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Dr A - follow up question ESWT

Posted by Mar on 2/09/03 at 16:18 (108606)

Dr A -

What do you mean that ESWT has its 'inherent risks and complications?' What might these be? When I had my ESWT done, I was told that there were NO risks. I'm just curious on the difference in 'opinion' here??? ... Mar

Re: Dr A - follow up question ESWT

Dr. A on 2/09/03 at 23:05 (108642)

risks include pain, swelling, bruising, no relief of pain, neuritis, nerve damage. there has also been reported nerve damage due to the needle when giving local anesthesia pre-procedure. I list all of these in my informed consent form before doing the procedure. To say that there are no risks to the procedure is not accurate in my opinion. To say that the risks are minimal and the benefits far out weight the risks is more accurate.

Re: Dr A - follow up question ESWT

Mar on 2/10/03 at 05:21 (108657)

This is very interesting. Before I signed my consent, I asked what the risks were, and I was told there are NONE! The swelling and bruising are no big deal, but nerve damage and neuritis??? That's serious stuff. Thanks for your input. Mar

Re: Dr A - follow up question ESWT

Dr. Z on 2/10/03 at 20:40 (108746)

Nerve damage is not a risk it is really a mistake. The doctor would have to place the shockhead directly over the nerve. Hitting a nerve with a needle is a mistake. No relief at all is a risk. Temporay Swelling and bruising are not risks they part of the normal course following ESWT if it happens at all. I am sure you were told that the procedure may not work.T
There really aren't any risk with ESWT. except that the procedure may not help you at all.

Re: Dr A - follow up question ESWT

Mar on 2/10/03 at 20:53 (108752)

Well, I didn;t have nerve damage so I can accept what you are saying very easily. Someone who did have nerve damage may consider it pure semantics -- mistake, risk...Kind of like my bunion surgery -- no risks I was told -- and here I SIT 2 years later -- but then again, all of life is a risk, isn;t it? ;-) I do get what you are saying though -- the ESWT itself does not have risks. Mar

Re: Dr A - follow up question ESWT

Dr. Z on 2/10/03 at 22:13 (108763)

Now Bunion is another ball game. There are risks that do happen. I guess a better way to describe a risk is it is something that no matter how perfect of a surgery it can and does happen. I risk is something that the procedure can cause not the doctor.

Were you really told no risk with bunion surgery. Off the top of head I tell patients that they can have infection, loss of motion, future surgery , bunion returning , healing six months or more. I really hope that you were told the complication or risks of bunion surgery if you weren't now that is a real complication

Re: Dr A - follow up question ESWT

Mar on 2/11/03 at 05:25 (108779)

Yes- a real complication! I was told of none of those things. I was told I better have the surgery if i don;t want to get arthritis when I get older and if I want to reamin active (ha - the sick joke is on me)! A cousin told me that the bunion could come back and of course I guess I know that infection is possible with any surgery, but none of these things were discussed. And that was when i was naive and didn;t research things and took the doctor's word as gospel truth! I suppose part of my problem now is the way my body heals, but some follow-up treatment surely should have been part of the whole thing and if I had known that loss of motion was a possibility I would never have chanced it I don;t think. And 6 months? Ha - he told me 2 weeks in surgical shoe, 4 weeks in sneakers, and then back to regular shoes and heels!! Anyway, I am trying to move on now and correct as much as possible to maybe be able to go for a walk someday again... Thanks for your input -- Mar

Re: how about plantar nerves- Dr. Z

Dr. A on 2/11/03 at 19:14 (108845)

don't you think it is possible that you can hit on of the branches of the tibial nerve. (medial/lateral plantar, 1st branch off the lateral plantar) when doing eswt and therfore causing nerve damage or at least neuritis? And if so, would this be a risk factor or just doctor error.

Re: how about plantar nerves- Dr. Z

Dr. Z on 2/11/03 at 19:23 (108846)

if the cross hairs are in beteen the double white lines produced by the ultrasound and you are at or near the insertion no I don't . It is the same as making a proper incision You have to know where to place cross hairs . Now if you start to work too far distal and above or below the double white line then problem could occur.

Re: how about plantar nerves- Dr. Z

Mar on 2/12/03 at 07:01 (108904)

And I suppose 'doctor error' would be considered an inherent risk in any surgery, and which i supppose would not be discussed as a 'risk' prior to any surgery, foot or otherwise? Mar

Re: Dr A - follow up question ESWT

Dr. A on 2/09/03 at 23:05 (108642)

risks include pain, swelling, bruising, no relief of pain, neuritis, nerve damage. there has also been reported nerve damage due to the needle when giving local anesthesia pre-procedure. I list all of these in my informed consent form before doing the procedure. To say that there are no risks to the procedure is not accurate in my opinion. To say that the risks are minimal and the benefits far out weight the risks is more accurate.

Re: Dr A - follow up question ESWT

Mar on 2/10/03 at 05:21 (108657)

This is very interesting. Before I signed my consent, I asked what the risks were, and I was told there are NONE! The swelling and bruising are no big deal, but nerve damage and neuritis??? That's serious stuff. Thanks for your input. Mar

Re: Dr A - follow up question ESWT

Dr. Z on 2/10/03 at 20:40 (108746)

Nerve damage is not a risk it is really a mistake. The doctor would have to place the shockhead directly over the nerve. Hitting a nerve with a needle is a mistake. No relief at all is a risk. Temporay Swelling and bruising are not risks they part of the normal course following ESWT if it happens at all. I am sure you were told that the procedure may not work.T
There really aren't any risk with ESWT. except that the procedure may not help you at all.

Re: Dr A - follow up question ESWT

Mar on 2/10/03 at 20:53 (108752)

Well, I didn;t have nerve damage so I can accept what you are saying very easily. Someone who did have nerve damage may consider it pure semantics -- mistake, risk...Kind of like my bunion surgery -- no risks I was told -- and here I SIT 2 years later -- but then again, all of life is a risk, isn;t it? ;-) I do get what you are saying though -- the ESWT itself does not have risks. Mar

Re: Dr A - follow up question ESWT

Dr. Z on 2/10/03 at 22:13 (108763)

Now Bunion is another ball game. There are risks that do happen. I guess a better way to describe a risk is it is something that no matter how perfect of a surgery it can and does happen. I risk is something that the procedure can cause not the doctor.

Were you really told no risk with bunion surgery. Off the top of head I tell patients that they can have infection, loss of motion, future surgery , bunion returning , healing six months or more. I really hope that you were told the complication or risks of bunion surgery if you weren't now that is a real complication

Re: Dr A - follow up question ESWT

Mar on 2/11/03 at 05:25 (108779)

Yes- a real complication! I was told of none of those things. I was told I better have the surgery if i don;t want to get arthritis when I get older and if I want to reamin active (ha - the sick joke is on me)! A cousin told me that the bunion could come back and of course I guess I know that infection is possible with any surgery, but none of these things were discussed. And that was when i was naive and didn;t research things and took the doctor's word as gospel truth! I suppose part of my problem now is the way my body heals, but some follow-up treatment surely should have been part of the whole thing and if I had known that loss of motion was a possibility I would never have chanced it I don;t think. And 6 months? Ha - he told me 2 weeks in surgical shoe, 4 weeks in sneakers, and then back to regular shoes and heels!! Anyway, I am trying to move on now and correct as much as possible to maybe be able to go for a walk someday again... Thanks for your input -- Mar

Re: how about plantar nerves- Dr. Z

Dr. A on 2/11/03 at 19:14 (108845)

don't you think it is possible that you can hit on of the branches of the tibial nerve. (medial/lateral plantar, 1st branch off the lateral plantar) when doing eswt and therfore causing nerve damage or at least neuritis? And if so, would this be a risk factor or just doctor error.

Re: how about plantar nerves- Dr. Z

Dr. Z on 2/11/03 at 19:23 (108846)

if the cross hairs are in beteen the double white lines produced by the ultrasound and you are at or near the insertion no I don't . It is the same as making a proper incision You have to know where to place cross hairs . Now if you start to work too far distal and above or below the double white line then problem could occur.

Re: how about plantar nerves- Dr. Z

Mar on 2/12/03 at 07:01 (108904)

And I suppose 'doctor error' would be considered an inherent risk in any surgery, and which i supppose would not be discussed as a 'risk' prior to any surgery, foot or otherwise? Mar