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Ice or not to Ice

Posted by Pauline on 6/25/04 at 20:31 (153943)

In light of Karel's post, as well as others prior to hers are we seeing the tip of the iceberg with doctors not following Dornier's protocol either during treatment or with post treatment care?

Either the doctors are not reading the manual, are not being trained properly or are not being given the correct information, but if Dornier has set a protocol to use heat following treatment, then the least we should be able to expect from doctors providing Dornier ESWT is that they are all on the same page with post treatment advice for the patients.

Let hope the word spreads quickly so every patient can obtain full benefit from their treatment.

Re: Ice or not to Ice

Ed Davis, DPM on 6/25/04 at 21:44 (153947)

I have seen no 'manual' from Dornier nor any direct communications from that company concerning protocol. I am unaware of a recommendation for using heat from Dornier. The information I have recieved has been through intermediaries such as United Shockwave. Elimination of NSAID's after ESWT is the universal precaution being supplied.

Re: Ice or not to Ice

Pauline on 6/26/04 at 09:08 (153970)

Dr. Ed,
Then what is Dr. Scott talking about when he say's:

''Re: Ice after ESWT? view thread
Posted by Donald Iain Scott on 6/15/04 at 03:45

To All,
Dornier has stated I so have I, 'That patients are only to apply HEAT to the treatment site after ESWT'. The reason is that it acts as a vasodilator to increase the movement of oxygenated blood into the region, thus to promote healing. Go back and do searches and you will see that ice is contraindicated in cases of ESWT. I do not suggest the use of a blow torch, but a wheat pack heated for 3 minutes and applied to the site.

Are he and Dr. Z the only ones that saw what Dornier has stated?

Re: Ice or not to Ice

Ed Davis, DPM on 6/26/04 at 18:20 (153998)

I don't know. It is possible that Dornier has communicated this opinion directly to buyers of their equipment but not to the user community at large. The rationale is understandable since we are trying to obtain acute inflammation and ice acts as an anti-inflammatory. There are no studies, to the best of my knowledge, to back up a 'preferred' protocol including an absence of studies concerning the no use of NSAID's after ESWT. This is a situation in which 'best judgement' need be used, particularly in the absence of more information. We generally obtain the vasodilatation because patients often are continuing PT modalities after ESWT.

Re: Ice or not to Ice

Dr. Z on 6/27/04 at 08:55 (154015)

I have also not seen any manuel that has been mentioned. I have been using heat way before Dornier had FDA approval in the USA. So that we don't go down the ice vs heat road patients should follow the advice of these treating doctor. There are many different ways to handle patients post eswt post surgery. The mehods will be different for differenct doctors.

Re: Ice or not to Ice

Pauline on 6/27/04 at 11:46 (154024)

Then why all the controversy in prior posts between hot and cold and why is Dr. Scott post possibly something that he made up. He certainly was speaking with authority by saying 'Dornier has said and so do I'.

From what we are hearing, Dornier hasn't said anything apparently or they only tell Australian doctors.

I agree we don't need to go down this road, but if Dornier hasen't taken the stand of using heat as their protocol then WE shouldn't be reading about it here as a policy directive from Dornier. The end.

Re: Ice or not to Ice

Janice N on 6/27/04 at 16:05 (154042)

I come here to read up on what others have tried.
If some have had success with one treatment or another. I appreciate the doctor's imput as well. Not too many situations where you can ask a doctor a question you are not going to and you get it answered. And should I not like the answer or agree with it then I am not obligated to take that advice.
I have a podiastrist of my own. But I do like to see what others are trying and see if there is anything I could bring up with my own doctor. I see no need to bite anyones head off when one of the podiatrist here gives an opinion or answers a question. If a person doesn't like what is presented here there are tons of web pages to read on the same subject. Since this is a discussion message board sure is nothing wrong bring ing up a different point of view. But what is with all these personal attacks lately? My doctor suggested surgery right off. But since I had read about EWST here I was abble to bring up a different option for me. I sure am glad this discussion group was here for me. Thanks to those of you who have answered my questions before the EWST and after it was done. I knew somewhat to expect and afterwards when I had questions I knew it was not just my doctor saying does and don't post treatment. So I am very apprecative to all.

Re: Ice or not to Ice

Dr. Z on 6/27/04 at 16:51 (154049)

Glad you are benefiting from the board. I wish your a pain free pf life.
I am glad that you understand that you will be getting many different opinions, advice from posters are well as doctors. Common sense as I can tell you have will point you in the right direction.
I try to give my opinion based on my years of experience with ESWT and what I see that works. Protocols are important but they aren't the final say if they do exist

Re: Ice or not to Ice

Janice N on 6/27/04 at 21:58 (154061)

You are so right Dr.Z. And like anything else what works for one person doesn't for another.
It is almost funny that for yrs they say don't eat eggs or butter. It is so bad for you. Now they say you can eat eggs and butter is the better choice for you. The other day I read about eating fats and they are good for you. What is a person to do?
Like me I needed to go back on my Bextra after four wks because of other chronic conditions. But for another person that might not be the right choice. I have only used ice once or twice since the ESWT. I thought I just couldn't wait. But it wasn't the magic I thought it was. I am just so happy I found this board with adivce from doctors and other patients like myself who have been through the problems with PF and the ESWT. Or I am sure I would be here complaining about surgery on my foot. That was what I was offered. As bad as my feet hurt I am not ready for that.

Re: Ice or not to Ice

KarelJ on 6/29/04 at 08:58 (154144)

I know that the ice should be done on a limited basis. I only did this when I had swelling in an area and for a short time. My second week is this week my left foot is the most problematic, I have a spot on the heel that is very sore and kept me up all night, I used a heating pad and that helped.....getting my checkup Friday after two weeks, the Right foot is better,,,,


Re: Ice or not to Ice

Ed Davis, DPM on 6/30/04 at 11:26 (154235)


Medicine is an art and a science. There just is not enough 'science' out there to provide experimental based conclusions for much of what we do and probably won't be for a long time to come. The cumulative experience of thousands of practitioners means a lot more to me than one poorly designed study so insurers should not be able to use such 'evidence' as an excuse not to to pay for legitimate treatments.

A lot of areas are very under-studied and nutrition is one. I think the advice to consider is that there are 'good' fats and 'bad' fats. Eggs and butter are in the 'iffy' category with some good and bad to say about them. The type of fats used in margarine, hydrogenated fats appear to be 'bad' fats. Marine fish oil, flax seed oil appear to be undisputably good fats.