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ESWT Pain

Posted by Pete R on 7/12/02 at 09:31 (089538)

Does anyone who has had ESWT treatment find they are worse than before ESWT. I'm 6 days on from ESWT and the pain is worse than its ever been. Does this clear up............please say, yes !!

Re: ESWT Pain

dave r on 7/12/02 at 10:02 (089543)

I found that my pain levels went up and down for a long time after eswt. It took me a couple of weeks for things to settle down

Re: ESWT Pain

Dr David Lee on 7/17/02 at 11:04 (089871)

Dear Pete,

Most patients experience some pain and in some cases more pain than before-initially. This is because of the bruising effect on the plantarfascia as well as the bone underneath. Eventually this clears up usually before 3 weeks after the treatment. Whether one has more pain than the next aptient depends on the technique used by the physician (very important) and alos the device used. (ultrasound guided or not guided) With ultrasound guided technology and side aiming like the EPOS there are potentially less complaints because shockwave is aimed not at the bone but rather across the width of the fascia allowing the exit of the shockwave out the foot and not up the leg.

Hang in there it gets better. I recommend that you meet with your physician for counselling.

Re: ESWT Pain

Sunny Jacob - Bayshore on 7/19/02 at 08:02 (090085)

1. Use of in-line ultrasound for ESWT: As I have stated its advantages numerous times, Dr. Lee has again emphasized the importance of locking the ultrasound image in the treatment zone during ESWT session/s.
2. It seems that some readers are confused with a clinic's success rate and a controlled peer reviewed clinical study. Dr. Lee has emphasized that the 85% success rate is his observation at his clinc.
3. 'Acquiring ESWT devices is cheaper in Canada' is not correct. It is just as expensive as in the United States, as is the operation of the clinic. Moreover, taxes (including personal income taxes) are substantially higher in Canada than in the U.S.

Re: ESWT Pain

john h on 7/19/02 at 09:12 (090093)

Sunny: I think you have mentioned this before and I think our board members sometimes forget what the meaning of 'Success' is when it comes to ESWT. My understanding it does not mean a 'Cure'. It seems that a 50% reduction in pain would be considered a success. Is this correct?

Re: ESWT Pain

Sunny Jacob - Bayshore on 7/19/02 at 17:51 (090151)

Yes, John. Every clinic's success evaluation can be different. Let me try to explain as best as I can.
The pain history of each patient who comes to our clinic is different. Some may have a history of 20 or more years and some had pain for just over 6 months, and there are many in between. Some patients had multiple surgery and may have considerable scar tissue formation. Therefore, one cannot expect all patients to have the same 'starting point' before ESWT and treatment outcome can differ accordingly.
In a proper clinical study all these factors have to be considered, including (at times) age, sex, occupation, etc.
Bayshore's 'success' rate is not based on other clinical studies we do in specific areas.
Let me explain our definition of 'success' with ESWT treatment:
As you know, the pain level is expressed in VAS (visual analog scale) with a range from 0 to 10, whereby the highest pain is 10.The levels are assessed prior to ESWT at rest and activity. (Pain level during activity is always somewhat higher. )
Irrespective of what the initial assessment level of a patient is (e.g. anywhere from VAS 6 to 9 at rest), we consider it a 'success' or 'cure' if the patient achieves a reduction in the pain level to 3 or below at rest. This may take up to 12 weeks post treatment. Our clinic's 'success' rate with this measurement is over 85%, i.e. over 85% of patients do achieve this considerable reduction in pain.
Most of the patients who come to Bayshore have already undergone all conventional treatments. Therefore, if they attain a level of 3 or below, almost all of them are absolutely satisfied with our treatment.
Many of the patients on this message board (and other clinics) express the success rate in percent, e.g. '50%', which means that the pain level is reduced to half of what it was prior to treatment.

In addition to Plantar fasciitis, Bayshore clinics treat various tendinopathies such as tennis elbow, patellar tendonitis, Achilles tendonitis, rotator cuff tendonitis, calcification and bursitis. Our results are a combination of all these treatments.
Our success rate for Plantar fasciitis alone (low energy ESWT/laser combination therapy) to date is over 86%.

Re: ESWT Pain

john h on 7/19/02 at 19:18 (090161)

Sunny: I bet your Liability Insurance coverage is not near what it is for Doctors in our litigous society here in the U.S.

Re: ESWT Pain

john h on 7/19/02 at 19:28 (090163)

Thanks for your explanation of 'success' as measured by Bayshore. I would be a howling success by your measurement and 5 years or so ago when I was at a pain level of 6-7 would have taken it. Now I am at a 1 or less and want more and will continue to work at this until someday I can announce I am 'Cured'! I am thankful for where I am and suspect that ESWT at Dr. Z's played an important part in it along with a couple of other things. If there is something mentioned on this board I have not tried it was an accident. ESWT should be high on the list of things to do after 6 months of conservative treatment.

Re: ESWT Pain

Dr. David Lee on 7/20/02 at 18:26 (090233)

I agree with Sunny

Re: ESWT Pain

Sunny Jacob - Bayshore on 7/21/02 at 07:31 (090266)

John,
As I have commented previously, based on the measurement of most clinics, your case can be considered a 'success'. Of course, as you have stated, 0' pain level would be ideal.

You are right that, in comparison to the U.S., Canadians and Europeans spend less on litigations. However, our patient mix is multinational (incl. European and other countries). Therefore we maintain a $4 Mill. Liability insurance. If you analyze the total operating cost, liability insurance premium is a small component.

Re: ESWT Pain

john h on 7/21/02 at 08:57 (090270)

Sunny: I do not know what the percentage of overhead in a Doctors practice is from liability insurance but I will see if I can research that subject. I do know that anathesiaologist and obstatricians seem to lead the way in cost of liability insurance. I have personally been on the witness stand at least 5 times in liability cases against our company, some of which were outrageous. On the last case we spent over $250,000 defending our case and the plantiff spent at least that much. After 4 years the jury came back and awarded no one anything. The only winners the lawyers to the tune of $500,00.00 dollars. The plantiff filled for bankruptcy. He and I still have coffee and discuss this case. Sidebar: Once when I took the witness stand I reached under my chair to pull up to the microphone. There was a large nail protruding underneith and I ran it throuhg my finger. The trail had to be called off for a few hours while I received medical treatment.

Re: ESWT Pain

scott r on 7/21/02 at 09:43 (090275)

John H, who did you work for?

Re: ESWT Pain

john h on 7/21/02 at 19:44 (090307)

I am a self employed consultant but will always consider myself a USAF pilot.

Re: ESWT Pain

dave r on 7/12/02 at 10:02 (089543)

I found that my pain levels went up and down for a long time after eswt. It took me a couple of weeks for things to settle down

Re: ESWT Pain

Dr David Lee on 7/17/02 at 11:04 (089871)

Dear Pete,

Most patients experience some pain and in some cases more pain than before-initially. This is because of the bruising effect on the plantarfascia as well as the bone underneath. Eventually this clears up usually before 3 weeks after the treatment. Whether one has more pain than the next aptient depends on the technique used by the physician (very important) and alos the device used. (ultrasound guided or not guided) With ultrasound guided technology and side aiming like the EPOS there are potentially less complaints because shockwave is aimed not at the bone but rather across the width of the fascia allowing the exit of the shockwave out the foot and not up the leg.

Hang in there it gets better. I recommend that you meet with your physician for counselling.

Re: ESWT Pain

Sunny Jacob - Bayshore on 7/19/02 at 08:02 (090085)

1. Use of in-line ultrasound for ESWT: As I have stated its advantages numerous times, Dr. Lee has again emphasized the importance of locking the ultrasound image in the treatment zone during ESWT session/s.
2. It seems that some readers are confused with a clinic's success rate and a controlled peer reviewed clinical study. Dr. Lee has emphasized that the 85% success rate is his observation at his clinc.
3. 'Acquiring ESWT devices is cheaper in Canada' is not correct. It is just as expensive as in the United States, as is the operation of the clinic. Moreover, taxes (including personal income taxes) are substantially higher in Canada than in the U.S.

Re: ESWT Pain

john h on 7/19/02 at 09:12 (090093)

Sunny: I think you have mentioned this before and I think our board members sometimes forget what the meaning of 'Success' is when it comes to ESWT. My understanding it does not mean a 'Cure'. It seems that a 50% reduction in pain would be considered a success. Is this correct?

Re: ESWT Pain

Sunny Jacob - Bayshore on 7/19/02 at 17:51 (090151)

Yes, John. Every clinic's success evaluation can be different. Let me try to explain as best as I can.
The pain history of each patient who comes to our clinic is different. Some may have a history of 20 or more years and some had pain for just over 6 months, and there are many in between. Some patients had multiple surgery and may have considerable scar tissue formation. Therefore, one cannot expect all patients to have the same 'starting point' before ESWT and treatment outcome can differ accordingly.
In a proper clinical study all these factors have to be considered, including (at times) age, sex, occupation, etc.
Bayshore's 'success' rate is not based on other clinical studies we do in specific areas.
Let me explain our definition of 'success' with ESWT treatment:
As you know, the pain level is expressed in VAS (visual analog scale) with a range from 0 to 10, whereby the highest pain is 10.The levels are assessed prior to ESWT at rest and activity. (Pain level during activity is always somewhat higher. )
Irrespective of what the initial assessment level of a patient is (e.g. anywhere from VAS 6 to 9 at rest), we consider it a 'success' or 'cure' if the patient achieves a reduction in the pain level to 3 or below at rest. This may take up to 12 weeks post treatment. Our clinic's 'success' rate with this measurement is over 85%, i.e. over 85% of patients do achieve this considerable reduction in pain.
Most of the patients who come to Bayshore have already undergone all conventional treatments. Therefore, if they attain a level of 3 or below, almost all of them are absolutely satisfied with our treatment.
Many of the patients on this message board (and other clinics) express the success rate in percent, e.g. '50%', which means that the pain level is reduced to half of what it was prior to treatment.

In addition to Plantar fasciitis, Bayshore clinics treat various tendinopathies such as tennis elbow, patellar tendonitis, Achilles tendonitis, rotator cuff tendonitis, calcification and bursitis. Our results are a combination of all these treatments.
Our success rate for Plantar fasciitis alone (low energy ESWT/laser combination therapy) to date is over 86%.

Re: ESWT Pain

john h on 7/19/02 at 19:18 (090161)

Sunny: I bet your Liability Insurance coverage is not near what it is for Doctors in our litigous society here in the U.S.

Re: ESWT Pain

john h on 7/19/02 at 19:28 (090163)

Thanks for your explanation of 'success' as measured by Bayshore. I would be a howling success by your measurement and 5 years or so ago when I was at a pain level of 6-7 would have taken it. Now I am at a 1 or less and want more and will continue to work at this until someday I can announce I am 'Cured'! I am thankful for where I am and suspect that ESWT at Dr. Z's played an important part in it along with a couple of other things. If there is something mentioned on this board I have not tried it was an accident. ESWT should be high on the list of things to do after 6 months of conservative treatment.

Re: ESWT Pain

Dr. David Lee on 7/20/02 at 18:26 (090233)

I agree with Sunny

Re: ESWT Pain

Sunny Jacob - Bayshore on 7/21/02 at 07:31 (090266)

John,
As I have commented previously, based on the measurement of most clinics, your case can be considered a 'success'. Of course, as you have stated, 0' pain level would be ideal.

You are right that, in comparison to the U.S., Canadians and Europeans spend less on litigations. However, our patient mix is multinational (incl. European and other countries). Therefore we maintain a $4 Mill. Liability insurance. If you analyze the total operating cost, liability insurance premium is a small component.

Re: ESWT Pain

john h on 7/21/02 at 08:57 (090270)

Sunny: I do not know what the percentage of overhead in a Doctors practice is from liability insurance but I will see if I can research that subject. I do know that anathesiaologist and obstatricians seem to lead the way in cost of liability insurance. I have personally been on the witness stand at least 5 times in liability cases against our company, some of which were outrageous. On the last case we spent over $250,000 defending our case and the plantiff spent at least that much. After 4 years the jury came back and awarded no one anything. The only winners the lawyers to the tune of $500,00.00 dollars. The plantiff filled for bankruptcy. He and I still have coffee and discuss this case. Sidebar: Once when I took the witness stand I reached under my chair to pull up to the microphone. There was a large nail protruding underneith and I ran it throuhg my finger. The trail had to be called off for a few hours while I received medical treatment.

Re: ESWT Pain

scott r on 7/21/02 at 09:43 (090275)

John H, who did you work for?

Re: ESWT Pain

john h on 7/21/02 at 19:44 (090307)

I am a self employed consultant but will always consider myself a USAF pilot.