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Anesthesia question - OssaTron

Posted by BrianG on 4/03/01 at 09:25 (043422)

Could someone explain to me what what type of anesthsia is used for the OssaTron treatments. Is there an Anesthesiologist involved? If so, is his fee over and above the fee for the ESWT treatment? Thanks in advance.

BCG

Re: Anesthesia question - OssaTron

Dr. Zuckerman on 4/03/01 at 13:52 (043446)

Hi.

This is my impresssion of the fee arrangement

1. Doctor fee
2. ASC fee
3. Anesthesiologist fee

All fees would be separate fees.

Re: Anesthesia question - OssaTron

Dr. Marlene Reid on 4/03/01 at hrmin (043464)

Anesthisia is a decision between the surgeon and the patient. Choices would be staight local injection, an injection with MAC sedation (so you don't feel the injection) or just sedation. The injections would be painful without haveing the MAC sedation. I do not do any procedure that requires more then one injection without MAC sedation. It is just not fair to the patient, but the OssaTron could be used with a local only. So could the Orbason. Dr. Weil, I believe, always uses anesthesia with his Orbasone.

The injection, always, is included in the procedural fee. If any ancellary services are performed for ESW or any surgery, including anesthesia, lab services, etc., they are billed seperately. As is the use of the machine. I do believe that some of the 6 people that own Orbasones do charge for the machine and or a room fee seperately from the physician services. It isn't an OssaTron vs. Orbasone issue that you all have been lead to believe, its more a physician preference. Also realise that those that use anesthesia do so to be able to use a higher power treatment. It has been shown to be more effective at higher power.

Re: Anesthesia question - OssaTron

Martha B. on 4/03/01 at 20:49 (043516)

Had ossatron in Toronto. They left some kind of cream on my leg for about 45 minutes prior to the block injection-then injected directly into the bottom of my foot. Both injections were a piece of cake compared to the dreaded cortisone injections I had gotten previously. As I have said many times before the last 3 minutes of ossatron HURT!

Re: Anesthesia question - OssaTron

BrianG on 4/03/01 at 20:52 (043518)

Hi Dr. Reid,

Thank you for the answers, which leads to another question. You mention that the injection is painful, and you would not give more than one, without anesthsia. Is the injection any more painfull than a cortisone injection? I've had a few cortisone shots, that had something like lidocaine in them, within a couple of minutes, my heel had no pain and felt like I could run a marathon, hahaaa. It seems to me once the 1st injection takes effect, a second or third would be a piece of cake. Am I missing something here?

Regards
BCG

Re: Anesthesia question - OssaTron

john h on 4/04/01 at 11:52 (043558)

i talked to two doctors brian. one in chicago and one in florida who use anesthesia. it is done in a hospital setting and it cost extra and there can be a nurse or gerneral anesthesiologist. as you know that is not cheap.

Re: Anesthesia question - OssaTron

Dr. Marlene Reid on 4/04/01 at 13:22 (043569)

The injections probably feel about the same. It is certainly an option having the ESW without the sedation. What we have been doing lately is not using the local injections at all. We've been doing straight sedation, that way, I can see how much pain relief people get IMMEDIATELY after the treatment, ie 20 minutes or so after the treatment. With injections, you will be numb for several hours and can not tell the IMMEDIATE relief at all. Its something that I am interested in seeing. However, if someone was really against the sedation, I would do an ankle block which is several shoots at various spots. Just numbing up the heel is not a good idea, because you do not want the fluid of the local to be in the direct path of the shockwave.

Re: To Dr. Reid Anesthesia question - OssaTron

Pauline on 4/04/01 at 13:48 (043573)

Dr. Reid,
If one can handle a true breast biopsy (not needle biopsy) done with only local anesthesia, no sedation can one handle the local anesthesia needed for use with the OssaTron?

Re: To Dr. Reid Anesthesia question - OssaTron

Dr. Ma on 4/04/01 at 14:34 (043578)

I suppose but the injections are painful.

Re: To Dr. Reid Anesthesia question - OssaTron

Pauline on 4/04/01 at 15:21 (043587)

Dr. Reid,
Is the patient put on a ventilator when given the general anaesthesia or are they using short acting drugs. Do you know which drugs?

Re: To Dr. Reid Anesthesia question - OssaTron

Dr. Marlene Reid on 4/04/01 at 21:36 (043644)

NO!!! General anesthesia is NOT used. All that is usually used is a mild sedation which keeps your drowsy or asleep for about 15 minutes, then the drugs wear off. Most people are groggy for 30 minutes to an hour afterward. You are not allowed to drive for the rest of the day. The drugs would depend on the individual. Lots of choices, depending on the person. Overall, it is quite a comfortable experience. Nausea is a possibility but not likely due to the very short term effects.

Re: Anesthesia question - OssaTron

BrianG on 4/05/01 at 09:02 (043680)

Thanks everyone, good string. It's information like this that helps when making the decision to have ESWT.

BCG

Re: To Dr. Reid Anesthesia question - OssaTron

Barbara TX on 4/06/01 at 11:56 (043823)

Dr. Reid - I assume that this is the sort of sedation that is used when, for instance, you have a dental procedure done, like getting a wisdom tooth pulled out. I had that sort of anesthesia twice, administered by two different doctors, and it really was awful.

First, I woke up in the middle of both procedures (cat-gut gagging me, pliers in my mouth, the whole deal). I was extremely nauseated and frightened by both experiences, out-of-it for an entire day, etc. Believe me, I would have much prefered a 'local' if such a thing were possible. Most frightening to me was the 'disembodied' way that I felt. I do thing it was one of the more disturbing moments of my life!

Doctors find it hard to understand that the patient would like to forgo aenesthesia. Perhaps they project their own feelings onto the patient, or feel a sort to maternal urge to protect them from pain. But, as doctors have learned from the whole natural childbirth movement, patients can request not to be sedated because of other health/comfort concerns, and undergo that pain gracefully and by choice.

I don't mean to stand on a soapbox here - and I feel a little strange defending the right to feel pain! But I think that it is important that the patient be able to choose what drugs she wants in her body. I am mot a purist about medication... I just know (because I acutally inhabit my body) what is good for me an what isn't.

I know that the Ossatron is more powerful, but I would only get it if I could have an ankle block, and not have my whole body be knocked out. My DPM here in TX says that is an option for me. I think that it should be an option for everybody. My second experience with the Orbasone was great - no needles, sedatives or anything. They also add to the expense of the procedure, so I was very happy to opt out of getting them. With my first Orbasone was not as pleasant. I had an ankle block and couldn't adjust the angle of my foot for comfort, and I came home with a very, very sore foot. With the second, I could adjust my foot periodically for comfort (because i could feel it, of course!) and I was able to ease the tension on my achilles from time to time and tell my DPM just how my foot felt.

I really feel strongly about the patient making decisions with their doctors about what chemicals to use, not the FDA, Healthtronics, Norland, or Dornier. Let them provide the spark plugs, and let me decide about the drugs!

Thanks for listening Dr. Reid - you make wonderful contributions to this board. Keep up the great work. B.

Re: To Dr. Reid Anesthesia question - OssaTron

Dr. Marlene Reid on 4/06/01 at 19:25 (043878)

I'm glad your pod will abide by your wishes. I would also for my patients. What worries me is why you failed the other ESW treatments, even after having 2 Orbasone treatments.

Re: Do ESWT doctors realize that ESWT treatments including the ossatron don't work in 100% of the cases

Dr. Zuckerman on 4/08/01 at 11:27 (043975)

It very important that new ESWT treating doctors realize that there is going to be about 20% complete no effect with any ESWT treatment. So Dr. Reid just like heel spur surgery there is going to be failed ESWT treatment but without the severe complication that can go with heel spur surgery.

Re: To Dr. Reid Anesthesia question - OssaTron

Barbara TX on 4/08/01 at 22:49 (044040)

Dr. Reid - I did not 'fail' the Orbasone treatments. Do you tell your patients who do not get better after the Ossatron that they have 'failed' Ossatron? I have done everything I can to get better, and I am worried as well. Thanks you for being so worried and concerned as to my progress. B.

Re: Anesthesia question - OssaTron

ines sz on 5/17/01 at hrmin (048090)

Dear Doctor,

I would like my face to be lifted(excluding forhead.)-I´m 70 years old,in
good heath,phisically, as well as menthally.My hight 1.73 and weight 68kg.
One of the Surgent chosen,intened using diprivan,and than use anaesthetic untill the end of the operation.
The other Doctor,wants to give sadative,and than local aenesthetic.
You might be able to help me choose,between the two of them,because the
second option seem to me very scary.
Thanks, beforehead your kindness
Truly,
Yours agi88@hotmail.com

ps.Forgive me for my bad English

Re: Anesthesia question - OssaTron

Dr. Zuckerman on 4/03/01 at 13:52 (043446)

Hi.

This is my impresssion of the fee arrangement

1. Doctor fee
2. ASC fee
3. Anesthesiologist fee

All fees would be separate fees.

Re: Anesthesia question - OssaTron

Dr. Marlene Reid on 4/03/01 at hrmin (043464)

Anesthisia is a decision between the surgeon and the patient. Choices would be staight local injection, an injection with MAC sedation (so you don't feel the injection) or just sedation. The injections would be painful without haveing the MAC sedation. I do not do any procedure that requires more then one injection without MAC sedation. It is just not fair to the patient, but the OssaTron could be used with a local only. So could the Orbason. Dr. Weil, I believe, always uses anesthesia with his Orbasone.

The injection, always, is included in the procedural fee. If any ancellary services are performed for ESW or any surgery, including anesthesia, lab services, etc., they are billed seperately. As is the use of the machine. I do believe that some of the 6 people that own Orbasones do charge for the machine and or a room fee seperately from the physician services. It isn't an OssaTron vs. Orbasone issue that you all have been lead to believe, its more a physician preference. Also realise that those that use anesthesia do so to be able to use a higher power treatment. It has been shown to be more effective at higher power.

Re: Anesthesia question - OssaTron

Martha B. on 4/03/01 at 20:49 (043516)

Had ossatron in Toronto. They left some kind of cream on my leg for about 45 minutes prior to the block injection-then injected directly into the bottom of my foot. Both injections were a piece of cake compared to the dreaded cortisone injections I had gotten previously. As I have said many times before the last 3 minutes of ossatron HURT!

Re: Anesthesia question - OssaTron

BrianG on 4/03/01 at 20:52 (043518)

Hi Dr. Reid,

Thank you for the answers, which leads to another question. You mention that the injection is painful, and you would not give more than one, without anesthsia. Is the injection any more painfull than a cortisone injection? I've had a few cortisone shots, that had something like lidocaine in them, within a couple of minutes, my heel had no pain and felt like I could run a marathon, hahaaa. It seems to me once the 1st injection takes effect, a second or third would be a piece of cake. Am I missing something here?

Regards
BCG

Re: Anesthesia question - OssaTron

john h on 4/04/01 at 11:52 (043558)

i talked to two doctors brian. one in chicago and one in florida who use anesthesia. it is done in a hospital setting and it cost extra and there can be a nurse or gerneral anesthesiologist. as you know that is not cheap.

Re: Anesthesia question - OssaTron

Dr. Marlene Reid on 4/04/01 at 13:22 (043569)

The injections probably feel about the same. It is certainly an option having the ESW without the sedation. What we have been doing lately is not using the local injections at all. We've been doing straight sedation, that way, I can see how much pain relief people get IMMEDIATELY after the treatment, ie 20 minutes or so after the treatment. With injections, you will be numb for several hours and can not tell the IMMEDIATE relief at all. Its something that I am interested in seeing. However, if someone was really against the sedation, I would do an ankle block which is several shoots at various spots. Just numbing up the heel is not a good idea, because you do not want the fluid of the local to be in the direct path of the shockwave.

Re: To Dr. Reid Anesthesia question - OssaTron

Pauline on 4/04/01 at 13:48 (043573)

Dr. Reid,
If one can handle a true breast biopsy (not needle biopsy) done with only local anesthesia, no sedation can one handle the local anesthesia needed for use with the OssaTron?

Re: To Dr. Reid Anesthesia question - OssaTron

Dr. Ma on 4/04/01 at 14:34 (043578)

I suppose but the injections are painful.

Re: To Dr. Reid Anesthesia question - OssaTron

Pauline on 4/04/01 at 15:21 (043587)

Dr. Reid,
Is the patient put on a ventilator when given the general anaesthesia or are they using short acting drugs. Do you know which drugs?

Re: To Dr. Reid Anesthesia question - OssaTron

Dr. Marlene Reid on 4/04/01 at 21:36 (043644)

NO!!! General anesthesia is NOT used. All that is usually used is a mild sedation which keeps your drowsy or asleep for about 15 minutes, then the drugs wear off. Most people are groggy for 30 minutes to an hour afterward. You are not allowed to drive for the rest of the day. The drugs would depend on the individual. Lots of choices, depending on the person. Overall, it is quite a comfortable experience. Nausea is a possibility but not likely due to the very short term effects.

Re: Anesthesia question - OssaTron

BrianG on 4/05/01 at 09:02 (043680)

Thanks everyone, good string. It's information like this that helps when making the decision to have ESWT.

BCG

Re: To Dr. Reid Anesthesia question - OssaTron

Barbara TX on 4/06/01 at 11:56 (043823)

Dr. Reid - I assume that this is the sort of sedation that is used when, for instance, you have a dental procedure done, like getting a wisdom tooth pulled out. I had that sort of anesthesia twice, administered by two different doctors, and it really was awful.

First, I woke up in the middle of both procedures (cat-gut gagging me, pliers in my mouth, the whole deal). I was extremely nauseated and frightened by both experiences, out-of-it for an entire day, etc. Believe me, I would have much prefered a 'local' if such a thing were possible. Most frightening to me was the 'disembodied' way that I felt. I do thing it was one of the more disturbing moments of my life!

Doctors find it hard to understand that the patient would like to forgo aenesthesia. Perhaps they project their own feelings onto the patient, or feel a sort to maternal urge to protect them from pain. But, as doctors have learned from the whole natural childbirth movement, patients can request not to be sedated because of other health/comfort concerns, and undergo that pain gracefully and by choice.

I don't mean to stand on a soapbox here - and I feel a little strange defending the right to feel pain! But I think that it is important that the patient be able to choose what drugs she wants in her body. I am mot a purist about medication... I just know (because I acutally inhabit my body) what is good for me an what isn't.

I know that the Ossatron is more powerful, but I would only get it if I could have an ankle block, and not have my whole body be knocked out. My DPM here in TX says that is an option for me. I think that it should be an option for everybody. My second experience with the Orbasone was great - no needles, sedatives or anything. They also add to the expense of the procedure, so I was very happy to opt out of getting them. With my first Orbasone was not as pleasant. I had an ankle block and couldn't adjust the angle of my foot for comfort, and I came home with a very, very sore foot. With the second, I could adjust my foot periodically for comfort (because i could feel it, of course!) and I was able to ease the tension on my achilles from time to time and tell my DPM just how my foot felt.

I really feel strongly about the patient making decisions with their doctors about what chemicals to use, not the FDA, Healthtronics, Norland, or Dornier. Let them provide the spark plugs, and let me decide about the drugs!

Thanks for listening Dr. Reid - you make wonderful contributions to this board. Keep up the great work. B.

Re: To Dr. Reid Anesthesia question - OssaTron

Dr. Marlene Reid on 4/06/01 at 19:25 (043878)

I'm glad your pod will abide by your wishes. I would also for my patients. What worries me is why you failed the other ESW treatments, even after having 2 Orbasone treatments.

Re: Do ESWT doctors realize that ESWT treatments including the ossatron don't work in 100% of the cases

Dr. Zuckerman on 4/08/01 at 11:27 (043975)

It very important that new ESWT treating doctors realize that there is going to be about 20% complete no effect with any ESWT treatment. So Dr. Reid just like heel spur surgery there is going to be failed ESWT treatment but without the severe complication that can go with heel spur surgery.

Re: To Dr. Reid Anesthesia question - OssaTron

Barbara TX on 4/08/01 at 22:49 (044040)

Dr. Reid - I did not 'fail' the Orbasone treatments. Do you tell your patients who do not get better after the Ossatron that they have 'failed' Ossatron? I have done everything I can to get better, and I am worried as well. Thanks you for being so worried and concerned as to my progress. B.

Re: Anesthesia question - OssaTron

ines sz on 5/17/01 at hrmin (048090)

Dear Doctor,

I would like my face to be lifted(excluding forhead.)-I´m 70 years old,in
good heath,phisically, as well as menthally.My hight 1.73 and weight 68kg.
One of the Surgent chosen,intened using diprivan,and than use anaesthetic untill the end of the operation.
The other Doctor,wants to give sadative,and than local aenesthetic.
You might be able to help me choose,between the two of them,because the
second option seem to me very scary.
Thanks, beforehead your kindness
Truly,
Yours agi88@hotmail.com

ps.Forgive me for my bad English