Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

dr b dr z?

Posted by paula g on 3/18/01 at hrmin (041770)

would still love to get a dr's anwer to question, how many iontophereis and ultra sounds can one safely recieve and are there any side effects or dangers?

Re: dr b dr z?

DR. Biehler on 3/18/01 at 12:04 (041777)

Iontophoresis is a methotd of driving medication into the skin using sound waves. You should be more concerned with the effects the cortisone in having on the skin , such as atrophy, thinning, etc. ( if that is what is being driven in ). The dangers of ultrsound vary with the patient ( ie vascular status,etc. ) but the main danger ( assuming the is not any metal in the area being treated ) is the heat that is generated at the change of densities if the tissues in the area being treated. This can usually be avoided by either using 'pulse' waves or in the way the clinition is moving the wand over the area being treated and the power and depth settings. Dr. B.

Re: dr b dr z?

paula g on 3/18/01 at hrmin (041778)

it is cortisone. so how many treatments are safe? and is there another medicine besides cortisone?

Re: dr b dr z?

Pauline on 3/18/01 at 16:21 (041793)

Paula,
I've had quite a few of both because I have had PF 3 times now. I asked my Ortho about the Ionto and he said that the amount that is actually drawn in each time is very small. It is also a very dilute solution. It is not the same as having an injection of cortisone directly into the foot.
If I remember correctly, I had it 3 times a week for 8 or 10 weeks. The ultra sound was about the same. We used a 20% Cortisone cream for the ultra sound machine made up at the local pharmacy to use with the wand. I had them put it on in layers because it was not a good conductor because of it's thickness. They didn't like it but eventually came around.

Over the years I have found the biggest problem with physical therapy is not the physical therapist but the 'Aids' that help them and take on doing the Ionto and Ultra Sound. They are usually so into themselves that you have to keep telling them where to use the equipment. They don't even look at what they are doing. Can't remember a thing. I remember one day they were going to hook up the Ionto pads the wrong way. If I had'nt been paying attention I would have paid for no treatment that day. I really dislike treatments with people who don't care about their work. My time is more valuable than wasting it on their mistakes.

Re: dr b dr z?

DR. Biehler on 3/18/01 at 16:57 (041797)

Pauline; So true. I have worked with doctors that when they were done with the treatment I had to tell them they never had turned the machine on. When my wife was treated , they treat long enough for it to have any effect. With high doses of topical cortisone you have to worry about thinning out the skin. Atophy of the skin can also be a problem The greatest fear is causing a bone burn with using ultra sound incorrectly. Dr. B.

Re: dr b dr z?

Pauline on 3/18/01 at 17:48 (041800)

Dr. B,
Isn't the skin on the bottom of the foot some of the thickest on the body.
Sort of reminds me of the Poseidon. If that is the case how much topical
Cortisone cream does it take on a repetive basis to thin that skin?

I would have to say mine still seems intack although I cannot measure its thickness but on observation it does not appear thinner. The vein color
appears the same in both feet and hands, no easy bruising, or bleeding. My guess to get the thinning you are describing is longer than what I have described and on a continual basis.

Re: dr b dr z?

paula g on 3/18/01 at 21:06 (041818)

pt put ionto where heelspur is and that took pain away in whole foot. it was like a miracle. but i'd still like to hear from dr b or z as to how much cortisone is safe for how long. thank you pauline. would like to hear from others on this also.

Re: dr b dr z

paula g on 3/18/01 at hrmin (041819)

oops, or dr w. hi. you must be new

Re: dr b dr z?

Nancy S. on 3/18/01 at 21:36 (041821)

Well what does the PT him/herself say? Mine followed guidelines that have been longstanding at the rehab hospital I went to, and my dr. trusted her as a professional to know what she was doing, which I believe she did. The PT herself did the ionto procedures, not an assistant or anyone else.
She said ten treatments of either ultrasound OR ionto in a row only; then a break; then more if needed. My understanding was that it would be stopped before ten only if the skin showed signs of burning -- which shouldn't happen, because the ionto machine can be put at different settings according to what any given individual tolerates. The amount of cortisone itself is minuscule, nothing like the shots, and so the amount was not the issue.

Re: dr b dr z?

paula g on 3/19/01 at hrmin (041841)

i'll ask the pt today, and she does ultra sound and ionto both. but i've discovered with this pf nightmare that you must get a number of opinions because medical folk have such varied answers. and then i try to take a middle course. so it is great to hear from you and pauline and others cause then i have a good idea what's within the safe range. that's why this board is so helpful to me. oh, and also, where does your pts put the shots? is over the heel spur a common place?

Re: dr b dr z?

DR. Biehler on 3/18/01 at 12:04 (041777)

Iontophoresis is a methotd of driving medication into the skin using sound waves. You should be more concerned with the effects the cortisone in having on the skin , such as atrophy, thinning, etc. ( if that is what is being driven in ). The dangers of ultrsound vary with the patient ( ie vascular status,etc. ) but the main danger ( assuming the is not any metal in the area being treated ) is the heat that is generated at the change of densities if the tissues in the area being treated. This can usually be avoided by either using 'pulse' waves or in the way the clinition is moving the wand over the area being treated and the power and depth settings. Dr. B.

Re: dr b dr z?

paula g on 3/18/01 at hrmin (041778)

it is cortisone. so how many treatments are safe? and is there another medicine besides cortisone?

Re: dr b dr z?

Pauline on 3/18/01 at 16:21 (041793)

Paula,
I've had quite a few of both because I have had PF 3 times now. I asked my Ortho about the Ionto and he said that the amount that is actually drawn in each time is very small. It is also a very dilute solution. It is not the same as having an injection of cortisone directly into the foot.
If I remember correctly, I had it 3 times a week for 8 or 10 weeks. The ultra sound was about the same. We used a 20% Cortisone cream for the ultra sound machine made up at the local pharmacy to use with the wand. I had them put it on in layers because it was not a good conductor because of it's thickness. They didn't like it but eventually came around.

Over the years I have found the biggest problem with physical therapy is not the physical therapist but the 'Aids' that help them and take on doing the Ionto and Ultra Sound. They are usually so into themselves that you have to keep telling them where to use the equipment. They don't even look at what they are doing. Can't remember a thing. I remember one day they were going to hook up the Ionto pads the wrong way. If I had'nt been paying attention I would have paid for no treatment that day. I really dislike treatments with people who don't care about their work. My time is more valuable than wasting it on their mistakes.

Re: dr b dr z?

DR. Biehler on 3/18/01 at 16:57 (041797)

Pauline; So true. I have worked with doctors that when they were done with the treatment I had to tell them they never had turned the machine on. When my wife was treated , they treat long enough for it to have any effect. With high doses of topical cortisone you have to worry about thinning out the skin. Atophy of the skin can also be a problem The greatest fear is causing a bone burn with using ultra sound incorrectly. Dr. B.

Re: dr b dr z?

Pauline on 3/18/01 at 17:48 (041800)

Dr. B,
Isn't the skin on the bottom of the foot some of the thickest on the body.
Sort of reminds me of the Poseidon. If that is the case how much topical
Cortisone cream does it take on a repetive basis to thin that skin?

I would have to say mine still seems intack although I cannot measure its thickness but on observation it does not appear thinner. The vein color
appears the same in both feet and hands, no easy bruising, or bleeding. My guess to get the thinning you are describing is longer than what I have described and on a continual basis.

Re: dr b dr z?

paula g on 3/18/01 at 21:06 (041818)

pt put ionto where heelspur is and that took pain away in whole foot. it was like a miracle. but i'd still like to hear from dr b or z as to how much cortisone is safe for how long. thank you pauline. would like to hear from others on this also.

Re: dr b dr z

paula g on 3/18/01 at hrmin (041819)

oops, or dr w. hi. you must be new

Re: dr b dr z?

Nancy S. on 3/18/01 at 21:36 (041821)

Well what does the PT him/herself say? Mine followed guidelines that have been longstanding at the rehab hospital I went to, and my dr. trusted her as a professional to know what she was doing, which I believe she did. The PT herself did the ionto procedures, not an assistant or anyone else.
She said ten treatments of either ultrasound OR ionto in a row only; then a break; then more if needed. My understanding was that it would be stopped before ten only if the skin showed signs of burning -- which shouldn't happen, because the ionto machine can be put at different settings according to what any given individual tolerates. The amount of cortisone itself is minuscule, nothing like the shots, and so the amount was not the issue.

Re: dr b dr z?

paula g on 3/19/01 at hrmin (041841)

i'll ask the pt today, and she does ultra sound and ionto both. but i've discovered with this pf nightmare that you must get a number of opinions because medical folk have such varied answers. and then i try to take a middle course. so it is great to hear from you and pauline and others cause then i have a good idea what's within the safe range. that's why this board is so helpful to me. oh, and also, where does your pts put the shots? is over the heel spur a common place?