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Question for Dr. Z.

Posted by Cherie on 11/21/02 at 15:51 (100825)

Sorry to keep bugging you. I just got back from seeing my doctor and he said he had never seen anything like the pain I am experiencing. It is 2 wks post Ossatron and I still have horrible pain and numbness in the ball and arch of my foot and my 1st three toes are extremely sensitive to touch. Now my heel is also very tender from walking on it to try to keep off the rest of my foot. You said you have seen this before??? He scheduled me for 3 weeks with a physical therapist. I so worried that this is not going to go away. I also got another 1 wk prescription for methylpredisone. Please just tell me your opinion. I trust my dr, but I would like to know what you think. This pain is so bad that I cannot go to work, I'm so upset and afraid of what is going to happen. Thanks so much

Re: ESWT complications

Heinz on 11/22/02 at 01:00 (100871)

ESWT is use is still in its early stages. Complications are rare but more will occur with time. Cherie's complication could be either from the nerve block or direct damage to the medial plantar nerve caused by ESWT itself. Either should resolve with time. Physiotherapy should help.

Keep in mind that complications of anesthesia can only happen with high energy ESWT, not low energy since no anesthesia is used. Nerve damage can occur if the shockwave head was misdirected as it should not be placed over a nerve trunk. Again, low energy units avoid this since the patient would be able to determine if shocks are applied to a nerve trunk, not to mention the fact that less power is used.

America is still in the first generation of machines. Europe has had this for 10 years and is moving more toward low energy which can be applied to more tendons in the body, is safer and less costly. Sometimes Americans have the philosophy that bigger or more is better. That may not be true for ESWT.
Heinz

Re: ESWT complications

Julie on 11/22/02 at 01:57 (100876)

Heinz, this is interesting in view of the discussions that have taken place here in high vs low energy ESWT. Are you posting from Germany? I hope you'll be able to stick around and contribute your experience to these discussions.

Re: ESWT complications

Dr. Zuckerman on 11/22/02 at 08:26 (100886)

Where did you get the information that Europe started with high energy and is now moving toward low energy. Please explain to me I am very confused about your conclusion and reference that Americans think that bigger or more is better. Not being smart just want to understand your thinking

Re: Question for Dr. Z.

Dr. Zuckerman on 11/22/02 at 08:30 (100888)

Yes I have seen this. As to the degree you are having no. The treatment program your doctor has you on is a very good first step The physical Therapy is an excellent method to stop the swelling and pain. I would also place you in a boot cast. May need to be on crutches. I am concerned that you could injury another part of your foot-lower extremity. Get the boot cast and or crutch asap

Re: ESWT complications

john h on 11/22/02 at 10:21 (100901)

Heinz: Bigger is better in America! You got that right. We must have more SUV's than the rest of the world. Is the Ossatron being used widely in Europe? Is there a comparable machine to the Ossatron in Europe? I believe the Ossatron is a hydraulic machine as opposed to spark gap. Is there a hydraulic machine in use in Europe?

Re: ESWT Low/High Energy

Sunny Jacob, Bayshore on 11/22/02 at 19:26 (100940)

Dr. Z.:
I have to agree with Heinz. To my knowledge, in Europe the majority of ESWT is done by low energy multiple treatment. However, I am not able to provide statistical information. The best source of information in this regard may be Dr. Wolfgang Schaden, General Secretary of the Interntional Society for Musculoskeletal Shockwave Therapy in Vienna. His email is (email removed), Tel. 011 43 43 160 1500, website: http://www.ismst.com

Re: ESWT Low/High Energy

Mar on 11/23/02 at 07:21 (100974)

Sunny --

Can one have the low energy ESWT after having the other? Has any done this and had positive results? Mar

Re: ESWT Low/High Energy

Sunny Jacob, Bayshore on 11/24/02 at 11:15 (101039)

Mar,
We have treated several patients who previously received low or high energy ESWT treatment elsewhere. The outcome of those patients had the same success rate as for first time ESWT patients.

IMPORTANT MESSAGE: We also treat several national team athletes. These are a special group of patients and I compare them to race horses. Though we may be able to treat their tendonitis successfully, their aim is to be back in the field for the next few games or races.
As a result, they may be back at the clinic again soon for another series of ESWT treatments. For them ESWT is no more than getting some relief, the same as aspirin for headache.

For those patients who are prone to injury or force themselves to injury from repetitive stress, ESWT may not be a long term solution.

Re: ESWT Low/High Energy

Mar on 11/24/02 at 17:12 (101053)

Sunny -

Do you mean that if the ESWT elsewhere was not successful for me, your treatment would not be successful either? Or that it would be like a brand new patient with the same possibility of success? Mar

Re: ESWT Low/High Energy

Dr. Z on 11/26/02 at 22:10 (101223)

I agree additional high or low treatment can help resolve pain when the first line or even the second has failed

Re: ESWT Low/High Energy

Mar on 11/27/02 at 05:35 (101237)

Thanks Dr Z -- Are there any stats to show which is better -- high or low energy? Or is it a matter of opinion? Do you think another high energy treatment would have the same chance of working as the low at this point? (Had 2 highs already.) Mar

Re: ESWT Low/High Energy

Dr. Z on 11/27/02 at 18:12 (101281)

I just posted what studies show for high energy ESWT. I would have to examine you to determine if any ESWT would help you. I realize that you have had two high energy ESWT treatments. Do me a favor e-mail me at my footcare @ comcast.net address . I would like to review your ultrasound evaluations that you had pre-eswt. This way another ultrasound can be done to see if there has been healing. I will need you name so I can look it on in the file.

Dr. Z

Re: ESWT complications

Heinz on 11/22/02 at 01:00 (100871)

ESWT is use is still in its early stages. Complications are rare but more will occur with time. Cherie's complication could be either from the nerve block or direct damage to the medial plantar nerve caused by ESWT itself. Either should resolve with time. Physiotherapy should help.

Keep in mind that complications of anesthesia can only happen with high energy ESWT, not low energy since no anesthesia is used. Nerve damage can occur if the shockwave head was misdirected as it should not be placed over a nerve trunk. Again, low energy units avoid this since the patient would be able to determine if shocks are applied to a nerve trunk, not to mention the fact that less power is used.

America is still in the first generation of machines. Europe has had this for 10 years and is moving more toward low energy which can be applied to more tendons in the body, is safer and less costly. Sometimes Americans have the philosophy that bigger or more is better. That may not be true for ESWT.
Heinz

Re: ESWT complications

Julie on 11/22/02 at 01:57 (100876)

Heinz, this is interesting in view of the discussions that have taken place here in high vs low energy ESWT. Are you posting from Germany? I hope you'll be able to stick around and contribute your experience to these discussions.

Re: ESWT complications

Dr. Zuckerman on 11/22/02 at 08:26 (100886)

Where did you get the information that Europe started with high energy and is now moving toward low energy. Please explain to me I am very confused about your conclusion and reference that Americans think that bigger or more is better. Not being smart just want to understand your thinking

Re: Question for Dr. Z.

Dr. Zuckerman on 11/22/02 at 08:30 (100888)

Yes I have seen this. As to the degree you are having no. The treatment program your doctor has you on is a very good first step The physical Therapy is an excellent method to stop the swelling and pain. I would also place you in a boot cast. May need to be on crutches. I am concerned that you could injury another part of your foot-lower extremity. Get the boot cast and or crutch asap

Re: ESWT complications

john h on 11/22/02 at 10:21 (100901)

Heinz: Bigger is better in America! You got that right. We must have more SUV's than the rest of the world. Is the Ossatron being used widely in Europe? Is there a comparable machine to the Ossatron in Europe? I believe the Ossatron is a hydraulic machine as opposed to spark gap. Is there a hydraulic machine in use in Europe?

Re: ESWT Low/High Energy

Sunny Jacob, Bayshore on 11/22/02 at 19:26 (100940)

Dr. Z.:
I have to agree with Heinz. To my knowledge, in Europe the majority of ESWT is done by low energy multiple treatment. However, I am not able to provide statistical information. The best source of information in this regard may be Dr. Wolfgang Schaden, General Secretary of the Interntional Society for Musculoskeletal Shockwave Therapy in Vienna. His email is (email removed), Tel. 011 43 43 160 1500, website: http://www.ismst.com

Re: ESWT Low/High Energy

Mar on 11/23/02 at 07:21 (100974)

Sunny --

Can one have the low energy ESWT after having the other? Has any done this and had positive results? Mar

Re: ESWT Low/High Energy

Sunny Jacob, Bayshore on 11/24/02 at 11:15 (101039)

Mar,
We have treated several patients who previously received low or high energy ESWT treatment elsewhere. The outcome of those patients had the same success rate as for first time ESWT patients.

IMPORTANT MESSAGE: We also treat several national team athletes. These are a special group of patients and I compare them to race horses. Though we may be able to treat their tendonitis successfully, their aim is to be back in the field for the next few games or races.
As a result, they may be back at the clinic again soon for another series of ESWT treatments. For them ESWT is no more than getting some relief, the same as aspirin for headache.

For those patients who are prone to injury or force themselves to injury from repetitive stress, ESWT may not be a long term solution.

Re: ESWT Low/High Energy

Mar on 11/24/02 at 17:12 (101053)

Sunny -

Do you mean that if the ESWT elsewhere was not successful for me, your treatment would not be successful either? Or that it would be like a brand new patient with the same possibility of success? Mar

Re: ESWT Low/High Energy

Dr. Z on 11/26/02 at 22:10 (101223)

I agree additional high or low treatment can help resolve pain when the first line or even the second has failed

Re: ESWT Low/High Energy

Mar on 11/27/02 at 05:35 (101237)

Thanks Dr Z -- Are there any stats to show which is better -- high or low energy? Or is it a matter of opinion? Do you think another high energy treatment would have the same chance of working as the low at this point? (Had 2 highs already.) Mar

Re: ESWT Low/High Energy

Dr. Z on 11/27/02 at 18:12 (101281)

I just posted what studies show for high energy ESWT. I would have to examine you to determine if any ESWT would help you. I realize that you have had two high energy ESWT treatments. Do me a favor e-mail me at my footcare @ comcast.net address . I would like to review your ultrasound evaluations that you had pre-eswt. This way another ultrasound can be done to see if there has been healing. I will need you name so I can look it on in the file.

Dr. Z