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Dornier with full IV

Posted by Chris vst on 2/02/04 at 15:02 (143485)

Dr Z and others.
I now understand the difference between a 'block' and local anesthesia.
I understand that you feel that local is contraindicated, and that a block is OK (and removes the pain much better).
Problem is that after re-checking with my NY surgery center that has done over 1,000 EWST's (both with Ossatron and Dornier), they now only do both under IV sedation. They claim that both Healthtronics (Ossatron) and UMS (Dornier) came out with an announcement in mid 2003 that both a block AND OR local might hurt outcomes, and they suggest IV sedation. This was always the case with the Ossatron, but new info for Dornier.
Now, there still seem to be other advantages for the Dornier vs Ossatron, but one of the biggies (no IV) seems to have been eliminated, at least in one big clinic in NYC.
Chris
PS Apparently there are some Dornier machines which are mobile and are actually sent from doctor to doctor. On these machines there is generally no IV, because the doctors do not have IV abilities in their local offices and use blocks which are easier to administer. However, on Dornier machines in a surgery center, where they can do IV, they will use IV because of potentially better outcomes.

Re: Dornier with full IV

Scott D. on 2/02/04 at 15:37 (143488)

Chris,

I am sorry but that is total and utter nonsense! Whoever told you that should be able to produce such a document from Dornier. I promise you that it does not exist! We do all of our treatments in a Surgical Center and treat kidney stone patients with IV sedation, so under your statement we should have been advised to do ESWT's that way. That never happened, nor will it.

Your source is telling you things that simply aren't true. Last week I believe that you posted that they had done 180 procedures, today it is over 1000? What is the name of this Center? I would like to give them a call and see where they have gotten their information.

Re: Dornier with full IV

Scott D. on 2/02/04 at 15:40 (143489)

Here was the post from last Tuesday......

Local vs full anesthesia (Dr. Z or others)
Posted by Chris vst on 1/27/04 at 16:29 View Thread
I spoke with the owner of a large outpatient surgery center which has both a Dornier machine and an Ossatron and has done 180 treatments in last 18 months on both. He claims that recent studies have shown that local injections may lead to sub-optimal outcomes in EWST. This has something to do with the swelling caused by the local injection influencing the subtle damage and regeneration of the tissues. His center is now using full sedation (IV based) for both the Dornier and Ossatron regimes.
He also claims that both treatments are painful (with the Ossatron being somewhat worse) and that it is much better to be sedated for both.
This seems to remove the one big advantage that Dornier had (the ability to skip the IV and only get a local injection).
Has anyone out there (DR Z) heard anything to confirm or deny this.
Thanks for your help.
Chris

Re: Dornier with full IV

Colleen K on 2/05/04 at 13:18 (143690)

My doctor uses the Ossatron, but he basically stated exactly what your doc did with the IV sedation vs. local, and the benefits of the IV. I will have the IV when I have my procedure done.

Re: Dornier with full IV

Mark L on 2/06/04 at 07:07 (143734)

There was one study that suggested that a local block where the anesthetic is injected into the treatment area may attenuate the effect of the therapy. This, however, was with LOW ENERGY ESWT. With the DORNIER EPOS HIGH ENERGY ESWT and using a properly applied PT block and a Sural nerve block there would be a very minimul amount of novacaine, if any at all, in the treatment area. Part of the driving force behind using the Ossatron, in my opinion,is so ASC's can bill for the IV sedation and fatten their pockets as well as the pockets of their 'gas passers' Why add the risks of IV sedation to a very safe procedure. Here's the reason-$$$$$$$$$$$$$$$$$$

Re: Dornier with full IV

Chris vst on 2/06/04 at 09:23 (143748)

You may be right about doctors using the Ossatron because they can charge more for the IV part. However, a counter argument can be made that because the Dornier is more and more being used as a mobile type device moved from office to office (vs at a surgery center) and local offices don't have anesthesiologists, therefore they can't offer IV sedation and must rely purely on block, regardless of pricing. Anyway, I'm sure that you are right that there are $$$ reasons behind everything.

Concerning prices, I promised to pass along the NYC prices to someone on this board. At my clinic which has done a ton of these (OK I don't know the exact #, but I know it is high) the full price for the Dornier is $ 3,200 and the Ossattron is $3,400. This includes everything from machine costs, IV, doctor etc. I believe the doctor gets about 1/3 of this amt. I do not know if this is higher or lower that what others in the US are paying. I do know that my insurer Oxford will not pay.

Finally, one other thing that I just recently discovered. This board has mentioned that one of the negatives of the Ossatron was the fact that during the procedure they zapped a larger part of the area in question, and some felt this may be overkill. Anyway, while this is apparently true, the larger area is actually about 1 inch larger (not all over the bottom of the foot as I mistakingly thought). This one inch larger area may be overkill, or it may actually hit some of the fraid fascia that the Dornier would miss.

I am still undecided which machine to use, but will make up my mind this weekend. Luckily, I think either will help me.

Re: Dornier with full IV

Pauline on 2/06/04 at 09:38 (143752)

Chris,
In the overall picture a $200 difference in price is very little considering the total cost between the treatments. The fact that if Ossatron is used you have the personal attention of an anesthesiologist for a difference of $200 doesn't seem out of line if your comparing only costs.

Re: Dornier with full IV

Chris vst on 2/06/04 at 09:43 (143754)

Pauline,
I should have mentioned that in my surgery center they perform both the Dornier and Ossatron under full IV. So the price includes IV for either procedure.
I'm not crazy about the IV part, but have had it before and it isn't that bad.

Re: Dornier with full IV

Mark L on 2/06/04 at 09:59 (143758)

IV sedation for ESWT adds an uneeded added risk to the patient and everyone who opts for ESWT should refuse IV sedation( unless they are so aprehensive that without IV they couldn't do it)- Otherwise it makes about as much sense to use the Dornier with IV sedation as taking a Vallium in order to get a haircut. I wonder when the patient who get put under finds the bill from the anesthesiologist pinned to their hospital gown like they usually do.

Re: Dornier with full IV-TO:Pauline

Mark L on 2/06/04 at 10:03 (143759)

The next time you need any kind of medical procdure would you like an additional procedure added that is not needed, that adds risk, and costs you an additional $200 or more?

Re: Dornier with full IV

Pauline on 2/06/04 at 10:04 (143760)

Chris,
I've never had either treatment so I have no personal experience of recovery from either machine, but I think if I had to have IV for either treatments I'd probably choose the Ossatron.

It will be interesting to follow your experience with what every machine you use so I hope you update us often and I'll pray and keep my fingers crossed that you have a terrific outcome. I'm praying for a total recovery for you. Best of luck.

Re: Dornier with full IV

Scott D. on 2/06/04 at 10:05 (143761)

Pauline,

Everything is relative... In my opinion the unnecessary cost of $200 for IV sedation on a machine/procedure that doesn't require it is far less repulsive than actually giving the unnecessary anesthesia!

Re: Dornier with full IV-TO:Mark

Pauline on 2/06/04 at 11:24 (143771)

Mark,
I realize the Ossatron treatment can be performed without IV if necessary so that is one thing that I personally would have discussed with my physician.

People should be informed about all their options and the only way they learn is to dig in and read not just this site but everything they can get their hands on.

It sounds like you've had success pounding square pegs into round holes all your life and it's the only way you know how to make them fit, but others have found that if they sanded the sharp edges of the square pegs the round holes accepted the pegs with more vigor. Give it some thought.

Re: Dornier with full IV

Pauline on 2/06/04 at 11:27 (143772)

Scott,
Good point.

Re: Dornier with full IV

Dr. Z on 2/06/04 at 12:14 (143776)

Pauline,

Since you always base your opinion on research where is the research that would back up your chose of machines. The research is 100% in favor of the dornier epos period. Both machine will work but the dornier is the better machine and the research proves this.

Re: Dornier with full IV

Pauline on 2/06/04 at 14:28 (143793)

Dr.Z,
1. First of all let's both understand I don't need ESWT treatment at this time because my pain has gone.

2. Although they may try, no one posting today will ever settle the controversy that exist, on this site---which machine is good, better or best. It just ain't going to happen, paper work or no paper work.

3. In my own personal case, after reviewing the data available if I was going to have ESWT I would have select the Ossatron. I'm not saying my choice should be another's choice, but that's the conclusion I arrived for me, myself, and I.

4. Whether you or anyone else agrees with the decision I would have made makes no difference to me.

5. Since I never ended up having ESWT, the discussion of which machine for my case of P.F is really null and void until such time that I get another case of it. At that time, I will once again look at all of my options, and make my personal decision based on my own convections and my condition at the time.

Re: Dornier with full IV

Dr. Z on 2/06/04 at 14:57 (143799)

Pauline,

I know you don't need ESWT Since you stated you base you opinion on data it would be nice to know what data you are talking about. I know of no data that supports that the ossatron is a more sucessful device. I do know of data that supports that the dornier is a better device. Maybe you can enlighten Dr. Z. Show us the data that you have researched We are ONLY talking about research and or data not your personal opinion. PS: Covections,personal decision are just find but they aren't data or research

Re: Dornier with full IV

Pauline on 2/06/04 at 15:47 (143804)

Dr. Z,
You don't need enlightening, your packing a pistol . I'm afraid you'll have to keep it in your holster. Sorry, I'm off to Maui for fun in the sun:*

Re: Dornier with full IV

Dr. Z on 2/06/04 at 17:40 (143817)

Only I want is the date or research. I don't want or need enlighting. I just want the data just the data. Your post with such authority so there must be data or maybe there isn't any data. Tob be contiuned

Re: Dornier with full IV-TO:Mark

Mark L on 2/07/04 at 09:36 (143850)

Pauline_ Do you have the slightest idea about what you are tralking about- Yor posts are nonsense!!

Re: Dornier with full IV

elliott on 2/09/04 at 11:04 (143987)

Since it is being oft-quoted, can someone provide a link to the 1-year (not 3-month) Ossatron results? Thanks!

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Re: Dornier with full IV

Will B. on 2/09/04 at 11:58 (143991)

I was told by several doctors that the Anesthisia is actually used to out them out so that relaxarion is at it's utmost. The dic I wnt to said that with the dornier some people get real pain at level 5. Differnt people have differnt pain thresholds also. I got verve block and went to 7 just fine and was completely relaxed, so the benefit for me should be just the same.