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Long Term Results

Posted by David on 4/04/02 at 13:16 (078486)

Here is an abstract from the March, 2002 issue of the Journal of Bone & Joint Surgery with long-term follow up on patients having ESWT.

Evaluation of low-energy extracorporeal shock-wave application for treatment of chronic plantar fasciitis.

Rompe JD, Schoellner C, Nafe B.

BACKGROUND: Although the application of low-energy extracorporeal shock waves to treat musculoskeletal disorders is controversial, there has been some limited, short-term evidence of its effectiveness for the treatment of chronic plantar fasciitis. METHODS: From 1993 to 1995, a prospective, two-tailed, randomized, controlled, observer-blinded pilot trial was performed to assess whether three applications of 1000 impulses of low-energy shock waves (Group I) led to a superior clinical outcome when compared with three applications of ten impulses of low-energy shock waves (Group II) in patients with intractable plantar heel pain. The sample size was 112. The main outcome measure was patient satisfaction according to a four-step score (excellent, good, acceptable, and poor) at six months. Secondary outcome measures were patient satisfaction according to the four-step score at five years and the severity of pain on manual pressure, at night, and at rest as well as the ability to walk without pain at six months and five years. RESULTS: At six months, the rate of good and excellent outcomes according to the four-step score was significantly (47%) better (p < 0.0001) in Group I than in Group II. As assessed on a visual analog scale, the score for pain caused by manual pressure at six months had decreased to 19 points, from 77 points before treatment, in Group I, whereas in Group II the ratings before treatment and at six months were 79 and 77 points (p < 0.0001 for the difference between groups). In Group I, twenty-five of forty-nine patients were able to walk completely without pain at six months compared with zero of forty-eight patients in Group II (p < 0.0001). By five years, the difference in the rates of good and excellent outcomes according to the four-step score was only 11% in favor of Group I (p = 0.071) because of a high rate of good and excellent results from subsequent surgery in Group II; the score for pain caused by manual pressure had decreased to 9 points in Group I and to 29 points in Group II (p = 0.0006 for the difference between groups). At five years, five (13%) of thirty-eight patients in Group I had undergone an operation of the heel compared with twenty-three (58%) of forty patients in Group II (p < 0.0001). CONCLUSIONS: Three treatments with 1000 impulses of low-energy shock waves appear to be an effective therapy for plantar fasciitis and may help the patient to avoid surgery for recalcitrant heel pain. In contrast, three applications of ten impulses did not improve symptoms substantially.

PMID: 11886900 [PubMed - in process]

Re: Long Term Results

john h on 4/04/02 at 15:17 (078494)

David: An excellent find! Good information that we all should put into our information bank when making our choice to have ESWT. The point that currently troubles me the most is that all locations outside the U.S. are using a three or more treatment protocol for low energy treatments. How did the FDA or whoever makes this decision come up with a one treatment protocol for the U.S.? Low energy ESWT has been around long enough that there should be some agreement as to the number of treatments for the initial treatment. I can see where there is some variance in the spacing between treatments such as one week in Australia and in some cases just one day in Canada.

Re: Long Term Results

David on 4/04/02 at 16:24 (078503)

From my understanding, the protocol is a combination of the manufacturers, the clinical investigators and the FDA. It was interesting to note in the abstract that the treatments were VERY conservative in that only 1000 pulses were given to the treatment group, vs the Canadian protocol of 2000 shocks per treatment. There were three treatment sessions total for a total shock count of 3000 in the study vs 6000 in Canada. It didn't list the interval. The protocols for both the Ossatron and the Dornier are published on the FDA web site.
I don't know what the reasoning behind the idea for 1 treatment vs 3, but I'm certain that cost has something to do with it because of anesthesia, facility fees etc.
My personal opinion is that the costs of these treatments in the US will come down dramatically once low energy devices like they have used in the study come into the marketplace, where no anesthesia is required and a machine can be operated out of a doctor's office on a fixed basis, as opposed to a device travelling around on a truck on a specific route to different surgery centers.

Re: Long Term Results

BrianG on 4/04/02 at 17:41 (078512)

Hi David,

It looks like there is some information missing here. The article by Rompe discusses the results of two LOW impluse methods. I think what we need to see is the results of a one time High Impulse treatment (like the Ossatron or Dornier) vs. 3 treatments with a low energy machine (Sonucor). Can you locate anyhing like that?

I think the FDA must have looked for a one time treatment, as most people are going to have to travel quite a distance to get the treatment. It's just unfortunate that the one time treatment is so painful, that foot blocks are required. Who knows, 10 years down the line, machines will be different, and I'm sure the protocol will be also.

Personally, I would rather have the one time treatment, with foot block, as no one near me is offering anything different.

Regards
BrianG

Re: Long Term Results

John h on 4/04/02 at 18:15 (078516)

After 4 treatments with moderately high energy my personal opinion is I want no blocks and I certainly do not want any anathesia under any circumstance. Maybe the Ossatron is a lot more painful than the orby and i might want a foot block but anathesia in a hospital setting is certainly overkill in my opinion and you are exposed to needless risk with anathesia.

Re: Is that you -- David Lowy?

Ed Davis, DPM on 4/04/02 at 20:29 (078532)

David:

If you are him----- I am anxiously awaiting availablity on the US side of the border.
Ed

Re: Is that you -- David Lowy?

Dr. Zuckerman on 4/04/02 at 20:42 (078536)

I wonder how the soncur is going to get insurance coverage without FDA approval for plantar fasciitis.

Re: Long Term Results

john h on 4/05/02 at 09:43 (078567)

Brian: It is my understanding tha the 'Dornier' and Sonoccur are 'Low Energy Machines'. The Ossatron and Orby are high energy machines. Please correct me if I am wrong.

Re: Long Term Results

john h on 4/05/02 at 11:21 (078585)

David: If the FDA set up the Dornier in the U.S. with a one treatment protocol because of cost then that is sure short sighted. The least expensive way is the one that will give you the best chance for a cure be it one treatment or 5 treatments. The Doctor in South Africa gives up to 5 treatments with the EPOS. The will exceed three in Australia for the same equipment.

As a patient I would sure like to sit in on some of those FDA meetings to see just how they determine a protocol. We know Doctors and manufacturers are there and they will have their own agenda to push. Who is the patients advocate in this process. With ESWT for the foot it would have made sense to have had a few people who have PF and have had ESWT to at least express their opinions. I bet that not one person in the decision making process had ever actually experienced PF or actually experienced a full course of ESWT.

Re: Long Term Results

BrianG on 4/05/02 at 18:48 (078615)

The Dornier Epos is a high energy machine, like the OssaTron. It can put out 3,800 pulses. I'm not positive, but it may also be adjustable, and will be able to deliver lower shocks as well.

BrianG

Re: Long Term Results

BrianG on 4/05/02 at 18:57 (078617)

Hi John,

I know there are risks with all anesthesia, but don't you think the foot blocks would have very little risk? Dr. Z, what do you think ? Isn't it the same as using a needle for a cortisone shot? The FDA protocol doesn't call for any more anesthesia, than a foot block, does it?

BrianG

Re: Long Term Results

Dr. Zuckerman on 4/05/02 at 22:44 (078635)

The Epos is a low, medium and high energy machine. We are using it at the high energy levels per FDA study protocol

Re: Long Term Results

Dr. Zuckerman on 4/05/02 at 22:45 (078636)

Only a foot block. The risks with a foot block are almost zero. I have never had a problem with a foot block in twenty two years. In theory you could get infection, pain , hematoma, and no anesthesia if no done correctly

Re: Long Term Results

John h on 4/06/02 at 10:11 (078659)

Brian: I do believe the OssaTron high energy machines calls for treatment in a hospital enviroment with anathesia. This is one of the reasons treatment is so expensive with this equipment. I think this is part of the FDA protocol. I talked to at least three doctors who use the equipment and have seen a couple of post confirming this. I do believe the Epos which may be adjustable is used at a setting which would be considered low energy in both Australia and Canada which may account for the three treatment protocol. I do not know if the FDA protocol in the U.S. calls for a different setting than in Canada with the EPOS Dr. Z can perhaps help us here. Actually I am not sure where the cut off is between high energy and low energy or even if is medically definied. I do know that my treatments with the Orby were between 16KV and 18KV and I think Dr Z called that high energy. I have read that damage to the tendons can begin to occur at 23 KV and I think the OssaTron is being used in the U.S at a setting higher than Dr. Z. used with the Orby so I would just speculate that they must be somewhere in the range of 20KV. As Dr. Z often points out the important thing is the energy reaching the area treated. I think Alan in Australia refered to the EPOS as a low energy machine and he is an operator. I will email him and pose that question. The EPOS in Canada I believe is being used without shots which would seem to indicate it is used in a low energy mode. In any event I found the orby at 18 KV less painful than a dentist and I had three treatments with no shots. I guess our discussion is probably far out as a rose by any other name is still a rose. My greatest concern is that there is always a risk with general anathesisa and that is why those who administer it have the highest insurance cost of any medical professional. We seem to be the only country using general anathesia for ESWT. I gather from Dr. Z that he uses his EPOS in his offices and uses an ankle block. I have had an ankle block and that did not hurt but if the EPOS is less energy than the orby why bother unless the FDA requires it.

Re: Long Term Results

John h on 4/06/02 at 10:19 (078661)

Dr. Z you have cleared up one thing for me in that you are using the machine in the high energy mode. Would that be in the same range as the orby? How many shocks per foot? Is the energy you use less than that of the OssaTron? I would have to guess yes on that one or why on earth would the FDA make General Anathesia a protocol for the OssaTron and not the EPOS. The FDA does indeed operate in strange ways. These machines as you know have been in use in Europe since 1996 or earlier and you would think the FDA is trying to reinvent the wheel. Do they even take into consideration all the European studies and experience when they start one of these trials? Lastly what is considered high energy and what is considered low energy?

Re: Long Term Results

Dr. Zuckerman on 4/06/02 at 10:20 (078662)

Th definition of high energy is any energy level above 0.28mj/mm2. Right now I am using the EPOS at 0.36mj/mm as per FDA study protocol. The EPos has the ability to use low, medium, and high energy.

Will I ever use the three treatment protocol. I need to use the proven protocol that I have been taught and the one that is published on the ESWT section on this boad first

Interesting note. I did a patellar tendon yesterday at full blast and was no problem with pain. I first used low to numb and then moved up to o.36mj/mm to treat.

It is my firm belief that I will eventually be doing one treatment high energy starting with low just like I do with the orbie.

So I would be to concerned with all treatment usnig a local. I would be concerned with using IV sedatin and general that is really an over kill

Re: Long Term Results

Dr. Zuckerman on 4/06/02 at 10:37 (078668)

The energy level that I am using with the epos is same as the ossatron. Yes this is the same range as the orbie. The FDA doesn't require the use of General or IV sedation for any machine period. Low energy is any energy below 0.28mj/mm2 and high is any thign above that level.

It is the manufactors and not the FDA that determines the place of setting or the use or lack of use of anesthetic. Ossatron choice the ASC for insurnace reasons

Re: Long Term Results

John h on 4/06/02 at 13:07 (078683)

Your point I guess Dr. Z is that Healthtronics chose the general anathesthetic protocol. I would assume to protect themselves? The General is a two edged sword however so I guess if any thing goes wrong there it is not the manufacturers fault but the hospital or one doing the general. Does a doctor who purchases an Ossatron or lesses one have to sign an agreement to use it in accordance with the manufacturers directions?ie: general anathesia?

Re: Long Term Results

Dr. Zuckerman on 4/06/02 at 13:10 (078684)

There is no agreement to use IV/general, however it is in the ASC and the pressure to use IV is there I don't believe general is being use for Ossatron ESWT, however IV sedation is

Re: Long Term Results

JudyS on 4/06/02 at 15:19 (078692)

Hmmm.......I kind of enjoyed the foot block I got at Dr. Z's last fall....TexBarb and John h had to carry me around until it wore off! :)

Re: Long Term Results

John h on 4/06/02 at 19:31 (078717)

Only sissy Judy and sissy Barb required foot blocks. Manly John did not. Sissy Judy and Barb also required wine immediately after their treatments. I must say in Barbs defense she did have a spur removed surgically right there in front of all. I would probably need more than an foot block for that deal.

Re: Long Term Results

BrianG on 4/06/02 at 20:48 (078723)

Hi John,

I don't think anyone is using general anesthesia for ESWT. A foot block is all it should take. When I had my EPF, it was a very painful procedure. It took a half hour, they cut a hole all the way through my heel, then scopped and cut! All with a local foot block. I did have a very small amount of IV sedation, but it was only used until my foot was numb from the block. Once the procedure stated, I was no longer on the IV sedation, only the block. My foot was totally numb for 18 hours. I was wide awake for the entire procedure and there was no pain.

Although I know that original needle, for the block, is going to hurt like hell, I also know my foot will be numb for any ESWT I may get. For me, the block is the way to go. I hope I can still hang out with you 'manly men' after outing myself :*) :*)

Yep, I'm a pain wimp!!!
BrianG

Re: Long Term Results

John h on 4/07/02 at 12:30 (078742)

Brian: My first treatment with the Orby Dr. Z used a foot block. I even took a pictures of him doing it. I found it no worse than geting a flu shot. Subsequent treatments I received no shots because after the first 10 shocks my foot became somewhat numb and the pain was not noticable. I do know that with the OssaTron they are giving you some sort of anathesia that they often refer to as putting you in the twylight zone. You may not be all the way out but I think it is by IV drip. One of you docs correct me if I am wrong on this.

Re: Long Term Results

john h on 4/08/02 at 09:59 (078808)

Brian from reading Dr. Z's info and Alan in Australia the Dornier Epos is adjustable up to a level 9 which has an output of .5mj/mm2. He also noted that with a simple software upgrade you can add an additional 4 higher energy levels. Bayshore has also noted that they also have the OssaTron but primarly use it for non-union bone fractures. Their primary machine for plantar fasciaitis is the Sonoccur with a 3 treatment protocol with the use of low intensity laser thearpy to speed the healing process. Like Dr. Z has mentioned they also note the patient can control the pain level during treatment by adjustment of the machine. I think with the input of Bayshore, Dr. Zuckerman, and Allan in Australia we are getting as good as information that is available anywhere. It is now up to us as patients to make our the choice of equipment,protocol,doctor, and experience.

Re: Is that you -- David Lowy?

Ed Davis, DPM on 4/08/02 at 20:24 (078867)

Good question since they are looking for an indication for lateral epicondylitis. My guess would be that once a permanent procedure code has been established for ESWT and once regular insurance approval is forthcoming, insurers won't quibble over which machine is being used.
Ed

Re: Long Term Results

john h on 4/04/02 at 15:17 (078494)

David: An excellent find! Good information that we all should put into our information bank when making our choice to have ESWT. The point that currently troubles me the most is that all locations outside the U.S. are using a three or more treatment protocol for low energy treatments. How did the FDA or whoever makes this decision come up with a one treatment protocol for the U.S.? Low energy ESWT has been around long enough that there should be some agreement as to the number of treatments for the initial treatment. I can see where there is some variance in the spacing between treatments such as one week in Australia and in some cases just one day in Canada.

Re: Long Term Results

David on 4/04/02 at 16:24 (078503)

From my understanding, the protocol is a combination of the manufacturers, the clinical investigators and the FDA. It was interesting to note in the abstract that the treatments were VERY conservative in that only 1000 pulses were given to the treatment group, vs the Canadian protocol of 2000 shocks per treatment. There were three treatment sessions total for a total shock count of 3000 in the study vs 6000 in Canada. It didn't list the interval. The protocols for both the Ossatron and the Dornier are published on the FDA web site.
I don't know what the reasoning behind the idea for 1 treatment vs 3, but I'm certain that cost has something to do with it because of anesthesia, facility fees etc.
My personal opinion is that the costs of these treatments in the US will come down dramatically once low energy devices like they have used in the study come into the marketplace, where no anesthesia is required and a machine can be operated out of a doctor's office on a fixed basis, as opposed to a device travelling around on a truck on a specific route to different surgery centers.

Re: Long Term Results

BrianG on 4/04/02 at 17:41 (078512)

Hi David,

It looks like there is some information missing here. The article by Rompe discusses the results of two LOW impluse methods. I think what we need to see is the results of a one time High Impulse treatment (like the Ossatron or Dornier) vs. 3 treatments with a low energy machine (Sonucor). Can you locate anyhing like that?

I think the FDA must have looked for a one time treatment, as most people are going to have to travel quite a distance to get the treatment. It's just unfortunate that the one time treatment is so painful, that foot blocks are required. Who knows, 10 years down the line, machines will be different, and I'm sure the protocol will be also.

Personally, I would rather have the one time treatment, with foot block, as no one near me is offering anything different.

Regards
BrianG

Re: Long Term Results

John h on 4/04/02 at 18:15 (078516)

After 4 treatments with moderately high energy my personal opinion is I want no blocks and I certainly do not want any anathesia under any circumstance. Maybe the Ossatron is a lot more painful than the orby and i might want a foot block but anathesia in a hospital setting is certainly overkill in my opinion and you are exposed to needless risk with anathesia.

Re: Is that you -- David Lowy?

Ed Davis, DPM on 4/04/02 at 20:29 (078532)

David:

If you are him----- I am anxiously awaiting availablity on the US side of the border.
Ed

Re: Is that you -- David Lowy?

Dr. Zuckerman on 4/04/02 at 20:42 (078536)

I wonder how the soncur is going to get insurance coverage without FDA approval for plantar fasciitis.

Re: Long Term Results

john h on 4/05/02 at 09:43 (078567)

Brian: It is my understanding tha the 'Dornier' and Sonoccur are 'Low Energy Machines'. The Ossatron and Orby are high energy machines. Please correct me if I am wrong.

Re: Long Term Results

john h on 4/05/02 at 11:21 (078585)

David: If the FDA set up the Dornier in the U.S. with a one treatment protocol because of cost then that is sure short sighted. The least expensive way is the one that will give you the best chance for a cure be it one treatment or 5 treatments. The Doctor in South Africa gives up to 5 treatments with the EPOS. The will exceed three in Australia for the same equipment.

As a patient I would sure like to sit in on some of those FDA meetings to see just how they determine a protocol. We know Doctors and manufacturers are there and they will have their own agenda to push. Who is the patients advocate in this process. With ESWT for the foot it would have made sense to have had a few people who have PF and have had ESWT to at least express their opinions. I bet that not one person in the decision making process had ever actually experienced PF or actually experienced a full course of ESWT.

Re: Long Term Results

BrianG on 4/05/02 at 18:48 (078615)

The Dornier Epos is a high energy machine, like the OssaTron. It can put out 3,800 pulses. I'm not positive, but it may also be adjustable, and will be able to deliver lower shocks as well.

BrianG

Re: Long Term Results

BrianG on 4/05/02 at 18:57 (078617)

Hi John,

I know there are risks with all anesthesia, but don't you think the foot blocks would have very little risk? Dr. Z, what do you think ? Isn't it the same as using a needle for a cortisone shot? The FDA protocol doesn't call for any more anesthesia, than a foot block, does it?

BrianG

Re: Long Term Results

Dr. Zuckerman on 4/05/02 at 22:44 (078635)

The Epos is a low, medium and high energy machine. We are using it at the high energy levels per FDA study protocol

Re: Long Term Results

Dr. Zuckerman on 4/05/02 at 22:45 (078636)

Only a foot block. The risks with a foot block are almost zero. I have never had a problem with a foot block in twenty two years. In theory you could get infection, pain , hematoma, and no anesthesia if no done correctly

Re: Long Term Results

John h on 4/06/02 at 10:11 (078659)

Brian: I do believe the OssaTron high energy machines calls for treatment in a hospital enviroment with anathesia. This is one of the reasons treatment is so expensive with this equipment. I think this is part of the FDA protocol. I talked to at least three doctors who use the equipment and have seen a couple of post confirming this. I do believe the Epos which may be adjustable is used at a setting which would be considered low energy in both Australia and Canada which may account for the three treatment protocol. I do not know if the FDA protocol in the U.S. calls for a different setting than in Canada with the EPOS Dr. Z can perhaps help us here. Actually I am not sure where the cut off is between high energy and low energy or even if is medically definied. I do know that my treatments with the Orby were between 16KV and 18KV and I think Dr Z called that high energy. I have read that damage to the tendons can begin to occur at 23 KV and I think the OssaTron is being used in the U.S at a setting higher than Dr. Z. used with the Orby so I would just speculate that they must be somewhere in the range of 20KV. As Dr. Z often points out the important thing is the energy reaching the area treated. I think Alan in Australia refered to the EPOS as a low energy machine and he is an operator. I will email him and pose that question. The EPOS in Canada I believe is being used without shots which would seem to indicate it is used in a low energy mode. In any event I found the orby at 18 KV less painful than a dentist and I had three treatments with no shots. I guess our discussion is probably far out as a rose by any other name is still a rose. My greatest concern is that there is always a risk with general anathesisa and that is why those who administer it have the highest insurance cost of any medical professional. We seem to be the only country using general anathesia for ESWT. I gather from Dr. Z that he uses his EPOS in his offices and uses an ankle block. I have had an ankle block and that did not hurt but if the EPOS is less energy than the orby why bother unless the FDA requires it.

Re: Long Term Results

John h on 4/06/02 at 10:19 (078661)

Dr. Z you have cleared up one thing for me in that you are using the machine in the high energy mode. Would that be in the same range as the orby? How many shocks per foot? Is the energy you use less than that of the OssaTron? I would have to guess yes on that one or why on earth would the FDA make General Anathesia a protocol for the OssaTron and not the EPOS. The FDA does indeed operate in strange ways. These machines as you know have been in use in Europe since 1996 or earlier and you would think the FDA is trying to reinvent the wheel. Do they even take into consideration all the European studies and experience when they start one of these trials? Lastly what is considered high energy and what is considered low energy?

Re: Long Term Results

Dr. Zuckerman on 4/06/02 at 10:20 (078662)

Th definition of high energy is any energy level above 0.28mj/mm2. Right now I am using the EPOS at 0.36mj/mm as per FDA study protocol. The EPos has the ability to use low, medium, and high energy.

Will I ever use the three treatment protocol. I need to use the proven protocol that I have been taught and the one that is published on the ESWT section on this boad first

Interesting note. I did a patellar tendon yesterday at full blast and was no problem with pain. I first used low to numb and then moved up to o.36mj/mm to treat.

It is my firm belief that I will eventually be doing one treatment high energy starting with low just like I do with the orbie.

So I would be to concerned with all treatment usnig a local. I would be concerned with using IV sedatin and general that is really an over kill

Re: Long Term Results

Dr. Zuckerman on 4/06/02 at 10:37 (078668)

The energy level that I am using with the epos is same as the ossatron. Yes this is the same range as the orbie. The FDA doesn't require the use of General or IV sedation for any machine period. Low energy is any energy below 0.28mj/mm2 and high is any thign above that level.

It is the manufactors and not the FDA that determines the place of setting or the use or lack of use of anesthetic. Ossatron choice the ASC for insurnace reasons

Re: Long Term Results

John h on 4/06/02 at 13:07 (078683)

Your point I guess Dr. Z is that Healthtronics chose the general anathesthetic protocol. I would assume to protect themselves? The General is a two edged sword however so I guess if any thing goes wrong there it is not the manufacturers fault but the hospital or one doing the general. Does a doctor who purchases an Ossatron or lesses one have to sign an agreement to use it in accordance with the manufacturers directions?ie: general anathesia?

Re: Long Term Results

Dr. Zuckerman on 4/06/02 at 13:10 (078684)

There is no agreement to use IV/general, however it is in the ASC and the pressure to use IV is there I don't believe general is being use for Ossatron ESWT, however IV sedation is

Re: Long Term Results

JudyS on 4/06/02 at 15:19 (078692)

Hmmm.......I kind of enjoyed the foot block I got at Dr. Z's last fall....TexBarb and John h had to carry me around until it wore off! :)

Re: Long Term Results

John h on 4/06/02 at 19:31 (078717)

Only sissy Judy and sissy Barb required foot blocks. Manly John did not. Sissy Judy and Barb also required wine immediately after their treatments. I must say in Barbs defense she did have a spur removed surgically right there in front of all. I would probably need more than an foot block for that deal.

Re: Long Term Results

BrianG on 4/06/02 at 20:48 (078723)

Hi John,

I don't think anyone is using general anesthesia for ESWT. A foot block is all it should take. When I had my EPF, it was a very painful procedure. It took a half hour, they cut a hole all the way through my heel, then scopped and cut! All with a local foot block. I did have a very small amount of IV sedation, but it was only used until my foot was numb from the block. Once the procedure stated, I was no longer on the IV sedation, only the block. My foot was totally numb for 18 hours. I was wide awake for the entire procedure and there was no pain.

Although I know that original needle, for the block, is going to hurt like hell, I also know my foot will be numb for any ESWT I may get. For me, the block is the way to go. I hope I can still hang out with you 'manly men' after outing myself :*) :*)

Yep, I'm a pain wimp!!!
BrianG

Re: Long Term Results

John h on 4/07/02 at 12:30 (078742)

Brian: My first treatment with the Orby Dr. Z used a foot block. I even took a pictures of him doing it. I found it no worse than geting a flu shot. Subsequent treatments I received no shots because after the first 10 shocks my foot became somewhat numb and the pain was not noticable. I do know that with the OssaTron they are giving you some sort of anathesia that they often refer to as putting you in the twylight zone. You may not be all the way out but I think it is by IV drip. One of you docs correct me if I am wrong on this.

Re: Long Term Results

john h on 4/08/02 at 09:59 (078808)

Brian from reading Dr. Z's info and Alan in Australia the Dornier Epos is adjustable up to a level 9 which has an output of .5mj/mm2. He also noted that with a simple software upgrade you can add an additional 4 higher energy levels. Bayshore has also noted that they also have the OssaTron but primarly use it for non-union bone fractures. Their primary machine for plantar fasciaitis is the Sonoccur with a 3 treatment protocol with the use of low intensity laser thearpy to speed the healing process. Like Dr. Z has mentioned they also note the patient can control the pain level during treatment by adjustment of the machine. I think with the input of Bayshore, Dr. Zuckerman, and Allan in Australia we are getting as good as information that is available anywhere. It is now up to us as patients to make our the choice of equipment,protocol,doctor, and experience.

Re: Is that you -- David Lowy?

Ed Davis, DPM on 4/08/02 at 20:24 (078867)

Good question since they are looking for an indication for lateral epicondylitis. My guess would be that once a permanent procedure code has been established for ESWT and once regular insurance approval is forthcoming, insurers won't quibble over which machine is being used.
Ed