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ESWT QUESTION??

Posted by BG CPed on 1/07/02 at 20:11 (069122)

I have read several of the threads on this procedure. I think if it works it is much better than cutting the fascia. This may be over simplified but if you compare this to the early days of laser eye procedures. In its early days you could only get it done in Canada (it was experimental, but also done via knife) The machines cost approx $500,000 and there was a 'royalty' fee of about $500 per patient that went to the company.

Many insurance didnt cover the procedure, and it was several thousand dollars per eye. Many folks went to Canada to have it done, then when it opened up in the US and the cost lowered it became more popular and more insurance covered it. Now there is a price war with some doing it for $1500 complete. Obviously when you have an expensive machine the more it is running the more it is making.

There was recently a big lasic chain in Canada that went belly up. Many of the Docs had newspaper ads claiming between 15 to 20 thousand procedures. Has anybody looked at the model and or method of how they got that technology thru the system? I dont know much about and I know FDA is also political and not perfect but how did the eye guys do it?

Re: ESWT QUESTION??

Ed Davis, DPM on 1/09/02 at 16:19 (069380)

BG, I do not know a lot about the LASIK situation but can tell you that my office manager went up to Vancouver, BC to get the procedure done with good results. The Canadians approved the procedure earlier and with less cost so they got the jump on us and started doing the procedure earlier and cheaper, attracting a lot of US patients.

Interestingly, I know few opthamologists or optometrists who have had the procedure done personally. I asked one why and he stated that there are some advancements that will make it even a better procedure within the next three years. Keep in mind that a failed ESWT means that plantar fasciitis has not been cured but failed Lasik would essentially end the career of someone in my profession or other occupations where good or correctable vision is critical.
Ed

Re: re-ESWT

elliott on 1/09/02 at 23:04 (069437)

If, say, three years from now, ESWT technology advances even way past Baby O (and becomes very affordable too), would it be safe and efficacious for someone who has had a failed ESWT to get it again on the new machine? Or is it one strike and you're out?

---

Re: re-ESWT

Dr. Zuckerman on 1/10/02 at 11:47 (069513)

You can have treatment on one machine more then once and even switch to another machine. We know that multiple treatment or accumulative treatments are beneficial to the healing process

Re: ESWT QUESTION??

Pauline on 1/10/02 at 16:08 (069560)

Dr. Davis,
You are correct and Lasik surgery is not without it's own risks. Currently, I have set up the First Hospital Based Support Group for people who suffer with huge dense Vitreous Opacities in their eyes resulting from many causes, one being Lasik Surgery. If you talk to the people I have contacting me who had a Lasik go bad, they are now left with many sight problems. Like many treatments in the medical field, not all patients receive the benefits they expected and for some the results have caused them major problems. We are just beginning to see some of these results.

The only option remaining for the patients joining this group is to have is a very dangerous surgery, Vitrectomy which carries a high risk of blindness and there is no guarantee it would totally cure their problem.
Trying to find a Vitreous Specialist to perform the surgery is almost imposible. Talk about depression. Most of these patients are young
men and women who had bright futures ahead of them and now cry themselves to sleep.

They struggle daily as do Plantar Fasciitis patients trying to maintain their jobs. Eye problems are very difficult for it's victims especially those who's occupations rely on good vision or students in law and medical schools, or younger students.

Your right many Opthamologists would not choose this surgery for themselves and fewer want to treat the problems left behind.

Re: re-ESWT

dave on 1/17/02 at 08:55 (070252)

What is your professional opinion on the Ossatron. Is there a better machine out there?

Re: re-ESWT

Ed Davis, DPM on 1/17/02 at 18:25 (070319)

Dave:

I do not think we have enough data yet to compare ESWT machines and the different protocols. We can comment on ESWT, in general, as opposed to the individual machines. ESWT does appear to be a promising treatment for plantar fasciitis and other tendon and ligament problems. Ossatron was the first machine approved for use in the USA and, at this time, is the only one available. Treatment is performed in a surgery center and involves anesthesia. Surgicenter, treatment and anesthesia costs additively, make Ossatron treatment very expensive and insurance approval has been slow. Some of the other machines awaiting approval are office based and do not require anesthesia so treatment can be provided at a substantially lower cost.
Ed

Re: re-ESWT

john h on 1/28/02 at 10:52 (071626)

Dr Ed: There should be sufficient evidence in Europe to compare the outcome of these machines as they have been in use there for years. Perhaps this has been done. I have seen a lot of the European studies but never one comparing outcomes of machine vs machine and protocol.

Re: ESWT QUESTION??

Ed Davis, DPM on 1/09/02 at 16:19 (069380)

BG, I do not know a lot about the LASIK situation but can tell you that my office manager went up to Vancouver, BC to get the procedure done with good results. The Canadians approved the procedure earlier and with less cost so they got the jump on us and started doing the procedure earlier and cheaper, attracting a lot of US patients.

Interestingly, I know few opthamologists or optometrists who have had the procedure done personally. I asked one why and he stated that there are some advancements that will make it even a better procedure within the next three years. Keep in mind that a failed ESWT means that plantar fasciitis has not been cured but failed Lasik would essentially end the career of someone in my profession or other occupations where good or correctable vision is critical.
Ed

Re: re-ESWT

elliott on 1/09/02 at 23:04 (069437)

If, say, three years from now, ESWT technology advances even way past Baby O (and becomes very affordable too), would it be safe and efficacious for someone who has had a failed ESWT to get it again on the new machine? Or is it one strike and you're out?

---

Re: re-ESWT

Dr. Zuckerman on 1/10/02 at 11:47 (069513)

You can have treatment on one machine more then once and even switch to another machine. We know that multiple treatment or accumulative treatments are beneficial to the healing process

Re: ESWT QUESTION??

Pauline on 1/10/02 at 16:08 (069560)

Dr. Davis,
You are correct and Lasik surgery is not without it's own risks. Currently, I have set up the First Hospital Based Support Group for people who suffer with huge dense Vitreous Opacities in their eyes resulting from many causes, one being Lasik Surgery. If you talk to the people I have contacting me who had a Lasik go bad, they are now left with many sight problems. Like many treatments in the medical field, not all patients receive the benefits they expected and for some the results have caused them major problems. We are just beginning to see some of these results.

The only option remaining for the patients joining this group is to have is a very dangerous surgery, Vitrectomy which carries a high risk of blindness and there is no guarantee it would totally cure their problem.
Trying to find a Vitreous Specialist to perform the surgery is almost imposible. Talk about depression. Most of these patients are young
men and women who had bright futures ahead of them and now cry themselves to sleep.

They struggle daily as do Plantar Fasciitis patients trying to maintain their jobs. Eye problems are very difficult for it's victims especially those who's occupations rely on good vision or students in law and medical schools, or younger students.

Your right many Opthamologists would not choose this surgery for themselves and fewer want to treat the problems left behind.

Re: re-ESWT

dave on 1/17/02 at 08:55 (070252)

What is your professional opinion on the Ossatron. Is there a better machine out there?

Re: re-ESWT

Ed Davis, DPM on 1/17/02 at 18:25 (070319)

Dave:

I do not think we have enough data yet to compare ESWT machines and the different protocols. We can comment on ESWT, in general, as opposed to the individual machines. ESWT does appear to be a promising treatment for plantar fasciitis and other tendon and ligament problems. Ossatron was the first machine approved for use in the USA and, at this time, is the only one available. Treatment is performed in a surgery center and involves anesthesia. Surgicenter, treatment and anesthesia costs additively, make Ossatron treatment very expensive and insurance approval has been slow. Some of the other machines awaiting approval are office based and do not require anesthesia so treatment can be provided at a substantially lower cost.
Ed

Re: re-ESWT

john h on 1/28/02 at 10:52 (071626)

Dr Ed: There should be sufficient evidence in Europe to compare the outcome of these machines as they have been in use there for years. Perhaps this has been done. I have seen a lot of the European studies but never one comparing outcomes of machine vs machine and protocol.