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A question to Dr. Z on ESWT

Posted by Terri on 3/17/05 at 10:27 (171398)

Is it normal for a doctor to turn the shockwave machine up higher than FDA approved levels? I had one treatment and he told me he turned it up one setting above FDA approved levesl with the Dornier Ultra because my foot is thin and he wanted to give it extra shock.

Re: A question to Dr. Z on ESWT

Dr. Zuckerman on 3/17/05 at 11:01 (171403)

I don't turn the machine up for plantar fasciosis ESWT with the dornier.
I have heard that some doctors are using higher energy levels such as what you are describing. I don't recommend turning the energy levels up with the dornier. I don't see how it is going to help you any better then the FDA protocol.

Re: A question to Dr. Z on ESWT

Cori P on 3/18/05 at 13:53 (171508)

Hello Terri,

I am providing ESWT treatments in Toronto, Canada at PainFree ESWT. It is our protocol to increase energy levels to the comfort level of the patient. However, I am using a low intensity ESWT machine (Sonocur). I do not use any anaesthetics nor do we use any blocks or numbing agents. For this reason we start at very low levels and work as high as the patient can tolerate. This is very different from which you have written. I don't believe that the doctor who administered your treatment should have given you an extra shock. The FDA approves protocols based on trials which have proven the protocols are effective. Giving you extra was simply your doctor's opinion. In any case I do hope your feeling better and for future always question what is being done. If there is an answer which seems logical it usually is the right one. Take care.

Cori P. PainFree ESWT

Re: A question to Dr. Z on ESWT

Ralph on 3/18/05 at 15:39 (171519)

Since you treat patients in Canada where the DolorClast is available can you line up these machines for us.

Apparently there was an early group from here that were treated by a Dr. Gordon in Canada who used the Ossatron on them. You use the Sonocur and now we learned there is this DolorClast machine available there too.

If Ossatron is a high power and Sonocur is low where does DolorClast fit in? Is it lower power than your Sonocur about the same or higher power?

Do you know if that Dr. Gordon is still treating patients for P.F. and if he is still choosing to use only the Ossatron? Is Dr. Gordon a Podiatrist or Orthopedic doctor?

Re: A question to Dr. Z on ESWT

elvis on 3/18/05 at 17:35 (171521)

Ralph..........I just got off the phone with West Coast Center for Orthopedic Surgery and Sports Medicine. I got their name and number form your post a day or two ago. They are the ones who did the FDA clinical trials for the Dolorclast machine. Someone is supposed to call me back over the weekend. I'll report back.

Re: A question to Dr. Z on ESWT

Dr. Z on 3/18/05 at 19:29 (171531)

I have a strange question. Why are you so interested in the dolorcast?. It hasn't made FDA approval yet. We don't know if it is more effective then the ossatron, dornier , or sonocur. We do know its three low energy treatments . We do know sometimes no anesthesia isn't needed. We don't know the long term sucess.
It is cause it might be the nice kid on the block. Just curious as to the why has this in two day been so involved. I do know the only reason Dr. ED like this machine is the cost maybe down for the physician in the future

Re: A question to Dr. Z on ESWT

elvis on 3/18/05 at 21:13 (171535)

Dr. Z.........I will try anything to get rid of the pain in my left foot. Can you tell me if there is a difference in the Dolorclast radial shock waves compared to the shock waves emitted by the Dornier or OssaTron? What picued my interest is the statement someone here made that the Dolorclast was the top selling ESWT machine in the world. That means something to me....not necessarily that it is the best though. It could just mean that it's the cheapest!! West Coast Sports Medicine is going to have someone call me who was involved in the actual FDA trial. I think it would be very valuable to talk to a person with that experience. Information is empowerment. I haven't come to any conclusions yet. Because there may be a differnce in the type of shock wave is another reason to take a closer look. It's a two edged sword though. A different type of shock wave could be good or it could be bad. Hopefully, I will figure it out.

When I had my LASEX surgery 6 years ago they said to write my questions down. I asked what the record was for the nukber of questions. They said most people 2-4 questions. I had 34. One of them was this, 'You know when you sit in your kitchen in the morning and there's a ray of sunshine and you can see all of those flecks of dust floating around in it? What happens to that stuff when they make the flap in your eye and do the laser treatment?' I was then told that it would be cost prohibitive to have every doctor spend money on a clean room to do this kind of surgery so they just have the regular old heating/AC in their office. They irrigate the eye and reduce exposure of the flap to as low a time period as possible. I had the surgey and let me tell you that surgery is a miracle. I was 10+ diopters in my right eye and 9+ in my left. I later looked up journal articles and yes there are people walking around with tiny dust bunnies in their cornea under the flap. the good news is that they nromally do not effect vision.

Re: Dolorcast

Julie on 3/19/05 at 01:46 (171542)

What excited Ed about the Dolorcast, as I recall from his messages from the conference, was the fact that cavitation was demonstrably produced by low energy ESWT.

Re: A question to Dr. Z on ESWT

vince on 3/19/05 at 06:41 (171550)

Cavitation can occur at an energy level too low to possibly be effective. Cavitation is produced by a ships propellar and I doubt that energy can be strong enough to start a plantar fascia healing.

Re: Dolorcast

Dr. Z on 3/19/05 at 10:58 (171568)

It was Dr. Rompe that pointed out to Dr. Z that you need high energy in order to have cavitational effects

Re: A question to Dr. Z on ESWT

Elias Chidiac on 10/02/05 at 14:44 (183933)

Dear Doctor,
I have been treated for shoulder calcification (4cm) with a dolorclast unit the result was impressive. Actually I don't feel any pain and I am back to sports activities. My question is where these fragments remain after treatment? and is it possible after months or years that it will appear again?
Your prompt response is highly appreciated.


Re: A question to Dr. Z on ESWT

Dr. Z on 10/02/05 at 15:55 (183936)

Studies show that the caclification may or may not disolve which has nothing to do with the results. Can they re-appear is always a possibility . I am not aware of any long term studies with your specific device. There is an excellent long term study that was published in the AMA journal showing results over a five year period. Dr. Rompe was one of the publishers. The device was the Dornier. This was one of the first studies that compared high energy vs low energy with calcific tenopathy of the shoulder. High energy two session treatment showed the best results, the resulsts were 94% over a one year period and 89% success over a six month period. Not all cases had dissolving of the calcication or predicted pain resolution