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ESWT-- what miracle?

Posted by Katie K on 12/31/02 at 04:00 (104359)

I finally had an ESWT treatment performed in October. I had a very good doctor who was thorough and honest, which I appreciated. After having done just about every other treatment out there (I've suffered from this horrid affliction for over 2 years) I was ready to try anything. I found my insurance would pay for ESWT under my circumstance (although, if you're thinking of doing this, be warned; the insurance company will likely give you the runaround before AND after you've had the procedure... Blue Cross did) but, I was still obligated to pay a large sum. Anyhow, I am approaching the three month mark, and I find my checkbook is lighter and the PAIN IS STILL AS BAD! It didn't seem to work at all. My doctor has suggested repeating the procedure, and has said the success rate increases to somewhere around 90.5% (as opposed to the first time run of 80%). I worry, since I still managed to be one of the unlucky 20% the first time. If it were free, sure, I'd do it, but I'm looking at another very sizable sum of money to do it again. Has anyone out there had any success only after the second try? Does anyone have any suggestions that perhaps I have overlooked? Thanks for any feedback I may receive. I'm at my wit's end.

Re: ESWT-- what miracle?

Dr. Z on 12/31/02 at 12:26 (104397)

It should be free. We don't charge the patient any amount of money if the first treatment did work . Talk to your doctor I am sure he will come around to this thinking. As for second treatment working when the first didn't I have alot of patients who have had this experience. One is an attorney who just posted on this board. I have no idea what the sucess for second treatments after failed first. I do know that with the dornier epos the one year sucess rate was 94% with sucess meaning either zero or very little discomfort after any activity. Feel free to ask any questions you may have

Re: ESWT-- what miracle?

Pauline on 12/31/02 at 15:25 (104412)

Katie,
Did you ever discuss the possibility of needing additional treatments prior to your first? Although the doctor can change his mind, my personal opinion is that this one has found a way to make a killing using ESWT and that is by charging for every individual procedure he does even repeat visits.

Patients may not see so much of this right now because ESWT is still new, but I think what your experience has been will be happening more and more in the future especially when insurance companies beginning picking up the tab.

There is no built in incentive for a doctor not to charge for each procedure if he can get paid by the insurance company for everyone he does even if they are repeat treatments.

Currently doctors know they need to convience most patients to fork over out of pocket money for the treatment so they are more apt. to sweeten the pot by throwing in additional treatments.

If I was risking my money on 'pork' futures, I'd put it on insurance coverage being charged on a per treatment basis. Sounds like your doctor may already be there.

Re: ESWT-- what miracle?

Dr. Z on 12/31/02 at 19:17 (104420)

There are some insurance companies that will pay for a second treatment. The paper work is hugh but they will pay. My personal opinion is that it should be included in the first payment so long as the first payment is fair and paid in full within 30 days

Re: ESWT-- what miracle?

Katie K on 1/01/03 at 04:40 (104435)

Actually, I know the doc isn't trying to line his pockets. He has been very clear from the start that there is always a possibility of a second treatment. He also made it very clear that he will go no further than two treatments, simply because it has not proven to be any more effective after two times. (It's an Ossatron machine, in case you're wondering). I feel that if he were trying to take my cash, he'd not be so clear on that. But aside from that, it's not up to him what is charged. The procedure was close to $6000, but HIS bill was smaller than almost every other. The machine is owned by a hospital (I had to drive 170 miles for the treatment, as it's the only one in the state of Oregon, right now) and THEY are the ones who charge so much. The doc is basically allowed to use it, along with all other qualified docs in the state. Not to mention, the machine is lent out to other areas. So, there simply is no way for me to ever get out of paying. It's not up to him, unfortunately. If it were, I honestly feel like he'd give me a break. He doesn't seem to be out to get me in the pocketbook, unlike some other docs I've had. So, I guess I'm still wondering what to do? I cannot understand how a second run will be more successful, if I had no result the first time. I am so skeptical of this whole thing. I keep hearing how wildly successful it is, but when I don't fall into the 80% margin, I find myself becoming more and more of a cynic. Here's one question though. I never had P.f. until I got a job that requires I stand on concrete for almost the entire 8-10 hours. I am convinced that this is what caused it. I cannot get a doc to concur with this, but I'm not sure what that's all about. I have asked two different doctors if I should get a thick pad to work on, and the first guy thought that was funny, and the second wasn't convinced it'd be effective. So, my question(s) is this: Is it truly possible that the concrete combined with the structure of my feet, caused this, and by continuing working as I am, will I impede my chances of healing?

Re: ESWT-- what miracle?

Dr. Z on 1/01/03 at 08:39 (104436)

Concrete can and does cause plantar fasciitis. A thick standing pad can at times help in the prevention of pf.

Now back to my comments about the second treatment. Healthroncis has in the past either reduced or eliminated their fee for the seond treatment.
Here is why a second treatment does help or cure. It is my opinion that the you need a certain amount of trauma to get the body's repair system to knick into the inflamatory phase then healing. We use a specific treatment protocol via the FDA. The amount of energy used in the first treatment is too low for YOUR specific plantar fasciitis. The treatment protocol of energy is always the same and some will be just the right amount and some will be too little . This has nothing to do with either the doctor or the machine it is in my opinion it is the law averages.
Again I have treated many patients with failed first treatments and then sucessful 2nd treatment.

I know how you feel. I had failed lasik surgery and I am sitting here with glasses.

Re: ESWT-- what miracle?

john h on 1/01/03 at 09:19 (104441)

If you can afford it Katie I would sure go for the second treatment. Most of the Doctors offer the second treatment at a very reduced cost or in some cases free. Have you asked your Doctor? In what state do you live and is that the state you had your treatment? Which machine was used?

Re: ESWT-- what miracle?

john h on 1/01/03 at 09:31 (104443)

Pauline: Several of the Docs I have talked with have no charge for the second treatment or at worst a very small one. I paid Dr. Z for my first treatment and my 2nd and 3rd on both feet were free. The Dornier Epos in the U.S. cost approximately $350,000.00 so you can see why this treatment is expensive. The only way we are going to get the price down is through volume treatments, volume selling by Dornier, and more Doctors learning about this treatment and making it available. There are many doctors in my city who just have little or no knowledge of this equipment or procedure and therefore the patients have no knowledge of it. I would be supprised if 10% of the PF population had any idea what ESWT is. I suspect follow on treatments with the Ossatron could run into a lot money regardless because of the hospial charges so a patient should through this in the mix when selecting a machine for this procedure. Dr Z or Dr A what is the expected useful life of the Dornier Epos? I assume it muust be based on number of shocks.

Re: ESWT-- what miracle?

john h on 1/01/03 at 09:44 (104447)

Katie the Epos Ultra charge on the high end is $2500 with no other charges and no hospital, no being put to sleep, and with a apparent success rate as high or higher than the Ossatron. Some Docs in some parts of the country charge under $2000. Both procedures are doing the same thing.

Re: ESWT-- what miracle?

Dr. Z on 1/01/03 at 12:59 (104458)

That shock head has to be changed every one million pulses. The price for that ranges anywhere from 5-7 thousand dollars. In addition the service warranty is for only one year after that you are going to pay thousands and thousands of dollars each year. The useful life span is all based on technology being outdated. I would estimate about five years of technology life span.

Re: ESWT-- what miracle?

Katie K on 1/01/03 at 13:28 (104464)

Hi John, Just in case you didn't see my post from last night, I will answer this. :) It was an Ossatron machine. The reason I had that over something else, is because currently in the state of Oregon, this is the only thing available, and it's not even available close to where I live. Unfortunately, it sounds like it's one of the only ones available in the Pacific Northwest, although I can't be sure. I just know that WA borrows the machine, as well, after reading a newspaper article out of Shelton, WA. I had been waiting for my first Podiatrist to get a machine, but after being told 'not yet' for 8 months, I gave up waiting. I made the drive and had it done by a doctor up there. Unfortunately, as I stated before, it's the hospital charges that I cannot change, not the doc's. If it were him, I imagine he would give me a break, so I am stuck with the charges.

Re: ESWT-- what miracle?

john h on 1/02/03 at 10:23 (104543)

Katie: Dr. Ed is in your general area you should give him a call. He sends some of his patients across the border for treatment with the Sonoccur which is really inexpensive. His address should be listed on this board where Scott list all the Doctors doing ESWT. Without a doubt a follow on treatment with the Ossatron will be expensive even if the machine and doctor made no charges as you would be stuck for the surgery center bill.

Re: ESWT-- what miracle?

Dr. Z on 12/31/02 at 12:26 (104397)

It should be free. We don't charge the patient any amount of money if the first treatment did work . Talk to your doctor I am sure he will come around to this thinking. As for second treatment working when the first didn't I have alot of patients who have had this experience. One is an attorney who just posted on this board. I have no idea what the sucess for second treatments after failed first. I do know that with the dornier epos the one year sucess rate was 94% with sucess meaning either zero or very little discomfort after any activity. Feel free to ask any questions you may have

Re: ESWT-- what miracle?

Pauline on 12/31/02 at 15:25 (104412)

Katie,
Did you ever discuss the possibility of needing additional treatments prior to your first? Although the doctor can change his mind, my personal opinion is that this one has found a way to make a killing using ESWT and that is by charging for every individual procedure he does even repeat visits.

Patients may not see so much of this right now because ESWT is still new, but I think what your experience has been will be happening more and more in the future especially when insurance companies beginning picking up the tab.

There is no built in incentive for a doctor not to charge for each procedure if he can get paid by the insurance company for everyone he does even if they are repeat treatments.

Currently doctors know they need to convience most patients to fork over out of pocket money for the treatment so they are more apt. to sweeten the pot by throwing in additional treatments.

If I was risking my money on 'pork' futures, I'd put it on insurance coverage being charged on a per treatment basis. Sounds like your doctor may already be there.

Re: ESWT-- what miracle?

Dr. Z on 12/31/02 at 19:17 (104420)

There are some insurance companies that will pay for a second treatment. The paper work is hugh but they will pay. My personal opinion is that it should be included in the first payment so long as the first payment is fair and paid in full within 30 days

Re: ESWT-- what miracle?

Katie K on 1/01/03 at 04:40 (104435)

Actually, I know the doc isn't trying to line his pockets. He has been very clear from the start that there is always a possibility of a second treatment. He also made it very clear that he will go no further than two treatments, simply because it has not proven to be any more effective after two times. (It's an Ossatron machine, in case you're wondering). I feel that if he were trying to take my cash, he'd not be so clear on that. But aside from that, it's not up to him what is charged. The procedure was close to $6000, but HIS bill was smaller than almost every other. The machine is owned by a hospital (I had to drive 170 miles for the treatment, as it's the only one in the state of Oregon, right now) and THEY are the ones who charge so much. The doc is basically allowed to use it, along with all other qualified docs in the state. Not to mention, the machine is lent out to other areas. So, there simply is no way for me to ever get out of paying. It's not up to him, unfortunately. If it were, I honestly feel like he'd give me a break. He doesn't seem to be out to get me in the pocketbook, unlike some other docs I've had. So, I guess I'm still wondering what to do? I cannot understand how a second run will be more successful, if I had no result the first time. I am so skeptical of this whole thing. I keep hearing how wildly successful it is, but when I don't fall into the 80% margin, I find myself becoming more and more of a cynic. Here's one question though. I never had P.f. until I got a job that requires I stand on concrete for almost the entire 8-10 hours. I am convinced that this is what caused it. I cannot get a doc to concur with this, but I'm not sure what that's all about. I have asked two different doctors if I should get a thick pad to work on, and the first guy thought that was funny, and the second wasn't convinced it'd be effective. So, my question(s) is this: Is it truly possible that the concrete combined with the structure of my feet, caused this, and by continuing working as I am, will I impede my chances of healing?

Re: ESWT-- what miracle?

Dr. Z on 1/01/03 at 08:39 (104436)

Concrete can and does cause plantar fasciitis. A thick standing pad can at times help in the prevention of pf.

Now back to my comments about the second treatment. Healthroncis has in the past either reduced or eliminated their fee for the seond treatment.
Here is why a second treatment does help or cure. It is my opinion that the you need a certain amount of trauma to get the body's repair system to knick into the inflamatory phase then healing. We use a specific treatment protocol via the FDA. The amount of energy used in the first treatment is too low for YOUR specific plantar fasciitis. The treatment protocol of energy is always the same and some will be just the right amount and some will be too little . This has nothing to do with either the doctor or the machine it is in my opinion it is the law averages.
Again I have treated many patients with failed first treatments and then sucessful 2nd treatment.

I know how you feel. I had failed lasik surgery and I am sitting here with glasses.

Re: ESWT-- what miracle?

john h on 1/01/03 at 09:19 (104441)

If you can afford it Katie I would sure go for the second treatment. Most of the Doctors offer the second treatment at a very reduced cost or in some cases free. Have you asked your Doctor? In what state do you live and is that the state you had your treatment? Which machine was used?

Re: ESWT-- what miracle?

john h on 1/01/03 at 09:31 (104443)

Pauline: Several of the Docs I have talked with have no charge for the second treatment or at worst a very small one. I paid Dr. Z for my first treatment and my 2nd and 3rd on both feet were free. The Dornier Epos in the U.S. cost approximately $350,000.00 so you can see why this treatment is expensive. The only way we are going to get the price down is through volume treatments, volume selling by Dornier, and more Doctors learning about this treatment and making it available. There are many doctors in my city who just have little or no knowledge of this equipment or procedure and therefore the patients have no knowledge of it. I would be supprised if 10% of the PF population had any idea what ESWT is. I suspect follow on treatments with the Ossatron could run into a lot money regardless because of the hospial charges so a patient should through this in the mix when selecting a machine for this procedure. Dr Z or Dr A what is the expected useful life of the Dornier Epos? I assume it muust be based on number of shocks.

Re: ESWT-- what miracle?

john h on 1/01/03 at 09:44 (104447)

Katie the Epos Ultra charge on the high end is $2500 with no other charges and no hospital, no being put to sleep, and with a apparent success rate as high or higher than the Ossatron. Some Docs in some parts of the country charge under $2000. Both procedures are doing the same thing.

Re: ESWT-- what miracle?

Dr. Z on 1/01/03 at 12:59 (104458)

That shock head has to be changed every one million pulses. The price for that ranges anywhere from 5-7 thousand dollars. In addition the service warranty is for only one year after that you are going to pay thousands and thousands of dollars each year. The useful life span is all based on technology being outdated. I would estimate about five years of technology life span.

Re: ESWT-- what miracle?

Katie K on 1/01/03 at 13:28 (104464)

Hi John, Just in case you didn't see my post from last night, I will answer this. :) It was an Ossatron machine. The reason I had that over something else, is because currently in the state of Oregon, this is the only thing available, and it's not even available close to where I live. Unfortunately, it sounds like it's one of the only ones available in the Pacific Northwest, although I can't be sure. I just know that WA borrows the machine, as well, after reading a newspaper article out of Shelton, WA. I had been waiting for my first Podiatrist to get a machine, but after being told 'not yet' for 8 months, I gave up waiting. I made the drive and had it done by a doctor up there. Unfortunately, as I stated before, it's the hospital charges that I cannot change, not the doc's. If it were him, I imagine he would give me a break, so I am stuck with the charges.

Re: ESWT-- what miracle?

john h on 1/02/03 at 10:23 (104543)

Katie: Dr. Ed is in your general area you should give him a call. He sends some of his patients across the border for treatment with the Sonoccur which is really inexpensive. His address should be listed on this board where Scott list all the Doctors doing ESWT. Without a doubt a follow on treatment with the Ossatron will be expensive even if the machine and doctor made no charges as you would be stuck for the surgery center bill.