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Test

Posted by john h on 5/03/01 at 20:48 (046546)

Dr Z: with apparently 5 or so people coming for ESWT on the 15th of june i suggest you chart their progress on a weekly basis. Ask each of us our pain level prior to treatment and immediately after treatment and once a week thereafter for 12 weeks. this should be interesting to observe.

Re: Test

Dr. Zuckerman on 5/03/01 at 21:02 (046550)

We are planning a video study for this or a phone study . We are dong this for patients every two weeks now. I would be very happy to do this with the five if they are good candidates for ESWT.

Re: Dr. Z Test

Pauline on 5/04/01 at 08:07 (046570)

Dr. Z,
Are you planning any placebo testing? Will all treatment be delivered exactly the same on each individual from anaesthesia to pulses and power if you are planning on using this as a study?

Re: Dr. Z Test

Kate on 5/04/01 at 08:26 (046572)

pauline,
I don't think that Dr. Z meant study in the way that you are interpreting it. And no, there is no way to use any type of placebo in this case.
Dr. Zuckerman follows all of his patients very closely post-tx, and I believe that in as much as he will be doing five patients in one day
( which he has done before) he will be following this group a little closer to establish any similarities in progress. If for no other reason, that to assure that these patient receive the best possible aftercare. That's how he is.
And also, just as no one patients pain or discomfort is exactly the same, while the treatment always falls into certain parameters and guidelines for pulses and anesthesia (if the patient requests or requires it), every treatment is as individual as the diagnosis. As well, the healing progression and end result may also differ from patient to patient. Dr.Z has always gone to great lengths however to determine any similiarities and/or likenesses, and to establish any common ground among pf and heelspur patients pre tx, during tx, and especially post tx. By doing so, he has set some of the standard of care for this treatment as it applies to those respective dianosis.

Re: Dr. Z Test

john h on 5/04/01 at 09:19 (046580)

john h will have no placebo! i am not flying to new jersey for a study but to get an ESWT treatment. i would very imagine the others who are coming feel the same way. i think several of us have already had treatments. of course 5 people is not a big enough sample to derrive anything from. since i feel i know the 5 involved i just thought it would be interesting to follow us all for 12 weeks since we will all be there for treatment at the same time and all know a lot about PF and more than the averabe bear about ESWT. maybe judy s will go for the placebo since she is only flying from the west coast. i would like to know how you administer a placebo with ESWT. if you have ever experienced several of those shock waves i cannot imagine how you could fool someone who has. if dr z tries a placebo on me i will put a curse on his world headquarter for 100 years and all his patients for 100 years.

Re: Dr. Z Test

Sherrie M. on 5/04/01 at 09:39 (046582)

Hi John, I can't stop laughing after reading your post. I'm going to be late to physical therapy if I don't get off the board and stop laughing. I'm with you if Dr.Z would try a placebo with me I don't know what I'd do but your suggestion is great! I only wish Pauline could come have treatment with us to see how it really is, and to see how great Dr. Z and staff really are.

Re: Dr. Z Test

john h on 5/04/01 at 10:42 (046586)

and how great we are sherrie!

Re: Placebos can help

BrianG on 5/04/01 at 10:49 (046589)

Pauline, I have read where some people in the hospital studies did get a placebo treatment, and 40% of them were healed! Interesting, isn't it.

BCG

Re: Never a placebo only the real deal. !!!!

Dr. Zuckerman on 5/04/01 at 11:08 (046594)

I will never use a placebo on you period end of story.

Re: Dr. Z Test

JudyS on 5/04/01 at 11:15 (046596)

Whoa.......have I become a test-taker overnight? Nope, no placebos for this SoCal girl......but I would consider a Margharita.....

Re: Never a placebo only the real deal. !!!!

Richard Perez, DPM on 5/04/01 at hrmin (046600)

In order to do a study which involves a placebo (AKA a blind study), one needs funds to offer free treatment to all patients. These funds come from two sources here in the United States; US government grants from the National Institutes of Health or from the private company. This is how many drug trials are conducted. Patients are paid to be in the study, in return, they may receive a placebo as part of their free treatment.

It is not feasable for a private practice to conduct a 'blind study' due to the cost involved. This is generally left to the research institutions or company sponsored sites.

Patients and insurance companies will not be opened to paying for possible placebo treatments.

Re: Dr. Z Test

To John Others on 5/04/01 at 12:30 (046609)

I asked Dr. Z this question out of sincerity because he did post at one
time that he was possibly considering running test. There is the possibility that the doctors that own the Orbasone may be providing the necessary documentation that the FDA is requiring of Norland. It was a simple sincere question----why the jokes?

Re: Dr. Z Test

Pauline on 5/04/01 at 12:31 (046610)

Forgot to add name to other post.

Re: To Richard Never a placebo only the real deal. !!!!

Pauline on 5/04/01 at 15:40 (046627)

I've been in blood pressure studies and never got paid, so I don't think all studies pay the people who are in them. This was done through U.of M medical center.

Re: Placebos can help

john h on 5/06/01 at 11:22 (046779)

in many or most of various studies i read about there are many patients that receive relief from what ever bothers them from placebo hence the very common pharase 'the placebo effect'.

Re: Placebos can help

Julie on 5/06/01 at 12:46 (046787)

John, I feel sure that the 'placebo effect' is actually important evidence of the intimate relation between the mind and the body. If we want to be helped, and if we believe that something is helping us, there is a good chance that it will help. This isn't something to be scoffed at, though it often is.

Re: Placebos can help

Pauline on 5/06/01 at 16:13 (046807)

It is interesting to note that in medication testing placebos seem to cause ill effects too. Hence I guess it can go either way.

Re: Placebos can help

john h on 5/06/01 at 18:36 (046824)

the mind body connection is very real. as you know some buddist monks can will their blood pressure and heart rate down to unbelievable levels.

Re: Placebos can help

john h on 5/06/01 at 18:40 (046825)

it sure can go either way! if you think the pill will make you sick their is a likely chance it will. i would suspect that a person who is receptive to ESWT and has confidence in it has a better chance of improvement than one who does not believe in it. placebo effects usually wear off, unfortunately, and your old mallady returns.

Re: Placebos can help

Pauline on 5/06/01 at 20:21 (046833)

You are so right about the Buddist Monks, you have to have so much respect for how they can control their entire bodies. It is truely amazing. I wonder if they could also control the pain from PF. if they had it.

Re: John what is your status?

Kim B. on 5/07/01 at 03:16 (046853)

I have lost track of your progress and Post Orbasone ESWT status. Would you update me? How many treatements have you had so far? Are you still having foot pain?

Regards, Kim B.

Re: John what is your status?

john h on 5/07/01 at 10:03 (046879)

kim: i had my first orbasone treatment in august 99 on both feet on the same day. a local was used. over the next 12 weeks i went from a pain level of around 4 to a pain level of 2. i had my second treatment the next spring and my pain level eventually settled to around a 1.5 although i have gone for 2 months at a pain level of no more than 1. i can still screw up and do to much and go back to a 2. there never was any pain after the treatments and i walked out of the doctors office and drove to baltimore and walked through 2 airports on the way home. i am scheduled for a 3rd treatment on the 15th of june on both feet. will try it without any shots this time. i think the treatment has provided positive results for me although i am not 'cured'. my sense of this is that one could get more than 3 treatments if they continue to show improvement after each treatment. no science behind this statement but just my thoughts.

Re: Placebos can help

john h on 5/07/01 at 10:08 (046882)

i have read that they do have some control over their pain. the pain may be there but they have the mental capacity to manage it in ways we do not understand. in some cultures people go through terrible ordeals mutilating their bodies as a rite of passage into manhood or womanhood and seem to manage it very well. most of us would pass out. having spent several years in the far east i find these people to handle pain much better than people of the western culture.

Re: That's encouraging new John

Kim B. on 5/07/01 at 10:10 (046884)

I'm glad to hear that you are getting the results you desire. That truly is good news :-) btw, do you fly yourself up to New Jersey or do you go commercial?

Kim B.

Re: That's encouraging new John

john h on 5/07/01 at 15:06 (046929)

i pay my way. leave little rock about 5:30. arrive in baltimore at 10:30, drive to dr zuckermans (2.5 hours) and have treatment in the after noon. fly back to little rock next morning arriving at noon. rountrip air on southwest $199. TWA $260 with reserved seats. i sure would not be making this trip if i did not think i was getting some benefit.

Re: That's encouraging new John

Pauline on 5/07/01 at 15:23 (046938)

John,
Do you wear Orthotics too even with the results of your treatments?

Re: That's encouraging new John

john h on 5/07/01 at 18:01 (046956)

i wear orthotics or birk sandals most of the time. i wear SAS shoes or the New Balance 853 cross trainer. on occasion i will wear a joseph seibel dress shoe or ecco dress shoe both of which have a good arch support built in. having hallux limitus in my right foot (i had a cheilectomy on my left one) it is important that i have a fairly stiff sole because bending the to up with hallux limitus produces 'PAIN'! the roll bar in the New Balance 853 also is a help with hallux limitus.

Re: That's encouraging new John

john h on 5/07/01 at 18:30 (046960)

i wear orthotics or birk sandals most of the time. i wear SAS shoes or the New Balance 853 cross trainer. on occasion i will wear a joseph seibel dress shoe or ecco dress shoe both of which have a good arch support built in. having hallux limitus in my right foot (i had a cheilectomy on my left one) it is important that i have a fairly stiff sole because bending the to up with hallux limitus produces 'PAIN'! the roll bar in the New Balance 853 also is a help with hallux limitus.

Re: John, i have a question

niels l on 5/08/01 at 02:25 (046998)

hi,

i also have both pf and hallux limitus (in both feet) and i am cosidering to have a hallux limitus surgery as i believe this will help my pf (since the extra stress constantly caused by hallux limitus on the plantars will be reduced).

Do you think i am right ? I know that you have had a surgery. Did it reduce yuor pf ?

Niels

Re: John, i have a question

john h on 5/08/01 at 09:52 (047022)

neils: ithink with hallux limitus you alter the way your foot strikes the ground in order to avoid the associated pain with hallux limitus. your fascia does not stretch as much as befor hallux limitus because your great toe will not bend up very much. hallux limitus will not get better on its on and will likely get worse (mine did). i had my left toe done 2 years ago along with a PF release and TTS release all at the same time. a cheilectomy to correct the hallux limitus takes about 30 minutes outpatient. i would not go for an artifical joint due to early failures. their are several methods of doing the chelictomy and i chose what i recall as the Valenti Procedure. Ask your doctor if he is familar with it. It is not enough just to remove the spurs in and around the joint. with the valenti procedure a wedge of bone in the joint is removed allowing for good upward flexion of the joint. it is very important to start flexing the joint upward pain or no pain as soon as possible so that you will have permenent and sufficient upward flexion. i plan on having a chelictomy on my other toe at some point in the future. one of my doctors had chelictomys on both of her toes. more common among women. do not do both at same time. you should be able to walk out after surgery in a stiff surgical shoe. dr zuckerman can describe the Valenti Procedure a lot better than me. i think their is a distinct correlation between hallux limitus and PF. dr kosovo, i think, seems to be of that opinion.

Re: John, i have a question

john h on 5/11/01 at 09:15 (047441)

neils: one other thing i failed to mention is that if you wait to long and your hallux limitus becomes hallux rigidus it may be that you have to have the joint fused as their would not be enough cartlidge left to perform a cheilectomy. my first doctor said i had virtually no cartilidge in my joint. my second doctor said i had plenty of cartlidge and a cheilectomy should be the recommended treatment. some people can live with the problem for years but i assume they do not engage in much activity that requires the bending of the great toe. please free to email me at johnlh@swbell.net if you have any questions.

Re: Test

Dr. Zuckerman on 5/03/01 at 21:02 (046550)

We are planning a video study for this or a phone study . We are dong this for patients every two weeks now. I would be very happy to do this with the five if they are good candidates for ESWT.

Re: Dr. Z Test

Pauline on 5/04/01 at 08:07 (046570)

Dr. Z,
Are you planning any placebo testing? Will all treatment be delivered exactly the same on each individual from anaesthesia to pulses and power if you are planning on using this as a study?

Re: Dr. Z Test

Kate on 5/04/01 at 08:26 (046572)

pauline,
I don't think that Dr. Z meant study in the way that you are interpreting it. And no, there is no way to use any type of placebo in this case.
Dr. Zuckerman follows all of his patients very closely post-tx, and I believe that in as much as he will be doing five patients in one day
( which he has done before) he will be following this group a little closer to establish any similarities in progress. If for no other reason, that to assure that these patient receive the best possible aftercare. That's how he is.
And also, just as no one patients pain or discomfort is exactly the same, while the treatment always falls into certain parameters and guidelines for pulses and anesthesia (if the patient requests or requires it), every treatment is as individual as the diagnosis. As well, the healing progression and end result may also differ from patient to patient. Dr.Z has always gone to great lengths however to determine any similiarities and/or likenesses, and to establish any common ground among pf and heelspur patients pre tx, during tx, and especially post tx. By doing so, he has set some of the standard of care for this treatment as it applies to those respective dianosis.

Re: Dr. Z Test

john h on 5/04/01 at 09:19 (046580)

john h will have no placebo! i am not flying to new jersey for a study but to get an ESWT treatment. i would very imagine the others who are coming feel the same way. i think several of us have already had treatments. of course 5 people is not a big enough sample to derrive anything from. since i feel i know the 5 involved i just thought it would be interesting to follow us all for 12 weeks since we will all be there for treatment at the same time and all know a lot about PF and more than the averabe bear about ESWT. maybe judy s will go for the placebo since she is only flying from the west coast. i would like to know how you administer a placebo with ESWT. if you have ever experienced several of those shock waves i cannot imagine how you could fool someone who has. if dr z tries a placebo on me i will put a curse on his world headquarter for 100 years and all his patients for 100 years.

Re: Dr. Z Test

Sherrie M. on 5/04/01 at 09:39 (046582)

Hi John, I can't stop laughing after reading your post. I'm going to be late to physical therapy if I don't get off the board and stop laughing. I'm with you if Dr.Z would try a placebo with me I don't know what I'd do but your suggestion is great! I only wish Pauline could come have treatment with us to see how it really is, and to see how great Dr. Z and staff really are.

Re: Dr. Z Test

john h on 5/04/01 at 10:42 (046586)

and how great we are sherrie!

Re: Placebos can help

BrianG on 5/04/01 at 10:49 (046589)

Pauline, I have read where some people in the hospital studies did get a placebo treatment, and 40% of them were healed! Interesting, isn't it.

BCG

Re: Never a placebo only the real deal. !!!!

Dr. Zuckerman on 5/04/01 at 11:08 (046594)

I will never use a placebo on you period end of story.

Re: Dr. Z Test

JudyS on 5/04/01 at 11:15 (046596)

Whoa.......have I become a test-taker overnight? Nope, no placebos for this SoCal girl......but I would consider a Margharita.....

Re: Never a placebo only the real deal. !!!!

Richard Perez, DPM on 5/04/01 at hrmin (046600)

In order to do a study which involves a placebo (AKA a blind study), one needs funds to offer free treatment to all patients. These funds come from two sources here in the United States; US government grants from the National Institutes of Health or from the private company. This is how many drug trials are conducted. Patients are paid to be in the study, in return, they may receive a placebo as part of their free treatment.

It is not feasable for a private practice to conduct a 'blind study' due to the cost involved. This is generally left to the research institutions or company sponsored sites.

Patients and insurance companies will not be opened to paying for possible placebo treatments.

Re: Dr. Z Test

To John Others on 5/04/01 at 12:30 (046609)

I asked Dr. Z this question out of sincerity because he did post at one
time that he was possibly considering running test. There is the possibility that the doctors that own the Orbasone may be providing the necessary documentation that the FDA is requiring of Norland. It was a simple sincere question----why the jokes?

Re: Dr. Z Test

Pauline on 5/04/01 at 12:31 (046610)

Forgot to add name to other post.

Re: To Richard Never a placebo only the real deal. !!!!

Pauline on 5/04/01 at 15:40 (046627)

I've been in blood pressure studies and never got paid, so I don't think all studies pay the people who are in them. This was done through U.of M medical center.

Re: Placebos can help

john h on 5/06/01 at 11:22 (046779)

in many or most of various studies i read about there are many patients that receive relief from what ever bothers them from placebo hence the very common pharase 'the placebo effect'.

Re: Placebos can help

Julie on 5/06/01 at 12:46 (046787)

John, I feel sure that the 'placebo effect' is actually important evidence of the intimate relation between the mind and the body. If we want to be helped, and if we believe that something is helping us, there is a good chance that it will help. This isn't something to be scoffed at, though it often is.

Re: Placebos can help

Pauline on 5/06/01 at 16:13 (046807)

It is interesting to note that in medication testing placebos seem to cause ill effects too. Hence I guess it can go either way.

Re: Placebos can help

john h on 5/06/01 at 18:36 (046824)

the mind body connection is very real. as you know some buddist monks can will their blood pressure and heart rate down to unbelievable levels.

Re: Placebos can help

john h on 5/06/01 at 18:40 (046825)

it sure can go either way! if you think the pill will make you sick their is a likely chance it will. i would suspect that a person who is receptive to ESWT and has confidence in it has a better chance of improvement than one who does not believe in it. placebo effects usually wear off, unfortunately, and your old mallady returns.

Re: Placebos can help

Pauline on 5/06/01 at 20:21 (046833)

You are so right about the Buddist Monks, you have to have so much respect for how they can control their entire bodies. It is truely amazing. I wonder if they could also control the pain from PF. if they had it.

Re: John what is your status?

Kim B. on 5/07/01 at 03:16 (046853)

I have lost track of your progress and Post Orbasone ESWT status. Would you update me? How many treatements have you had so far? Are you still having foot pain?

Regards, Kim B.

Re: John what is your status?

john h on 5/07/01 at 10:03 (046879)

kim: i had my first orbasone treatment in august 99 on both feet on the same day. a local was used. over the next 12 weeks i went from a pain level of around 4 to a pain level of 2. i had my second treatment the next spring and my pain level eventually settled to around a 1.5 although i have gone for 2 months at a pain level of no more than 1. i can still screw up and do to much and go back to a 2. there never was any pain after the treatments and i walked out of the doctors office and drove to baltimore and walked through 2 airports on the way home. i am scheduled for a 3rd treatment on the 15th of june on both feet. will try it without any shots this time. i think the treatment has provided positive results for me although i am not 'cured'. my sense of this is that one could get more than 3 treatments if they continue to show improvement after each treatment. no science behind this statement but just my thoughts.

Re: Placebos can help

john h on 5/07/01 at 10:08 (046882)

i have read that they do have some control over their pain. the pain may be there but they have the mental capacity to manage it in ways we do not understand. in some cultures people go through terrible ordeals mutilating their bodies as a rite of passage into manhood or womanhood and seem to manage it very well. most of us would pass out. having spent several years in the far east i find these people to handle pain much better than people of the western culture.

Re: That's encouraging new John

Kim B. on 5/07/01 at 10:10 (046884)

I'm glad to hear that you are getting the results you desire. That truly is good news :-) btw, do you fly yourself up to New Jersey or do you go commercial?

Kim B.

Re: That's encouraging new John

john h on 5/07/01 at 15:06 (046929)

i pay my way. leave little rock about 5:30. arrive in baltimore at 10:30, drive to dr zuckermans (2.5 hours) and have treatment in the after noon. fly back to little rock next morning arriving at noon. rountrip air on southwest $199. TWA $260 with reserved seats. i sure would not be making this trip if i did not think i was getting some benefit.

Re: That's encouraging new John

Pauline on 5/07/01 at 15:23 (046938)

John,
Do you wear Orthotics too even with the results of your treatments?

Re: That's encouraging new John

john h on 5/07/01 at 18:01 (046956)

i wear orthotics or birk sandals most of the time. i wear SAS shoes or the New Balance 853 cross trainer. on occasion i will wear a joseph seibel dress shoe or ecco dress shoe both of which have a good arch support built in. having hallux limitus in my right foot (i had a cheilectomy on my left one) it is important that i have a fairly stiff sole because bending the to up with hallux limitus produces 'PAIN'! the roll bar in the New Balance 853 also is a help with hallux limitus.

Re: That's encouraging new John

john h on 5/07/01 at 18:30 (046960)

i wear orthotics or birk sandals most of the time. i wear SAS shoes or the New Balance 853 cross trainer. on occasion i will wear a joseph seibel dress shoe or ecco dress shoe both of which have a good arch support built in. having hallux limitus in my right foot (i had a cheilectomy on my left one) it is important that i have a fairly stiff sole because bending the to up with hallux limitus produces 'PAIN'! the roll bar in the New Balance 853 also is a help with hallux limitus.

Re: John, i have a question

niels l on 5/08/01 at 02:25 (046998)

hi,

i also have both pf and hallux limitus (in both feet) and i am cosidering to have a hallux limitus surgery as i believe this will help my pf (since the extra stress constantly caused by hallux limitus on the plantars will be reduced).

Do you think i am right ? I know that you have had a surgery. Did it reduce yuor pf ?

Niels

Re: John, i have a question

john h on 5/08/01 at 09:52 (047022)

neils: ithink with hallux limitus you alter the way your foot strikes the ground in order to avoid the associated pain with hallux limitus. your fascia does not stretch as much as befor hallux limitus because your great toe will not bend up very much. hallux limitus will not get better on its on and will likely get worse (mine did). i had my left toe done 2 years ago along with a PF release and TTS release all at the same time. a cheilectomy to correct the hallux limitus takes about 30 minutes outpatient. i would not go for an artifical joint due to early failures. their are several methods of doing the chelictomy and i chose what i recall as the Valenti Procedure. Ask your doctor if he is familar with it. It is not enough just to remove the spurs in and around the joint. with the valenti procedure a wedge of bone in the joint is removed allowing for good upward flexion of the joint. it is very important to start flexing the joint upward pain or no pain as soon as possible so that you will have permenent and sufficient upward flexion. i plan on having a chelictomy on my other toe at some point in the future. one of my doctors had chelictomys on both of her toes. more common among women. do not do both at same time. you should be able to walk out after surgery in a stiff surgical shoe. dr zuckerman can describe the Valenti Procedure a lot better than me. i think their is a distinct correlation between hallux limitus and PF. dr kosovo, i think, seems to be of that opinion.

Re: John, i have a question

john h on 5/11/01 at 09:15 (047441)

neils: one other thing i failed to mention is that if you wait to long and your hallux limitus becomes hallux rigidus it may be that you have to have the joint fused as their would not be enough cartlidge left to perform a cheilectomy. my first doctor said i had virtually no cartilidge in my joint. my second doctor said i had plenty of cartlidge and a cheilectomy should be the recommended treatment. some people can live with the problem for years but i assume they do not engage in much activity that requires the bending of the great toe. please free to email me at johnlh@swbell.net if you have any questions.