Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

To Bev

Posted by Pauline on 4/02/03 at 09:44 (115149)

Hi Bev,
Dr. Zingas M.D. the Orthopedic Foot and Ankle Specialist who ran the FDA studies on the Dornier machine is now using the Ossatron to treat P.F. If your still looking for a doctor you might want to check with his office for information. Lakeshore Orthopedic's. They have two offices the newest is in Macomb Township near Lakeside Mall off Hall Road.

Re: To Bev

Bev on 4/02/03 at 10:58 (115156)

Thankyou very much, Pauline :) :) , Bev

Re: To Bev

john h on 4/02/03 at 12:28 (115168)

Bev: the main Doctor who consults with Bayshore uses both the Sonoccur and Orssatron and has been doing these procedures for many years called me on the phone last year. He recommended that I have the Ossatron on my foot that had previous surgery because as he said scar tissue could be an issue. For the foot that had not had surgery he recommeded the Sonoccur. At Bayshore I think both treatments cost the same so cost was not the issue.

Re: To Bev

Pauline on 4/02/03 at 14:04 (115176)

John,
I believe Sunny posted the prices at Bayshore and from what I remember the Ossatron treatment is much higher. Like the U.S. anesthesia involvement add to the costs.

Re: John here is Sunny's post

Pauline on 4/02/03 at 14:09 (115178)

Here is Sunny's post about costs. Actually the two are not that far apart and the Ossatron cost is certainly more reasonable than in the U.S. unless one has insurance coverage for it.

ESWT just done in Toronto - High Intensity View Thread
Posted by Sunny Jacob, Bayshore on 2/06/03 at 20:56

Molly,
Thank you for providing information about your ESWT treatment at Bayshore in Toronto in your own words.
For the readers, let me clarify our fee structure. According to the patient's condition and time availability we recommend either low intensity or high intensity ESWT. For the majority of patients we recommend low intensity. Our fee for low intensity ESWT (3 sessions) is USD 1,050.--. For high intensity ESWT (1 session) the total fee is USD 1,700.--. This includes the anesthesist's fee and the orthopedic surgeon's fee. Both treatments can be booked through (email removed)

Re: To Bev

BrianG on 4/02/03 at 16:40 (115191)

Hi Pauline,

Are you saying that Dr. Zingas was in on the FDA studies (with Ma Gen Hospital) for the Dornier, but is now using the OssaTron? Do yo know if he has both machines? If not, did he ever use the Dornier? I know that Ma General is still using their Dornier Epos, after they also used it in the FDA trials.

I wish the FDA would do some more trials on patients that have had previous surgery. No one that had previous heel surgery was allowed to participate in any of the FDA trials. I have to believe that surgery causes some changes in the make up of the foot.

Regards,
BrianG

Re: To Brian

Pauline on 4/02/03 at 17:31 (115195)

Brian,
Yep. He's the one with his name on the Dornier studies that Elliott researched to death, but he is using the Ossatron machine to treat his P.F. patients. More power.

He does not have the Dornier. The Ossatron he is using is set up at a surgical center.

I wonder what happened to Elliott. I really enjoyed his posts.

Re: To Brian

Dr. Z on 4/02/03 at 17:54 (115199)

Pauline,

Did you ask him why he didn't purchase the dornier. Was it cost? I know you can use the ossatron without any investment at this time. I know at one time the FDA docs have the option of purchasing the dornier if they didn't it was removed and then sold somewhere else

Re: John here is Sunny's post

john h on 4/02/03 at 18:04 (115202)

Pauline thanks for Sunny's post. When I talked the Doctor early last year I specifically asked him about cost as I was pondering which machine to use. At that time he told me he would charge me the same for either procedure. I have forgotten his name but he is the Guru of ESWT and did most of the ESWT on the original Ossaton 6 which included Mohez and our own Scott.Maybe he was just offering me a special deal as I was considering doing the Sonoccur on one foot and the Ossatron on the other.

Re: To Brian

Pauline on 4/02/03 at 19:20 (115212)

Didn't have a whole lot of time to talk, but plan to catch up on things later.

He left the medical center where the studies were done. To date they never purchased the Dornier or any ESWT machine . I don't think cost was a factor because the medical center would have been the one making the purchase.

Should know more when I talk to him again. I'm interested in knowing how he compares both machines especially since he did Dornier studies.

Re: John here is Sunny's post

Pauline on 4/02/03 at 19:25 (115213)

I think Dr. Robert Gordon did the original 6. Perhaps like everyone else their prices went up.

How are Scotts feet now? Does he have any left over pain or was he cured?

Re: John here is Sunny's post

rekha s on 4/03/03 at 01:23 (115248)

It could have been Dr Galea...from what I can recall back from then

Re: John here is Sunny's post

john h on 4/03/03 at 10:42 (115282)

rekha: it was not Dr Galea as I remember him. I am going back to my old post. I know he has presented papers in Europe on ESWT and has been doing this for a long time. He called me on the phone one time and spent 20 minutes talikd with me. He was educated in Oklahoma.

Re: John here is Sunny's post

john h on 4/03/03 at 10:51 (115286)

Pauline: you are right on it was Dr. Gordon who called me. He was doing a study last year I think comparing high energy vs low energy.

Re: To Brian

john h on 4/03/03 at 10:57 (115289)

I remember Allan in Australia who was providing ESWT with the EPOS telling me that he EPOS treatment in Australia was around $200. This would indicate the machine must have cost a lot less in Australia than in the U.S. I also talked to a Doctor in South Africa who provided ESWT and his price was only a few hundred dollars. Maybe these machines are like drugs in that the manufacturer has different prices for different nations.

Re: John here is Sunny's post

Sunny Jacob, Bayshore on 4/03/03 at 10:57 (115290)

During shock wave application the shockwave head of Ossatron is moved around the pain area. Within this location, there may be one or more tender spots. Ossatron does not have the in-line ultrasound imaging component to locate the specific tender spot. Thus, by moving the equipment head around the pain area the shock waves reach the tender as well as the non tender spots within the marked boundaries of the pain area.
As many readers already know, the mode of action of ESWT is a symbiosis of various mechanisms which together induce a long-term analgesic effect. During the shock wave application, the chronic status is changed to an acute stage. Therefore, it is quite understandable that after treatment with high energy ESWT under anesthesia patients can feel some soreness and pain. For some patients it may take a few days to feel comfortable again. Usually there is only one treatment session with Ossatron.

Sonocur Plus , with which we have the most experience has an in-line ultrasound imaging as equipment component. Therefore the shock head can be locked to focus the shock waves exactly to the specific tender spot to be treated (indicated by a hairline cross on the screen.) With Sonocur, the shock head is not moved during shockwave application. Throughout the treatment the tiny tender spot is observed by the therapist on the screen and, if necessary, the target is re-aligned. This protocol also avoids that shock waves reach any non-tender area. If the patient has more than one tender spot, the equipment is targeted specifically to each spot. This procedure, is of course done without anesthesia and usually low to medium equipment settings are used (see below). During treatment, the level of energy applied can be controlled by the patient to make him/her feel comfortable. There are usually three treatment sessions.

When positive energy is applied to a 5 sq.mm focal area at various levels there is a substantial difference in energy between Ossatron and Sonocur. High energy also is not always ideal for tendonitis and PF and there are studies available on that subject.

Comparison of energy output with different equipment settings:
Positive energy in 5 sq.mm area with equipment set at low level:
Ossatron 2.5 / Sonocur Plus 0.4
Positive energy in 5 sq.mm area with equipment set at medium level:
Ossatron 5.4 / Sonocur Plus 1.3
Positive energy in 5 sq.mm area with equipment set at high level:
Ossatron 10.0 / Sonocur Plus 2.8

--------------
About the 'Original Six'
I assume this treatment was given in Toronto free of charge as part of a study by Ossatron and introduction of the equipment, possibly by physicians such as Dr. Galea or Dr. Gordon. From my knowledge (limited) it was in a sports institute and the equipment was on a loan basis. As far as I know, Dr. Galea does not have an Ossatron equipment. I know Dr. Galea, but I am not aware if he currently uses ESWT. Dr. Galea is a well-respected specialist in sports medicine. Dr. Gordon, our orthopedic surgeon, currently does Ossatron ESWT with Bayshore.

Re: John here is Sunny's post

john h on 4/03/03 at 12:02 (115299)

Sunny: thanks for bringing me back up to speed on the Ossatron and Sonoccur. I know Dr.Gordon phoned me last year and probably as a result of some conversation you may have had with him. I was very impressed that he took about 20 minutes to talk with me. I suspect your have a 1st class professional facility with some highly experienced well trained people.

Re: To John

Pauline on 4/03/03 at 13:13 (115307)

This might be a good time for Scott to begin a ESWT travel group called
'Travel for the Cure'.

Re: To Sunny

Pauline on 4/03/03 at 13:33 (115308)

Sunny,
Since Bayshore is probably one of the few clinics where patients have access to two different machines Ossatron and Sonocur which machine at Bayshore has had the most success for 'cures' if we measure success not simply by pain reduction but by patients becoming totally pain free?

Would your chronic long term sufferers do better with an Ossatron treatment over Sonocur? What is suggested for the real chronic P.F. cases?

Re: To John

john h on 4/03/03 at 14:28 (115314)

Pauline: Dr. Gordon told me he used the Ossatron for PF primarly on people who had previous surgery for PF. This being because of scar tissue. Other than that I assumed he primarly used the Sonocur for PF.

Re: To John

Pauline on 4/03/03 at 14:42 (115315)

Why didn't you consider the Ossatron this last time? With your pain level so low even before your last treatment have you ever considered that
your pain may not be related to real P.F.?

You've reported 1 -2 pain levels following the Orbie which was years ago. I just wonder if your P.F. is gone and something else isn't the real cause of your current condition.

I wonder if this could be the case for many posters who linger in that low pain level?

Re: To John

john h on 4/03/03 at 14:56 (115318)

Pauline: the main reason I went for the Epos was convenience as it was a 45 minute flight to St Louis and cost. Epos is new and seems to get some good reviews and since I had it only on one foot which was the foot that has not had surgery then the Epos seemed like a good choice.

Of course I have often wondered if something other than PF was a possible cause of my pain. All the symptoms and at least 6 doctors all say I have PF. Symptoms: 1. Pain is localized at the point where the fascia attaches to the heel on the inside of the bottom of the foot 2. Pressing on this area can produce pain most of the time 3. A steriod shot into this area stopped the pain for several days 4. Sometimes after excessive activity there can be some endema in this area 5. Some activity on my feet like excessive walking can increase the pain level in this area 6. Pain begin slowly while running every day of the week until the pain would not let me run at all. 7. Negative on numerous x-rays for any stress fractures. I have not read of any other disease process that makes any sense other than PF.

Re: To John

Pauline on 4/03/03 at 15:07 (115319)

If ESWT turns chronic tissue conditions to an acute condition and it doesn't repair itself following 4 treatments then perhaps more isn't necessarily better or the answer. Perhaps there reaches a point where the tissue cannot come back or be regenerated. Just speculating.

Re: To Sunny

Sunny Jacob, Bayshore on 4/03/03 at 17:58 (115347)

Pauline,
We cannot promise a cure. What we achieve with our combination therapy of ESWT and laser is a substantially reduced pain level, i.e. success. Our method of measuring success is different from that of many ESWT clinics in the U.S. who treat PF. We also treat various other form of joint tendonitis.
Patients who come to our clinic have already been diagnosed by their respective physician or specialist.
They have already undergone all of the conventional treatments except (most cases) surgery.
Most patients arrive with a pain level between 6 and 10, as measured on the VAS scale.
Almost all of our patients had a chronic condition between 6 months and 25 years.
We call the treatment a success if the patient's pain level is reduced to VAS 3 or below (with activity) within 12 weeks post treatment.
86% of our patients achieve this success rate.

Of course, some patients do achieve complete pain relief. The factors that influence the success rate are numerous, including length of the chronic condition and other comorbid condition of the individual patient.

We also treat professional athletes for joint tendonitis (mainly due to repetitive stress injury). This entirely different group of patients occasionally needs to return for ESWT even after successful treatment as they are more prone to repetitive injury. For professional athletes we do not insist on the general rule of 6 months chronic, but may treat their acute condition.
Re Ossatron vs. Sonocur for PF and tendonitis, please refer to my comments to you of March 25th.

Re: To Sunny

Dr. Z on 4/03/03 at 18:03 (115348)

Sunny,

Do you ever use the Roles Maudsley scoring instead of VAS?. VAS is very subjective.

Re: To John

john h on 4/03/03 at 19:08 (115356)

Pauline Mohez had 11 treatments before he was cured. With a very narrow focus it may just be a matter of hitting the correct spot. All this is just guessing on my part but are we not all guessing when it comes to PF? My thought is I will just keep trying anything if I think it will help. You never know when lighting will strike. Keep the faith Pauline. All pilots think they are bullet proof or else we could not fly. We also think we become invisable in a bar.

Re: To Sunny

Sunny Jacob, Bayshore on 4/04/03 at 05:30 (115373)

Dr. Z.,
I fully agree tht VAS is subjective. When we started our first clinic in Canada we had to develop our clinical protocol. For several months our clinic (not in Toronto) treated patients and compared data with some of the German clinics who were using the VAS scale. When we established our clinic in Toronto we just continued using VAS.
Since you have mentioned it, perhaps I should make it a priority to convert to Roles Maudsley in the coming months. Thank you for the advice.

Re: To Sunny

john h on 4/04/03 at 10:36 (115390)

Sunny: the attached URL shows a study where they used both Roles Maudley and VAS in evaluating the patients in the study. There are some differences but not huge. http://www.aofas.org/02summer/200207130852.asp

Re: To Sunny

Dr. Z on 4/04/03 at 14:49 (115417)

I will fax you a copy of the R/M scoring from the Blue Textbook that the International Society of Shockwave Therapy published back in the year 2000
What is your fax number?

I find that patients reallly appreciate the R/M scoring when it is explained to them. Patients seem to really comprehend the results much more then when we explain VAS scoring

Re: To Sunny

Sunny Jacob, Bayshore on 4/05/03 at 10:59 (115471)

Thank you, Dr.Z. I really aprpeciate that.
Please send to fax number: 905-822-8397, attention J. P. (Sunny) Jacob