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I now think my doctor may not be looking out for my best interests...

Posted by Nicole K. on 11/28/01 at 15:59 (065524)

After doing a lot of reading on this board and website (thank you so much for this site, and the people) I asked my Podiatrist about ESWT and Celebrex. Regarding ESWT, he was quick to say basically, that it was not an option for me (funny, I think it's my only option at this point). He said stuff like, 'the jury's still out on that...' and that 'it would be a lot of money and not covered by insurance...' and 'the only people doing that are being investigated by the AMA...' or some medical association. Then I asked him what he thought about Celebrex and he told me it's $12 a pill and the side effects outwigh the benefit and that the people posting good comments about it were probably paid off by the manufacturer.

Whew! I was so discouraged to hear him ranting all of that crap... I am very upset that he doesn't even seem to think ESWT is an option because most people around here, it seems that their docs do suggest they try ESWT before surgery. Anyhow, I seem to get the message that he really wants to do another surgery on me (the third surgery, see My Story thread a few down). I have to say that I am not pleased and think it's time to find a new doctor in spite of the fact that he is supposedly the best Pod in my area and even a friend to me. I feel that ESWT is worth the gamble if it means not having heel spur surgery. What do you all think?

Re: I now think my doctor may not be looking out for my best interests...

cindyp on 11/28/01 at 16:43 (065529)

I always say if you feel like that go somewhere else to another dr. Ya have to have a level of comfort and if ya don't then what's the point?

Re: I now think my doctor may not be looking out for my best interests...

D.Thomas on 11/28/01 at 16:47 (065530)

I hate to say it but he doesn't sound that good if you ask me. Sounds like he has alot of opinions and no facts to back them up. ESWT has had some very positive effects for people with PF around the ankle. Which is very well supported in the medical journals. The problem is that insurance companies are being slow with their acceptance and very few pay anything at all for ESWT.

The foot doctors I tended to dislike the most had strong opinions like the one you describe above. I remember talking about the Internet to one Pod and he said that nobody on the Internet knows about PF and I shouldn't read anything on the Internet.

My advice - Try finding another doctor.

Re: I now think my doctor may not be looking out for my best interests...

Beverly on 11/28/01 at 17:55 (065538)

My orthopedic surgeon who specializes in foot/ankle was quick to send me for an EWST evaluation as soon as it became available in our area.
As it turned out, I was not a good canidate... had too many pain spots throughout feet and ankles. But I was happy to have the chance to be evaluated.

I've learned to change doctors when I feel uncomfortable. Could you ask your GP or internist for a couple of names of top orthopedic docs who specialize in foot/ankle? I always ask if a specialist is board certified in his particular field.
Good luck,
Beverly

Re: I now think my doctor may not be looking out for my best interests...

JudyS on 11/28/01 at 19:04 (065552)

Nicole, my Pod said exactly the same thing to me when I asked him about ESWt! He was quick to discourage the idea.....and neither he nor the HMO Podiatric department even wanted to learn about ESWT - at least not from a lowly patient. At any rate, I did the ESWT anyway - twice so far. And I've had marked improvement (PF for three years) both times. Once last June and again in September.
It's so strange to hear that your doc even discourages Celebrex - it almost sounds like he was on an 'automatic discourage' setting! Lots of PF folks here have used Celebrex - does your insurance cover prescriptions?

Re: I now think my doctor may not be looking out for my best interests...

~~~~~e C on 11/28/01 at 19:11 (065553)

Well, I'm not paid off by the manufacturer. I earn enough to support myself through my occupation as a physical oceanographer.

I just bought 90 of the 200mg Celebrex capsules (these are the large dose, not the 100mg); I pay 25% and my insurance pays 75%. My bill was $55. That comes to $220/90 per pill, or about $2.44 per capsule. My prescription was to take 1 capsule per day, until recently when he told me I could take two.

Re: I now think my doctor may not be looking out for my best interests...

Carole C on 11/28/01 at 19:18 (065556)

sorry, that was from me, Carole C. I punched the button to send it, by mistake. Anyway, I don't know of anybody that takes more than 400 mg/day and most people I've met who are on it for arthritis only take 100 mg/day. The range would be from $1.22 to $4.88 per day. This is from the first drug store I tried, a well known chain (but I'd better not say which or your doctor will think I work for them! LOL). I haven't shopped around, because they are nearby and have a drive through.

My doctor didn't want to prescribe it for me, either. I think that they are concerned because first of all, the insurance companies don't like to pay for these medications due to their expense. Secondly, as I understand it conventional wisdom in the medical community has it that most patients don't need something this high powered anyway and that Celebrex and Vioxx are over-prescribed.

Carole C

Re: I now think my doctor may not be looking out for my best interests...

BG CPed on 11/28/01 at 19:46 (065561)

I would search elsewhere for another opinion. For the Celebrex, I am not a Doc but a lowly shoe cobbler. It works for some people very well, it can cause alergic reaction in some and irritate stomach in others. I find it ironic he pooh poohs ESWT when in my humble guess he would be more than happy to do a plantar fascia release after doing too many injections of cortisone. I would bet that if you did a poll you would find more reduction in symptoms with celebrex or ESWT compared to pf release procedure.

Not cutting on your Doc but when somebody shoots down all ideas and overstates facts without proof whether they are an auto mechanic or a school teacher it sends up a flag. Maybe one of the Docs on here can refer you to an associate in your area

Re: I now think my doctor may not be looking out for my best interests...

cindyp on 11/28/01 at 20:13 (065564)

well as for the celebrex i was on 200 mgs twice a day and after two weeks it stopped working. Medicine is medicine and I myself dont advocate taking any long term because all you are doing is fixing symptoms and not the problem. But if your doctor isn't willing to listen to you you have no trust and then what's the point? Go elsewhere and find somebody who will listen toyou. Stand up on the table and jump up an down and say listen dumbo i pay you listen to me.

Re: Time for a 2nd and 3rd opinion

BrianG on 11/28/01 at 20:32 (065565)

Hi Nicole,

Your doctor was not 100% wrong in that some ESWT machines are being investigated. However it is not the AMA, it is the FDA, the group that approves the machines for use in this this country. There are no guarantees with ESWT, which can cost many thousands of dollars at this moment. I believe the doctors are saying it has a 60% chance of helping you to get better. These odds are not good enough for me, at this time.

I would get a 2nd, and 3rd opinion. If at all possible try to put off your decision for another year. I'm hoping we will see more hospitals performing ESWT, with more insurance companies picking up the bill. Surgery should be a last resort, imho! Good luck

BCG

Re: I now think my doctor may not be looking out for my best interests...

DR Zuckerman on 11/28/01 at 22:00 (065577)

Wow that is alot of doctors being investigated. Healthronics has trained over one thousand doctors to use the ossatron unit. Yes there was some competitive complaining between manufactors and now it looks like all manufactors will have to go thru class three review before they can take their machine to market. ESWT is a great non-surgical, non-invasive procedure that should be used before any surgery in the right patient

Re: Time for a 2nd and 3rd opinion

DR Zuckerman on 11/28/01 at 22:02 (065579)

Who is saying that the results are 60%. I know that FDA studies for the ossatron was 62% but their results are in reality much higher

Re: I now think my doctor may not be looking out for my best interests...

Julie on 11/29/01 at 02:42 (065592)

Nicole, your pod may have the reputation of being the best in the area, but it doesn't sound as though he's the best pod for you. I suspect there may be many podiatrists out there who are good at lots of things but haven't the patience to deal with long-term PF. I agree with everyone who has already said it's time for you to find another.

Where do you live? Perhaps one of the doctors here can recommend someone near you.

Re: I now think my doctor may not be looking out for my best interests...

john h on 11/29/01 at 10:27 (065611)

Nicole: Your doctor sounds like a 'quack' to me. By all means find another doctor and get some other advice.

Re: I now think my doctor may not be looking out for my best interests...

Beverly on 11/29/01 at 12:17 (065628)

And an honest doctor like Dr. Z. will tell you if you;re a good candidate or not, but I don't see how a pod who doesn't even perform EWST is in a position to say whether someone is a good canidate or not. I was told by the Dallas doctors that I could try it but my odds were not as good as someone with pain in a specific spot on the heel. Mine is in too many areas. And after describing my symptoms over a period of time, Dr. Z. said I was not a good candidate for it. I appreciated his honesty even though it was disappointing to hear.

So, I decided not to waste my money on slim odds. But I am ever so glad I investigated it. I weighted the odds, asked about possible contraindications and medical conditions that would increase risk, and then I made an informed decision.

Now, someday, if insurance starts paying for this, I may give it a try because I'll see it as what do I have to loose?
Beverly

Re: I now think my doctor may not be looking out for my best interests...

Nicole K. on 11/29/01 at 18:54 (065677)

Whew! Thanks for all of the replies. Indeed I am going for aanother opinion and I have spoken with someone who does ESWT and says I would be a good candidate for it. I am meeting with him next week. For me, it's almost worth the risk, monetary wise. The gamble.... It's better than a third surgery! I really wish to not have this pain anymore. Thanks, all for letting me vent and making me realize I am not crazy (which my doctor was apparently trying to tell me).

Re: I now think my doctor may not be looking out for my best interests...

john h on 12/04/01 at 09:17 (066068)

It is also amazing to me that a doctor would discourage Celebrex unless you have some underlying problem that would prohibit it. I continue to be amazed at the number of doctors who have little knowledge of ESWT. What it tells me they are not reading their professional journals and not up with the latest in medicine. If i went to a doctor and he had no knowledge of ESWT I would have a tendancy to just move on. If he discouraged ESWT I would want a clear explanation of why.

Re: I now think my doctor may not be looking out for my best interests...

cindyp on 11/28/01 at 16:43 (065529)

I always say if you feel like that go somewhere else to another dr. Ya have to have a level of comfort and if ya don't then what's the point?

Re: I now think my doctor may not be looking out for my best interests...

D.Thomas on 11/28/01 at 16:47 (065530)

I hate to say it but he doesn't sound that good if you ask me. Sounds like he has alot of opinions and no facts to back them up. ESWT has had some very positive effects for people with PF around the ankle. Which is very well supported in the medical journals. The problem is that insurance companies are being slow with their acceptance and very few pay anything at all for ESWT.

The foot doctors I tended to dislike the most had strong opinions like the one you describe above. I remember talking about the Internet to one Pod and he said that nobody on the Internet knows about PF and I shouldn't read anything on the Internet.

My advice - Try finding another doctor.

Re: I now think my doctor may not be looking out for my best interests...

Beverly on 11/28/01 at 17:55 (065538)

My orthopedic surgeon who specializes in foot/ankle was quick to send me for an EWST evaluation as soon as it became available in our area.
As it turned out, I was not a good canidate... had too many pain spots throughout feet and ankles. But I was happy to have the chance to be evaluated.

I've learned to change doctors when I feel uncomfortable. Could you ask your GP or internist for a couple of names of top orthopedic docs who specialize in foot/ankle? I always ask if a specialist is board certified in his particular field.
Good luck,
Beverly

Re: I now think my doctor may not be looking out for my best interests...

JudyS on 11/28/01 at 19:04 (065552)

Nicole, my Pod said exactly the same thing to me when I asked him about ESWt! He was quick to discourage the idea.....and neither he nor the HMO Podiatric department even wanted to learn about ESWT - at least not from a lowly patient. At any rate, I did the ESWT anyway - twice so far. And I've had marked improvement (PF for three years) both times. Once last June and again in September.
It's so strange to hear that your doc even discourages Celebrex - it almost sounds like he was on an 'automatic discourage' setting! Lots of PF folks here have used Celebrex - does your insurance cover prescriptions?

Re: I now think my doctor may not be looking out for my best interests...

~~~~~e C on 11/28/01 at 19:11 (065553)

Well, I'm not paid off by the manufacturer. I earn enough to support myself through my occupation as a physical oceanographer.

I just bought 90 of the 200mg Celebrex capsules (these are the large dose, not the 100mg); I pay 25% and my insurance pays 75%. My bill was $55. That comes to $220/90 per pill, or about $2.44 per capsule. My prescription was to take 1 capsule per day, until recently when he told me I could take two.

Re: I now think my doctor may not be looking out for my best interests...

Carole C on 11/28/01 at 19:18 (065556)

sorry, that was from me, Carole C. I punched the button to send it, by mistake. Anyway, I don't know of anybody that takes more than 400 mg/day and most people I've met who are on it for arthritis only take 100 mg/day. The range would be from $1.22 to $4.88 per day. This is from the first drug store I tried, a well known chain (but I'd better not say which or your doctor will think I work for them! LOL). I haven't shopped around, because they are nearby and have a drive through.

My doctor didn't want to prescribe it for me, either. I think that they are concerned because first of all, the insurance companies don't like to pay for these medications due to their expense. Secondly, as I understand it conventional wisdom in the medical community has it that most patients don't need something this high powered anyway and that Celebrex and Vioxx are over-prescribed.

Carole C

Re: I now think my doctor may not be looking out for my best interests...

BG CPed on 11/28/01 at 19:46 (065561)

I would search elsewhere for another opinion. For the Celebrex, I am not a Doc but a lowly shoe cobbler. It works for some people very well, it can cause alergic reaction in some and irritate stomach in others. I find it ironic he pooh poohs ESWT when in my humble guess he would be more than happy to do a plantar fascia release after doing too many injections of cortisone. I would bet that if you did a poll you would find more reduction in symptoms with celebrex or ESWT compared to pf release procedure.

Not cutting on your Doc but when somebody shoots down all ideas and overstates facts without proof whether they are an auto mechanic or a school teacher it sends up a flag. Maybe one of the Docs on here can refer you to an associate in your area

Re: I now think my doctor may not be looking out for my best interests...

cindyp on 11/28/01 at 20:13 (065564)

well as for the celebrex i was on 200 mgs twice a day and after two weeks it stopped working. Medicine is medicine and I myself dont advocate taking any long term because all you are doing is fixing symptoms and not the problem. But if your doctor isn't willing to listen to you you have no trust and then what's the point? Go elsewhere and find somebody who will listen toyou. Stand up on the table and jump up an down and say listen dumbo i pay you listen to me.

Re: Time for a 2nd and 3rd opinion

BrianG on 11/28/01 at 20:32 (065565)

Hi Nicole,

Your doctor was not 100% wrong in that some ESWT machines are being investigated. However it is not the AMA, it is the FDA, the group that approves the machines for use in this this country. There are no guarantees with ESWT, which can cost many thousands of dollars at this moment. I believe the doctors are saying it has a 60% chance of helping you to get better. These odds are not good enough for me, at this time.

I would get a 2nd, and 3rd opinion. If at all possible try to put off your decision for another year. I'm hoping we will see more hospitals performing ESWT, with more insurance companies picking up the bill. Surgery should be a last resort, imho! Good luck

BCG

Re: I now think my doctor may not be looking out for my best interests...

DR Zuckerman on 11/28/01 at 22:00 (065577)

Wow that is alot of doctors being investigated. Healthronics has trained over one thousand doctors to use the ossatron unit. Yes there was some competitive complaining between manufactors and now it looks like all manufactors will have to go thru class three review before they can take their machine to market. ESWT is a great non-surgical, non-invasive procedure that should be used before any surgery in the right patient

Re: Time for a 2nd and 3rd opinion

DR Zuckerman on 11/28/01 at 22:02 (065579)

Who is saying that the results are 60%. I know that FDA studies for the ossatron was 62% but their results are in reality much higher

Re: I now think my doctor may not be looking out for my best interests...

Julie on 11/29/01 at 02:42 (065592)

Nicole, your pod may have the reputation of being the best in the area, but it doesn't sound as though he's the best pod for you. I suspect there may be many podiatrists out there who are good at lots of things but haven't the patience to deal with long-term PF. I agree with everyone who has already said it's time for you to find another.

Where do you live? Perhaps one of the doctors here can recommend someone near you.

Re: I now think my doctor may not be looking out for my best interests...

john h on 11/29/01 at 10:27 (065611)

Nicole: Your doctor sounds like a 'quack' to me. By all means find another doctor and get some other advice.

Re: I now think my doctor may not be looking out for my best interests...

Beverly on 11/29/01 at 12:17 (065628)

And an honest doctor like Dr. Z. will tell you if you;re a good candidate or not, but I don't see how a pod who doesn't even perform EWST is in a position to say whether someone is a good canidate or not. I was told by the Dallas doctors that I could try it but my odds were not as good as someone with pain in a specific spot on the heel. Mine is in too many areas. And after describing my symptoms over a period of time, Dr. Z. said I was not a good candidate for it. I appreciated his honesty even though it was disappointing to hear.

So, I decided not to waste my money on slim odds. But I am ever so glad I investigated it. I weighted the odds, asked about possible contraindications and medical conditions that would increase risk, and then I made an informed decision.

Now, someday, if insurance starts paying for this, I may give it a try because I'll see it as what do I have to loose?
Beverly

Re: I now think my doctor may not be looking out for my best interests...

Nicole K. on 11/29/01 at 18:54 (065677)

Whew! Thanks for all of the replies. Indeed I am going for aanother opinion and I have spoken with someone who does ESWT and says I would be a good candidate for it. I am meeting with him next week. For me, it's almost worth the risk, monetary wise. The gamble.... It's better than a third surgery! I really wish to not have this pain anymore. Thanks, all for letting me vent and making me realize I am not crazy (which my doctor was apparently trying to tell me).

Re: I now think my doctor may not be looking out for my best interests...

john h on 12/04/01 at 09:17 (066068)

It is also amazing to me that a doctor would discourage Celebrex unless you have some underlying problem that would prohibit it. I continue to be amazed at the number of doctors who have little knowledge of ESWT. What it tells me they are not reading their professional journals and not up with the latest in medicine. If i went to a doctor and he had no knowledge of ESWT I would have a tendancy to just move on. If he discouraged ESWT I would want a clear explanation of why.