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Equipment

Posted by Mark Evans on 9/12/04 at 13:09 (159786)

Is there a supplier of this equipment in England?

Re: Equipment

Dr. Z on 9/12/04 at 18:45 (159791)

http://www.dornier.com

Re: Equipment

Mark Evans on 9/12/04 at 21:42 (159801)

Dr. Z,

Thanks for the e-mail address. Do you think this treatment is the latest fad or is there more to it? Have there been any double blind randomised controlled trials, for instance?

Re: Equipment

Dr. Z on 9/13/04 at 15:58 (159828)

Yes
This is an FDA approved procedure. I have long term results of five years. I would be happy to share all of the studies that I have so far

Re: Re:Studies

Mark Evans on 9/13/04 at 16:55 (159830)

Dr.Z - that would be of great interest to many practitioners. Have you published your results?

Re: Re:Studies

Dr. Z on 9/13/04 at 19:16 (159837)

Mark,

I haven't published the results. I am waiting for help with this project from a local medical school. We were suppose to start but another project replaced me.

Re: Re:Studies

Mark Evans on 9/13/04 at 19:25 (159840)

Dr.Z. that sucks - care to share our results with me? e-mail:(email removed)

Re: Re:Studies

Dr. Z on 9/13/04 at 21:12 (159846)

Hi
I hope this is a good start

Re: Re:Studies

Pauline on 9/14/04 at 08:14 (159849)

Sorry, I've gotten lost on this one. What are the studies about?

Re: Re:Studies-Abstract

Mark Evans on 9/14/04 at 10:26 (159854)

Dr.Z. - thanks for sending a copy of the abstract. If you have a moment I would indeed like to see the full article. I am exploring the possibility of introducing this technology to my practice in England.

Re: Re:Studies

Mark Evans on 9/14/04 at 10:27 (159855)

Pauline, I asked if there have been any studies carried out validating ECSWT in the treatment of heel pai. Dr. Z. kindly responded.

Re: Re:Studies

Pauline on 9/14/04 at 10:37 (159858)

It would be helpful if you spelled out ECSWT.

Re: Re:Studies

Mark Evans on 9/14/04 at 12:17 (159861)

ECSWT - Pauline, perhaps you would care to take a look a the header section of the website?

Re: Re:Studies

Pauline on 9/14/04 at 13:15 (159865)

Mark,
As you know there is a relatively strict code of ethics associated with research that authors must adhere to who are hoping to be published. One being the confidentiality of the documents. I don't think any researcher with sufficient strength to warrent publication in a scientific journal would chance violating the code of confidentiality prior to submiting his/her article.

Practicing in England as you say you do, with Europe being the homeland of published research on ESWT I'm very surprised that you haven't had any access to their 10 years of published documents on ESWT and its recent use in heel pain.

Dr. Jan Rompe who most tend to call the 'father' of ESWT research and his colleagues are right in your backyard. As I understand he has worked with every type of ESWT machine in existance. Who better to contact than the the 'Godfather' of ESWT who with his colleagues has actually published many articles.

Maybe it's the name Mark, but this thread is a bit strange.

Re: Re:Studies

Mark Evans on 9/14/04 at 14:40 (159870)

Hello Pauline - Thanks for your thoughts. I do have a research background. I have no idea what you find strange about my enquiry. I am a Podiatrist on a career brake in the US and will soon be returning to the UK. I have not a single colleague in the UK who uses this treatment - it is prohibitively expensive and way beyond the budget available to the average private practitioner. Although I am the Head of Podiatric Surgery, it is equally difficult to obtain NHS funding for 'new' treatments. To the best of my knowledge none of the hospitals in my area have this equipment. A UK website search regarding this technology also reveals very little.

For your further information. Dr. Z. is referring to PUBLISHED research. Europe may be the homeland of ECSWT, I really have no idea if this is correct or not, but it has not received a great deal of attention in England, at least not in our professional literature.

I am always interested in reading about such research, preferably independent research so please feel free to send me the articles.

Hope this clarifies your confusion.

PS What about the name Mark?

Re: Re:Studies

Pauline on 9/14/04 at 15:41 (159873)

I'm very surprised about it being prohibitively expensive in the U.K, because we've found much lower costs associated with ESWT in other countries Germany, Australia, and Canada.

If I read your post correctly to Dr. Z, you asked him if he published his studies yet: Re:Studies view thread
Posted by Mark Evans on 9/13/04 at 16:55

Dr.Z - that would be of great interest to many practitioners. Have you published your results?

and he replied:

Posted to Category: ESWT

Mark,

I haven't published the results. I am waiting for help with this project from a local medical school. We were suppose to start but another project replaced me.
Posted to Category: ESWT

Then you specificlly asked him to share HIS results with you.

Re:Studies view thread
Posted by Mark Evans on 9/13/04 at 19:25

Dr.Z. that sucks - care to share our results with me? e-mail:(email removed)
Posted to Category: ESWT

Now you can easily see from the conversation why I assumed Dr. Z sent you HIS OWN studies because that was the topic of your conversation.

With Socialized Medicine in the U.K. would your Government have to approve the use of ESWT prior to introduction and usage by practitioners?

Re: Re:Studies

Ed Davis, DPM on 9/14/04 at 15:55 (159876)

Mark:
Please go to http://www.ismst.com for good leads on the literature and manufacturers.
Ed

Re: Re:Pauline

Julie on 9/14/04 at 16:21 (159880)

Pauline, I know your suspicions of doctors, but why in heaven's name are you taking such a confrontational attitude towards a new poster? Mark is a doctor in the UK who has apparently come to this website to learn about ESWT, which, as he correctly states (I have looked into it) is scarcely known or practised in England. Germany yes (where the Dornier machine comes from) England no.

Maybe he'll learn enough, through talking to the doctors and posters here, to consider kick-starting an ESWT revolution here. And maybe he'll be able to give useful help from his knowledge base to our posters. But he's unlikely to stick around if you keep challenging him. Please lay off!
.

Re: Re:Studies

Julie on 9/14/04 at 16:25 (159886)

Mark, where in the UK do you practice?
.

Re: Re:Pauline

Pauline on 9/14/04 at 16:33 (159889)

Julie,
Suspicious yes, but certainly nicer than those welcomes extended by others to Dr. Sandell, Dr. Manoli, Dr. Kiper, or Dr. Reid and a few others.

I believe the Relfectron is use in the U.K. and was surprised to find out that he didn't know about the studies done in Europe.

Re: The ISMST website

Pauline on 9/14/04 at 16:59 (159891)

A helpful website that is often given to professionals and since it's base is in Europe may be very useful.

ISMST The international Society for Musculoskeletal Shockwave Therapy.

http://www.ismst.com/

http://www.shockwavetherapy.org/4_1_ismst.html

Re: To Julie

Pauline on 9/14/04 at 17:10 (159892)

Confused. When you said 'I looked into it' in your post did you mean that you confirmed Mark was a doctor or that you looked into the use of EWST
in the U.K.? I think you meant the latter.

Now you've got me wondering where his practice is too.

Re: Re:Studies

Mark Evans on 9/14/04 at 20:11 (159900)

Pauline - you obviously have issues and I am not getting involved any further. Dr.Z. e-mailed me privately and thats where your concern ends.

Re: Re:Studies

Mark Evans on 9/14/04 at 20:12 (159901)

Hi Ed - thanks for the pointer. I appreciate it.

Re: Re:Studies

Mark Evans on 9/14/04 at 20:22 (159903)

Julie - thanks for your words of support! I have no idea why Pauline has been so aggressive - she does not know me and I do not know her. But she should check out all of the facts before attacking posters new to this site. I will contribute to the site but do not plan to respond to harrassments any further.

To answer your question, I lead the foot surgery team in the Midlands. I specialize in foot surgery and see many patients with heel pain on a regular basis. As a managers in the National Health Service I have to cope with very tight budgets, especially with services such as ours, and as the service lead I am accountable for and have to make a GOOD case for any new expenditures. I doubt the NHS would make the funds available for this equipment but if it proves its worth I plan to integrate the treatment in my private practice, so that patients can at least take advantage of the technology. That of course means gathering experience and evidence.

Re: Re:Studies

Dr. Z on 9/14/04 at 21:18 (159910)

Mark,
In the USA most of the machines are owned by ESWL companies and then rented to the doctor for a per patient use. I am probaby the only podiatrist in the USA that formed a company from scratch. We have well over one hundred doctors sharing our Dornier Epos. Take a look at our web site http://www . eswtusa.com. I will send you the FDA studies. I am trying to locate this article. You can go to the FDA site. http://www.fda.com and search dornier and you will see the FDA approval study. Dr. Ed gave you an excellent web site http://www . ismst to review.

Re: Re:Pauline

Bill, jr on 9/14/04 at 22:01 (159913)

Pauline,

Please keep your personal feelings about Dr. Z. off this board. It is distracting to read your attacks that are clearly aimed at Dr. Z. He is a podiatrist who contributes his time for free to help people on this board.

Please correct me if I am wrong but you are not a medical professional so please let the professionals give us their advice. After all, they have first hand experience treating patients with plantar fasciitis.

Re: To Julie

Julie on 9/15/04 at 02:13 (159915)

Yes, that's right, Pauline: I meant the latter.
.

Re: Re:Studies

Julie on 9/15/04 at 02:50 (159917)

Mark

I think Bill is correct in saying that Pauline's aggression was directed more towards Dr Z than to yourself. They've had an ongoing battle here for years: it's one of the 'features' of the site. Pauline thinks Dr Z is using this forum to 'sell' ESWT and pick up patients. Others value Dr Z's willingness to spend time here sharing information and helping people. I have no view on the matter, and don't get involved in the regular skirmishes, but I could see that what she said would be intepreted as hostility to you, and that's why I weighed in.

For what it's worth, I have been impressed by what I've learned here over four years about the essentially non-invasive approach of ESWT to healing PF. It seems to me to be safer than cutting, and I've been disappointed by the apparent lack of interest in it in the UK. My own podiatrist in London, who was otherwise excellent, more or less brushed off my mention of it (to be fair, I haven't seen him since my own PF resolved almost four years ago, and he may know more now).

It's good that you are taking an interest in ESWT and considering integrating it into your private practice. It gives PF patients another option, and I would like to see that happen here. Of course I'm aware of the constrictions of NHS budgets, but I imagine that the initial expense of the machine would be fairly quickly offset by savings on surgical procedures, and it would be wonderful if at least one health authority invested in a machine. Maybe it will be yours!

There has been a good deal of research on outcomes of ESWT, and I'm sure your participation here will help you gather the experience and evidence you need. Apart from that, it's good to have another doctor contributing - and a British one at that. Makes me feel even more at home.

Welcome!
.

Re: Re:Studies

Mark Evans on 9/15/04 at 15:24 (159948)

Julie,

Please do not be too critical of your London Podiatrist. I too remember hearing about ESWT 4-5 years ago. New treatments are always of interest to the profession - but also professionals learn to be cautious. Especially when this involves expensive equipment. I have forgotten the number of new 'miracle' cures I have seen come and go over the years. I have invested in new equipment myself caught in the wave of enthusiasm and seduced by clever marketing, only to be discarded and now covered in dust somewhere, unused, unloved but serving as a reminder to be on guard, and a valuable learning experience too. Sadly at times, patients and professionals learn the treatment may not be all it seemed. Perhaps not everyone gets good results, or there are complications, the pain comes back, not everyone is a suitable candidate etc.

Also, it is important to remember that a BIG majority of patients (85%+) with heel pain get better with simpler remedies. So you have to bear in mind that if you decide to purchase this equipment (when I last checked some years ago,it cost around $50 000, perhaps it is cheaper now: Dr.Z. any comment?)you are looking to find an alternative treatment for quite a small number of patients. And as Podiatrists the treatment is confined almost exclusively to the heel, for this one complaint only. So understandably, you may hear sufferers complain their pain is worth the investment - but if you are faced with this decision, would YOU spend this amount of money and, if you are in a small rural practice, MAYBE treat 2-3 patients per week? If you are in private practice you can be sure you are unlikely to recover the cost of your investment, much less make money from it! If there are people criticising Dr's for advertising their ESWT service - think about the capital investment necessary to offer this treatment. And working with budgets in the NHS you have an obligation to spend scarce public resources in such a way as to make treatments available to as wide a patient group as possible i.e. you cannot ethically blow 1/5th of your budget on a patient group representing perhaps 1% of the patient throughput.... not if you want to keep your job!

Regarding research findings - most professionals will be cynical of research findings when there is a potential of bias e.g. researchers are funded by the company or stand to gain from positive results in some way.
So if you find publications cited on the manufacturer's websites you can virtually guarantee the outcome favours the company. Just as if you want to buy a car and visit the distributors website those guys will not slur their own products...makes sense, right? It is important to realise not everything that appears in print, even the pretigious journals, can always be trusted.

SO what I have to do in this instance is to consider a literature search covering all of the major publications, over the last 5 years or so, to look at all of the available trials, decide on the merit of the trials, look at the variables, seek out weaknesses and strengths etc. So far I have found one such meta-analysis, after random searching, but right now I am not in a postion to begin this process in earnest (still in the US and busy planning my move back to England). I am using the time to get a feel for the treatment and I have learnt over the years to listen carefully to patients' stories and experiences. Is this forum the right way to start? Time will tell!

OK thats my little rant over with. I will certainly be interested to hear from patients about their experience of ESWT.... good and bad!

Re: Re:Studies

Julie on 9/16/04 at 08:53 (159975)

Mark

I'm not critical of him. He is a dedicated foot doctor: a thorough and accurate diagnostician, and a first-rate provider of treatment. He was a great help to me. I felt, though, that he could have been more open to what I told him about ESWT. Perhaps his having recently qualified in surgery was the reason he wasn't.

Your other points are perfectly understood. Your perspective from a totally different health care environment should be of great interest to doctors and others here.
.

Re: Re:Pauline

Dr. Z on 9/16/04 at 15:32 (159992)

If you go back and look I kindly welcomed all of the above named doctors that you mentioned and in addition have brought doctors such as Dr. Wander, Dr. Wishnie, Dr. Cozz, and too many to mention to this board.

Re: Re:Studies

Ed Davis, DPM on 9/16/04 at 21:25 (160014)

Mark:

If possible, try to get a hold of Dr. Jan Rompe at the University of Mainz in Germany -- you will see his name on many papers at the http://www.ismst.com site. I think that the only real controversy you will run into is over the issue of high energy vs. low energy. The information on ismst is more valuable to me than many US studies as I find it to be less politicized.

Ed

Re: Re:Studies

Ed Davis, DPM on 9/16/04 at 21:31 (160015)

ps. I really don't want to rehash a lot of the politics of US healthcare because I feel that that issue should not cloud your perspective on much of the information out there. Please feel free to email me at (email removed) since I may be able to give you a slightly different perspective that may be, in my opinion, advantageous to a practitioner outside of the US.
Regards,
Ed

Re: Re:Pauline

Ed Davis, DPM on 9/16/04 at 21:52 (160017)

Pauline:
Please don't try to compare yourself to those who may have criticized some of the other docs. You have been here longer, are more knowlegeable and try to lead by example. Mark basically is looking for information. Some of the other docs had the appearance of trying to 'sell' something so it certainly is reasonable to be 'critical' in the scientific sense of examining their claims.
Ed