my mailing address is;
Jonathan Kay
376 Brock Street
Peterborough, Ontario
K9H 2R3
Canada

Re: Dear David Lowry

David Lowy on 10/10/00 at 13:38 (030180)

Experienced ESWT physicians point out a difference with higher energy
and lower energy ESWT treatment. Higher energy devices usually result in an average of 1.5 to 1.8 treatments to the affected site to achieve good results, and lower energy devices usually require approximately 2.8 to 3.0 treatments to achieve good results in chronic painful conditions. If there is absolutely no improvement after these initial treatments, then it is unlikely that additional therapy will result in a better outcome. If however , there is significant improvement after these initial treatments, then additional treatment may offer additional benefit. The patient should
wait at least six weeks or longer after the first series of treatments to consider further ESWT therapy. In some cases, the maximum effect from treatment is not realized for up to 12 weeks after the last treatment. Regardless of whether higher energy or lower energy devices are used ( both are effective) up to 20% of patients will be 'non-responders' and will not improve with ESWT treatment.

In view of this, our treatment protocol at Sonorex Therapy Centers is generally as follows:

1) The patient is scheduled for a series of three (3) treatments usually, but not necessarily, one week apart.
2) If after one (1) or two (2) treatments the patient is pain free, no further treatment is necessary.
3) After three (3) treatments, the patient should wait at least six weeks to see how he or she progresses. Most patients require no further treatment.
4) If after three (3) treatments the patient has had no improvement, then the patient is considered a non-responder and should seek alternative therapy.
5) If after three (3) treatments and a suitable waiting period to reach maximum benefit (6-12 weeks) the patient has had significant improvement but still has residual symptoms, the patient may benefit from up to two (2) additional treatments. Once again, the patient should wait at least 6 weeks after these final ESWT sessions before evaluating success or failure.
6) If the patient still has pain after a total of five (5) treatments with the lower energy device, then it is unlikely that further benefit will be obtained and the patient should seek alternative treatment.

We believe that treatment with the lower energy offers several
advantages:

1) It is much more cost-effective. In Canada, a series of three (3) Siemens Sonocur treatments is about half the charge (50%) of a single (1) treatment with a higher energy device.
2) No anesthesia is necessary, so the patient is not required to have
painful local anesthetic injections or other types of anesthesia.
3) Lower energy allows for clinical focusing of shock waves which is felt to be more precise than flouroscopy/x-ray or ultrasound. Imaging devices cannot 'see' pain, but only identify anatomical structures which may or may not be the actual site of the painful pathology.
4) Lower energy treatment ensures that ESWT treatment energy levels stay below the energy density level which can result in tissue injury. This significantly reduces the chance of bleeding (hematoma, etc) in the treated site and reduces the post treatment pain and swelling while preserving the beneficial pain-relieving and healing effects of ESWT treatment.

I apologize for this long answer, but I wanted you to know of our
experience so that you can better evaluate your response to ESWT treatment. You have had multiple treatments to two separate sites. If you have had no response or only minimal pain relief, then you will probably not benefit from further treatment. You may be one of that 20% who is a non-responder.

Regards,
David Lowy
Vice President, Canada
Sonorex Therapy Centers http://www.sonorex.com Toll Free: 1 877 766-6287

Re: Dear David Lowry

john h on 10/10/00 at 15:41 (030185)

your post david seems to reflect some of the information i read in the ESWT Book from Europe. It indicated that improvement after an ESWT treatment could continue for up to 3 months. i assume blood vessiles are still forming in the damaged area during this period.

Re: Dear David Lowry

Dr. Zuckerman on 10/10/00 at 18:37 (030214)

I have your address . Will mail to you asap