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Ossatron vs. Soni.-cost and preferences question for the doctors

Posted by Robert on 11/18/04 at 01:40 (164221)

My wife had the ossatron 16 weeks ago and is worse than she was before the proceedure. Her podiatrist wants to reapeat the ossatron.

Although the ossatron was covered by United, we still paid 750 to the doctor, 50 for the anesthesiologist, and 1030 to healthtronics

We have been considering the Soni/low frequency instead and using another podi that is familiar with it in our area. How do the costs compare? How do the results compare? Are there any benefits specific to each?

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

john on 11/18/04 at 06:15 (164230)

Robert,

Could you tell us what the total bill was for the doctor, anesthesiologist and healthtronics?

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

VINCE on 11/18/04 at 06:59 (164235)

When your wife is 6 months post therapy find a podiatrist @ http://www.unitedshockwave.com and have the procedure repeated by one of their doctors using the FDA APPROVED DORNIER. I had my foot treated with the low energy and it didn't work at all.The podiatrist who used the Sonicur had one in his office for a year, gave up using it and now uses the Dornier. The repeat with the Dornier eliminated my PF problem almost completely and almost immediately. United Healthcare covers the therapy and you may be able to negotiate with United Shockwave and the doc to accept what United Healthcare pays.
The podiatrist that treated me with the Dornier also had used the Ossatron in the past and was of the opinion that the Dornier works better. He said that the treatment doesn't hit right on the heel bone like with the Ossatron and he found a lot of his patients treated with the Ossatron had more pain for a longer time. He told me a lot of the people he treated with the Dornier had no more discomfort starting right after the treatment.
One of the major advantages is that with the Dornier no IV sedation is needed.
MY ONLY PURPOSE IN POSTING THIS INFORMATION IS TO RELATE MY PERSONAL EXPERIENCES. MY RESULTS MAY BE UNIQUE AND MAY NOT APPLY TO ANYBODY ELSE.

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

Tina H on 11/18/04 at 07:07 (164238)

Wow this was 'covered' by insurance, and you are still out 2,000$???

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

vince on 11/18/04 at 07:51 (164241)

I'm not going to talk about tht matter either.

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

john on 11/18/04 at 08:29 (164243)

Vince,

Are you sure that you don't work for United Shockwave? The Ossatron was used to treat Robert's wife and it is FDA approved. Many orthopedic surgeons use the Ossatron and are happy with the results. There is no studies that show that the Dornier performs better than the Ossatron.

If Robert's wife had the treatment performed by a United Shockwave podiatrist then the out-of-pocket expenses would likely be the same. As a participating provider, United Shockwave is required by contract to charge the patient copays and deductables and United Shockwave's prices are similar to Healthtronics when insurace covers the procedure.

United Shockwave cannot forgive patient copays or deductibles any more than your doctor can. If you can provide any documents that show otherwise, I am sure that the insurance company lawyers and state regulators would be interested to investigate whether United Shockwave is properly charging patients.

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

Ed Davis, DPM on 11/18/04 at 16:06 (164269)

Robert:
Please take some time to read through this board and the site as the information you are asking about has been discussed frequently here. Many who come on the board to give advice do so anonymously and, as such, one is not sure where their biases lie. I am a podiatrist in private practice and am not anonymous. I have used all three machines and my experience is that while I have used Sonorex and Dornier more than Ossatron, the results are fairly similar. I feel that the Ossatron financial 'model' is very costly and if one feels that they prefer high energy, Dornier presents a more cost effective approach. Low energy treatment with Sonocur is considered FDA 'off label' but is the standard in Canada and Western Europe and is the least costly of the three. Some would want you to beleive that obtaining FDA approval for a procedure is like a seal of approval in the medical profession -- it is not. Keep in mind that ESWT is not a 'stand alone' procedure and that all apsects of the problem may need to be addressed -- see Scott's Heel Pain Book on this site to see if all bases have been covered. Ossatron is usually performed in a surgicenter or hospital so those entities are billing as is an ansesthesiologist. With Dornier, the treatment is often done in the office with a local block done by the practitioner. Low energy, Sonorex, is performed without anesthesia in a doctor's office or clinic.
Ed

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

Dr. Z on 11/18/04 at 16:22 (164274)

Robert,
Before you consider another ESWT treatment whether high or low it is very important to detemine if in factor there is plantar fasciosis and if there is any nerve entrapement and or Tarsal tarsal involvement. There are tests to help diagnosis these problem but clinical experience is very important.

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

Dr. Z on 11/18/04 at 16:40 (164277)

Ed,

I hope that Dr. Rompe can help out with this. It is my impression that the Sonocur machine is a HIGH energy repetitive treatment protocol and not a ' low energy treatment as it is labeled. Sunny hasn't been back to answer my question about 0.33mj/mm2 ( as was used in the AMA journal study for shoulder tendinosis) and how Dr. Rompe labeled this as HIGH energy.
I do know that the Sonocur treatment for labels was around 0.08mj/mm2 and this is definitely LOW energy treatment protocol.
The energy levels that Sunny quoted in his clinic ( o.4mj/mm2) is considered High energy.
Any thoughs about this ?

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

Ed Davis, DPM on 11/18/04 at 17:53 (164284)

Dr. Z:

There is a definite level of arbitrariness in the labelling of energy levels and we are going to need some standardization process to nail this down. I think that the ISMST may be the right place and have been tempted to go to one of their conventions. I have placed more emphasis on the total energy delivered to tissue as opposed to the amount of energy delivered per shock although, there must be a minimum per shock for a therapeutic effect. The figure of 1300 mj/mm squared is the 'bottom line' total needed to affect the plantar fascia based on my discussions withh Kim Eckmier (sp?) DPM of Chicago who had been involved in much of the research and consulted for United. She feels fairly strongly about the total energy delivered being the key element in success. It is my understanding that Sonorex is not 'sitting back' and is going forward with some research projects concerning low energy. If every protocol for every tendon in the body is going to be presented for FDA clearance, it will take more than 100 years to get body wide use and tens of millions of dollars. I think that providers need to be provided with reasonable latitude as to protocols based on their experience as with any treatment modality. Eventually, the terminilogy of 'high' and 'low' will be thrown out and replaced with more precise descriptions of spot size, total energy delivered to an area and number of shocks.

I, too will wait for Sunny's response.
Regards,
Ed

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

vince on 11/18/04 at 19:33 (164297)

Dr Davis- Are you saying that because a posters name, rank, and serial # is not known here any and all info they post is to be considered suspect? I dont care if there is a motive for a poster to give out certain info- if the post is true and accurate that's all I think about. I don't care who give me info. If I can find out if it's accurate then it's got value. I wonder how many orthopods would look down their nose at your DPM if you posted orthopedic info on a site that they visited.
Doctors of all types should step down from their lofty self created perches and stop thinking that the world should bow and scrape at the mere site of them.

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

Dr. Z on 11/18/04 at 19:43 (164302)

DR. Ed

I do agree that the total energy delivered is an important goal, however I don't agree that we have determined that 1300mj/mm2 delivered in one session is the same as in three sessions. It was dornier that did the FDA single session that proved that when you deliver 1300mj/mm2 to the fascia you get a safe, effective treatment. I am not aware of any machine except for the Dornier Epos Ultra that shows you that you have delivered 1300 mj/mm2. The ossatron only shows total shockwaves.

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

john on 11/18/04 at 20:38 (164309)

Dr Davis,

Can you point to one research article that shows that three low energy treatments get the same results as one high energy treatment? I can point to one research article that shows the opposite to what you have said. Dr. Rompe's 2003 JAMA article on rotator cuff proves that high energy is better than low energy treatments. Is there something wrong with the logic in this article?

You talk about discussions with Kim Eckmier, can you give a reference to any articles that she has published in a respected journal on ESWT? Can you point to any research articles by Kim Eckmier that explored total energy delivered? Is she as knowledgable as Dr. Rompe?

Are you saying that Sonorex is conducting FDA trials on the treatment of plantar fasciitis? If so, when was it started? If not, why not? Are they worried that the results would be bad?

High energy is defined in Dr. Rompe's 2003 JAMA article and the definition is consistent with the one used in many other publications. Furthermore, you should be more precise, 1300 mj/mm squared in not TOTAL ENERGY. It is POSITIVE ENERGY FLUX DENSITY! Total energy is different. You can read the definitions on the ISMST website. They define positive energy, total energy, positive energy flux density and total energy flux density. Each of these terms has a precise definition and the number that you are talking about from Dornier is positive energy flux density.

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

J. P. (Sunny) Jacob on 11/18/04 at 21:54 (164312)

Dr. Z,
I have already stated in detail the energy range of the Sonocur equipment and what is, in my opinion, high or low energy (based on certain physiological cellular changes). I cannot answer for Dr. Rompe. I am sure he has his own opinion and reason for stating 0.33mJ/mm2 as being high energy level.
I am curious to know who labelled ESWT equipment in categories of ‘high' and ‘low' energy. Based on your previous statements about energy levels of Dornier Epos, perhaps Sonocur is also a high/low energy equipment.
Since we both are providers, our opinions about a specific equipment could be perceived as biased. The patients in general are well read and informed prior to choosing ESWT and a clinic. I think they have had more than enough information on this message board regarding the two types of treatment:
a) 'high energy', single session treatment with local anesthesia
b) 'Low energy' multiple session treatment with no anesthetics for approx. half the cost
Both provide satisfactory results for the patients. Both are non-invasive with no known side effects, - so let the patients decide their preference.

Other:
Several weeks ago you were wondering on this message board why U.S. patients come to Canada as it may be cheaper in USA, considering the hotel and travel cost. The direct answer from a patient who received a bilateral treatment in Toronto is self explanatory.

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

Julie on 11/19/04 at 03:09 (164324)

Vince, I certainly share your sentiments about 'lofty self-created perches' but that is probably an unfair judgement when applied to the doctors here, who give their time and knowledge to people who come here asking questions.

We should always care about who gives us information. Only when we know who they are, where they come from, what their background, knowledge, and area of expertise is, and what their interest in outcome is, can we properly evaluate the information they give.
.

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

Dr. Z on 11/19/04 at 06:18 (164331)

Sunny,

This is an ESWT board. Have we ever had enough information about equipment, treatment etc.
I will correct you on a few comments that you have made and then move.
Low energy isn't approx half the cost. Our group fee for single session high energy with 2nd treatment treatment included is about the same fee that that was quoted by Connie. There are alot of other High energy providers with fees in the same range in the USA. But as I stated before and I know you understand what I am talking about FEES are just part of your choice and shouldn't be your only choice when choicing a provider

I believe Dr. ED will use a calcaneal nerve block at times if the low energy is too painful for the patient. There are time that low energy HURTS. This is my personal opinion it is an obseration from patients

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

Ed Davis, DPM on 11/19/04 at 10:39 (164343)

Sunny and Dr. Z:
There are vast differences in pain tolerance between patients, psychologic factors such as fear. Those going to Canada realize that no anesthesia is an option (usually) so are in the mindset of tolerating a bit of discomfort. I would say that about 15 to 20% of the time, my patients, realizing that analagesia is available, ask for it. The important thing to understand is that the anesthesia is not local, that is, no fluid is injected into the site where ESWT is to be performed but is 'regional' as a medial calcaneal block. Also, we never start with anesthesia because low energy requires that the area of maximaum tenderness be found but may interupt treatment for the medial calcaneal block. The other option is nitrous oxide which can be administered at moments notice at any time. I has one triathlete who insisted on running 13 miles in the wee morning hours before she came to my office for ESWT-- she would not take 'no running' for an answer. She was cured with ESWT, low energy inolving two sets of 3 low energy treatments. She did require a medial calcaneal block on several occasions part of the way through the procedure since she approached the treatment after the run.
ed

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

Ed Davis, DPM on 11/19/04 at 11:04 (164352)

Vince:
One does not need to be a doctor to be credible BUT one should be honest about their bias. When 'regulars' establish a strong stand and do so anonymously, readers should have the right to know where the poster's bias lies.
Ed

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

Ed Davis, DPM on 11/19/04 at 14:03 (164367)

Dr. Z:
Good point. Patients need to remember that the majority of patients respond to 'conventional' treatment so if there is a lack of response that leaves two possibilities: 1)a wrong diagnosis or 2)plantar fasciosis/intractable PF.
Ed

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

john on 11/20/04 at 08:39 (164403)

Julie,

You talk about knowing the background, knowledge and area of expertise for each poster. How do you really know any of this information for any poster? Who provides this information and how is verified? You really don't know the knowledge or background of many of the regulars on this board. How do you know that they are really experts?

A person can make many claims on this board as to their knowledge and expertise. Most of the claims cannot be verified directly. You can get an idea about the truth of their claims by looking at the truth and accuracy of their posts. In the case of podiatrists, you might ask what schools they attended? How many years have they practiced? How big is their practice? Answers to these questions might give an indication of their expertise.

Readers should read all posts with a high level of suspicion. Many posters make claims about the effectiveness of certain machines or protocols. These claims should be supported by externally varifiable facts.

It seems a waste of time to insist on 'knowing' the background of each poster. It seems better to verify the information provided from independent outside sources.

Re: john

Julie on 11/20/04 at 09:30 (164406)

Should one? Read all posts with a high level of suspicion? I wonder. Not me, thanks: I don't have a suspicious nature. I would rather be selective with my suspicions and trust the people I have 'known' (a euphemism when applied to the internet, but I'll let it stand) for more than four years here. I 'know' a number of the posters here, including the professionals: Dr Ed, Dr Z, Dr Wander, and Richard Cped. I am aware of their training, their preoccupations, their views about ESWT and other matters pertaining to foot care, and the various bees in their bonnets which I weigh when reading what they say.

So while I can't say I 'really know' them, as I have never met them face to face, I think I do know (without quotation marks) that they are here with good intentions.

I don't know this about you (though I would like to, because I do prefer to trust people). In fact I know nothing about you; and I don't know, and can't judge, whether your outside sources are reliable. When I asked you the other day to tell us more about yourself and the basis of your bias, it was because you'd arrived out of the blue with technical information that was interesting, but which I guessed would be available only to a person with a vested interest in a firm (I'm not guessing which firm) and the equipment and service it sells. Apart from that vague suspicion, I know nothing about you, and you've divulged nothing, which increases my suspicion: your lack of candor speaks for itself.

I commented when Vince said: 'I don't care who give (sic) me info'. I do care who gives me info. In fact the first thing I want to know when given a piece of information is 'Who is it who is giving me this information?' Apart from my response to Vince's post, I left this topic a week ago and have responded to your post only because you asked me a direct question. I am now wondering whether you and Vince are the same person....That does happen on the internet.

But I would rather trust you.
.

Re: john

john on 11/20/04 at 11:13 (164414)

Julie,

You certainly have a suspicious nature as has been demonstrated in your previous posts.

Overall, I'm surprised by your response. One of my outside sources was written by Dr. Rompe, a respected international researcher and occasional poster to this website. Many of my outside sources were published in leading medical journals, e.g., Journal of the American Medical Association, New England Journal of Medicine, and others. These journals are considered reliable by the vast majority of praticing doctors worldwide. These journals report on the state-of-the-art in medicine.

I return to my original point, people post for many reasons. Regardless of their intentions, it is prudient to carefully consider what is posted and verify, verify, verify before following any medical advice posted on the Internet. The first thing I want to know when I receive a piece of information is whether there are objective third parties who agree with the advice.

Scott can varify that I am not the same person as Vince. My lack of candor speaks to my concern over my privacy on the Internet. My posts contain facts, tainted by my bias, that are supported by independent, third party research. I am biased towards all ESWT that has been proven to work in properly conducted studies. It would be nice if everyone who gives medical information on this website supported their views with research and data.

To illustrate my point about the importance of scientific studies, in the eighteen hundreds it was common for medical professionals to treat illness by bleeding patients. The vast majority of doctors believed that their experience supported the practice. It was common to hear 'I have cured hundreds of patients by bleeding and I know that it works'. Once bleeding was properly studied, it was shown to be ineffective in curing illness. While experience matters, it is no substitute for scientific studies. Let's see if low energy ESWT is the 'bleeding' of the twenty-first century or whether it can be proven to work!

Re: john

Julie on 11/20/04 at 11:32 (164416)

John, I don't disagree with any of this (except your judgement of my nature :) ). Your posts are interesting and well-informed. I continue to think you should have been, and should be, more open about 'where you're coming from'.
.

Re: john

Ed Davis, DPM on 11/20/04 at 12:46 (164427)

John:
I hardly think that without the weight of science, doctors would go back to 'bleeding patients' as in the 1800's. We do have a vast amouunt of knowledge of physiology, pharmacology, anatomy and biochemistry available to guide our experience. I don't know how you feel about ESWT and body wide use but you do have to realize that it would take more than 100 years to get FDA approval to treat the whole body based on the methods you want. Does that sound reasonable to you?
Ed

Re: john

john on 11/20/04 at 20:09 (164458)

Dr Davis,

I'm intereste in the numbers you used for your calculations. So far, Healthtronics has obtained aproval for two sites in four years. As far as I have seen there are no more than 10 sites currently being treated with ESWT so it should only take 20 years not 100 years.

In terms of 'Bleeding patients' you missed the point. When doctor's make decisions based on their limited experience they make mistakes. We need properly conducted studies to rule out random chance. In the case of illness, when people got better, the doctors of the time attributed it to the bleeding. Of course we know now that this was a mistake but at the time the doctors believed their experience!

In our case, you attribute low energy ESWT with success for the patients that you treat. How do you know that low energy ESWT was the reason? You need to rule out placebo and other factors.

Re: john

Ed Davis,DPM on 11/21/04 at 20:46 (164513)

john:
Do you have any idea concerning the number of sites that could be potentially treated via ESWT? TWO sites in 4 years implies that 10 sitw would be approved in 20 years -- we are talking of approval by FDA-- the number of sites approved. Keep in mind that the FDA has approved PROXIMAL PF, not even distal PF so we, under FDA indication don't even have the whole plantar fascia to treat.

I think that YOU are missing the point with the bleeding example. Doctors may have believed what they were doing was right based on some experience but did not have the knowledge of anatomy, physiology, pharmacology, pathology, etc. that the modern physician has. It is unlikely that one would get too far off course with that knowlwedge.
Ed

Re: john

john on 11/21/04 at 22:02 (164518)

Dr Davis,

There is no generally accepted explanation for how ESWT works. None!

Now you can talk about today's doctors knowing so much about anatomy, physiology, pharmacology, apthology, etc. but the fact remains, there is no proven, generally accepted explanation for how ESWT cures patients.

In 200 years what will the future doctors be saying about our time? What are our doctors doing today that will be judged foolish 200 years from now? It is easy to be arrogant but there are so many things that we just don't know.

Re: john

Ed Davis, DPM on 11/22/04 at 13:45 (164547)

john:
There are good theories as to why ESWT works and we have good experiential
results with it. I think that the only arrogance comes from those who insist that anything less than a double blinded peer reviewed study plus FDA acceptance is needed to validate a treatment. Those out 'in the field' have patients to treat and are obligated to do the best based on a combination of medical knowledge, cumulative experiential data and experimental methods.
Ed

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

Robert on 11/23/04 at 17:38 (164623)

What is plantar fasciosis?
At week 15, my wife had an mri. Here is what it read - 'Ligamentous and tendinous structures are intact. Joint effusions tibiotalar and talocalcaneal are seen. The joint spaces are normal. The plantar fascia itself is of normal contour and signal texture. Findings are compatible with moderate plantar fascitis. '

Re: Ossatron vs. Soni.-cost and preferences question for the doctors

Ed Davis, DPM on 11/23/04 at 19:04 (164631)

Robert:
'Fasciosis' is a more accurate way to describe most cases of intractable plantar fasciitis. The suffix '-itis' means inflammation. What occurs in intractable plantar fasciitis is minimal inflammation but degeneration of the fascia. That degeneration is seen by thickening, addition of scar tissue and a decrease in tissue quality. The term 'fasciosis' implies a decreased tissue quality so many suggest that that is a more accurate way to describe intractable plantar 'fasciitis.'
Ed