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UNBELIEVABLE

Posted by Elyse B on 5/11/05 at 08:59 (174698)

I heard a local radio advertisment today and they said that this podiatry consortium in NYC is providing United Shockwave ESWT for heel spurs and PF. The advertisement said it is a 20 minute procedure wherein you walk in and walk right out. Wow, I was shocked.

Re: UNBELIEVABLE

Ralph on 5/11/05 at 09:21 (174701)

Elyse,
We unless they state that you are Completely Cured or Pain Free when you walk out they are not lying. The patient does walk in and they walk right out. The tricky part is did the treatment help or eliminate their pain in any way. The walking in and walking out was the easy part of the procedure.

Re: UNBELIEVABLE

Elyse B on 5/11/05 at 09:58 (174707)

Ralph, I guess you are right. But one might 'assume' if you walk in and walk out you would be 'cured'. Dumb assumption but 'I' might assume that I would be 'cured' especially if I were in terrible pain and desperately needed help.

Re: UNBELIEVABLE

Ralph on 5/11/05 at 12:22 (174709)

Ah, but that is the assumption that they want you to have. The patient made the connection not the facility or the advertisement. Pretty slick advertisement that is used a lot I think. The advertisers provide the beginning and end. The individual fills in the middle.

Re: UNBELIEVABLE

Elyse B on 5/11/05 at 12:27 (174710)

you are soo right, this place advertises on a local radio station all the time and I am going to listen very carefully tonight and see what they say.

I am sure that doctors never promise a cure. I have never had ESWT nor would I ever but from reading these boards, I see that there many podiatrists really believe in it as a 'cure.' I am not so sure there really is a 'cure' for PF.

Re: UNBELIEVABLE

Ed Davis, DPM on 5/11/05 at 12:35 (174716)

Ralph:
One does walk after ESWT but not for any significant distance and is not cured until about 12 weeks.
Ed

Re: UNBELIEVABLE

Ed Davis, DPM on 5/11/05 at 12:37 (174717)

Elyse:
You may want to ask the person who runs this site, Scott Roberts, as I would think that he attributes his cure to ESWT.
Ed

Re: UNBELIEVABLE

Elyse B on 5/11/05 at 14:00 (174720)

sorry to be the skeptic, but after reading the ESWT board it does not seem to me that anyone is really cured. They seem 'better', but not 'cured.' I would be curious to know if Scott can same exact activities as before his ESWT and at the same level? I guess part of it is that we don't hear from the people that are 'cured'.

Re: UNBELIEVABLE

Elyse B on 5/11/05 at 14:02 (174721)

Dr. Davis, can you post your statistics on your cure rate using ESWT? I am sure you see many PF patients and have done tons of ESWT and have kept records, so for people reading this board, if the good doctors (all of them) would post their success rates, it might help people to make decisions on whether or not to have ESWT. Thanks

Re: UNBELIEVABLE

Rob M on 5/11/05 at 14:16 (174726)

Dear Elyse

Cure is not the word I use to describe ESWT treatment. I have had it twice, on 2 different locations (lateral epicondylitis and bursitis in my left foot)

My elbow is significantly better. Prior to treatment, I had severe pain at rest and could not lift an empty dinner plate from the table. 4 weeks after treatment, the pain was pretty much gone, and I could lift normal things. I then did very light physio for 6 months and now, it is 99% improved. Is that a cure? No, I still know that I had an injury, and I know that too much football or squash will aggravate it.

Same with my foot - I was in severe pain, hobbled for my first few steps, and throbbing at night. After ESWT, the pain is controlled. I still know that I have an injury. If I ride my bike in sandals, it will flare up. But in both cases, the pain is under control, and I can do most physical activities.

Different people get more or less relief. But for people with chronic pain, it makes sense.

Rob
PainFree ESWT
1 866 444 3798

Re: Cure?

Julie on 5/11/05 at 14:19 (174727)

Elyse

You express your skepticism about the curative value of ESWT (and orthotics, and other modalities), ask Dr Ed to give chapter and verse on his ESWT 'cure rate'. And you say you do not believe there is a cure for PF. I agree with you, and 'Cure' is not a word I often use. I don't believe that it is useful (except possibly in a very limited sense, in certain circumstances).

I had PF five years ago. I was symptom-free within six months, and have been since January 2001. But I do not consider myself 'cured', because I know that the biomechanical imbalances and other factors that predisposed me to PF have not significantly changed. They were corrected (successfully) with orthotics, Birkenstocks, and other suitable footgear, and I continue to wear these to avoid recurrence. I consider myself in remission from PF, not cured.

I had breast cancer eleven years ago. I had surgery and hormonal treatment and have been cancer-free since then. I do not consider myself 'cured'. I am in remission. It has been a nice long remission, and I hope it lasts, and I hope that the life I lead will contribute to it lasting. But I know that it may not last.

So I don't think the concept of 'cure' is an especially useful one. I do believe in healing, which is a very different matter. There is much that we can do to heal ourselves: living sensibly, acknowledging that we may need to make changes in our lives in order to facilitate our healing, and doing all we can to encourage our inner healing forces to co-operate with our desire to be well and pain-free - but I don't think it is helpful to think in terms of cure.
.
.

Re: Cure?

Elyse B on 5/11/05 at 14:57 (174733)

Julie you are right, I used the wrong word, 'cure' was not right word. I guess I basically would be interested in the 'remission' rate of ESWT. Is it my imagination or does it seem like there are more negative postings about ESWT than positive ones and I always can stand to be corrected on this. I have not been on the boards very long but for the last year there seems to be more negative than positive to say about ESWT.

Re: UNBELIEVABLE

Elyse B on 5/11/05 at 15:01 (174734)

Dr. Davis, you use the 'word' cure with ESWT, can you please provide statistics from your practice on your cure rate for PF. Thanks

Re: Rob M

Elyse B on 5/11/05 at 15:11 (174735)

are you paid to advertise for Pain Free ESWT? The telephone number is listed under your name.

Re: Cure?

Julie on 5/11/05 at 15:28 (174737)

Elyse, it's my impression too that we read more negative than positive postings about ESWT, but I doubt that it's possible to draw any meaningful conclusions on the basis of them. As with surgery, people who are disappointed with their treatment and are still in pain are more likely to come here and write about their experience than people who have been successfully treated and are happy with the outcome. I think that is simply human nature, but it means that what we read here may bear little or no relation to what is going on in the whole PF-population.

Also, the success of any treatment depends on several factors, among them the skill of the treating doctor and probably above all the accuracy of the diagnosis. Maybe some, or many, of the unsuccessful ESWT treatments are due to lack of doctor experience and incorrect diagnosis, neither of which invalidates the treatment itself or the theory behind it.

I have no strong views, but tend to be biased in ESWT's favour. The theory makes sense to me, and I ive in Europe, where it has a longer history of acceptance (and is more affordable). If I had needed treatment for PF other than the conservative treatments that worked relatively quickly for me, I'd have gone for ESWT before considering surgery.
.

Re: Cure?

Elyse B on 5/11/05 at 15:43 (174739)

I guess you are right that we read more negatives than positives. Since my case of PF is moderate and I have chosen to live with pain and continue my running routine, I have not spent that much time researching ESWT. Everything is relative and the internet may not be the best place to get information. I read and post on another message board website and it is true that only the most 'sick' patients post and those who are not having treatment or who are in remission do not post.

Julie do you think that posting success rates is out of line?

Re: Cure?

Dr. Z on 5/11/05 at 17:48 (174749)

I have no idea why the word cure is used but the definition of CURE is restoration of health.
There are many patients that had complete pain free outcomes with ESWT . Both the ossatron and the dornier reported 60% Excellent results at the 12 week FDA end point. Excellent means no pain and the ability to resume all activities without pain.

Re: Cure?

vince on 5/11/05 at 18:00 (174752)

Instead of 'cure' would you be happy knowing that ESWT has reduced PF symptoms in approximatly 85% of those who were treated to a level where there was very little negative impact on their quality of life. I think the doctors on this board would agree that those numbers are resonable- or won't they???

Re: Cure?

Elyse B on 5/11/05 at 18:44 (174757)

thank you for posting.

Re: Rob M

Rob M on 5/11/05 at 19:22 (174759)

I own the clinic. I put the name of the company so that people know that I am affiliated with a provider, and not a visitor. But I've also been a patient.

Rob

Re: Cure?

Dr. Z on 5/11/05 at 19:34 (174762)

Vince,
I would agree that ESWT has helped alot of patients. Where did you get the 85% number. It appears to sound right but where can I find this specific number. I have quoted the number 94% after a one year follow up of those patients that were contacted after they finished the FDA study. I believe that 75% of the patient were availabe for interview. This number has been attacked but it has been printed and PUBLISHED in International Foot and Ankle Journal.

I still find it amazing that people NEVER question heart bypass procedures that some studies have shown are no more effective then medication when it comes to saving lives. This was a study of patients that were treated with medication vs those treated with surgery. At the end of five years the death rate was the same.

Re: Cure?

vince on 5/11/05 at 20:36 (174766)

Dr Z- I can't recall just where that 85% number came from- If it's not totaly accurate I think you would agree that the % was in the ballpark of that figure.

Re: Cure?

Dr. Z on 5/11/05 at 21:02 (174770)

I would agree 100 %. ESWT is very effective and has provided tens of thousands of patient relief from Chronic plantar fasciosis.

Re: UNBELIEVABLE

Ralph on 5/11/05 at 21:09 (174773)

Another post that indicated that Physical Therapy was used following ESWT.
I find this interesting because these patients report good results so I wonder if PT should be part of the post treatment protocol for ESWT but I also wonder if without it the patients would have seen such good results.

Either way since some sites are using it maybe it should be considered or studied as a post ESWT protocol.

Re: UNBELIEVABLE

elliott on 5/11/05 at 22:47 (174779)

Elyse,

Maybe what's it's saying is that if you are able to walk in, you are able to walk out. No wheelchair after the procedure. :-)

elliott

Re: UNBELIEVABLE

elliott on 5/11/05 at 22:50 (174780)

Elyse,

Even if they post their 'cure' rates (what they mean and at what point in time seem to be crucial in determining the significance), would that be definitive? Dr. Jan R has claimed that a private provider's statistics are just not the same as a supervised study, which can still have problems of their own.

Re: Cure?

elliott on 5/11/05 at 23:06 (174781)

Julie,

Regarding your comment about the difficulty in drawing meaningful conclusions about the negative ESWT posts here due to inherent negative bias on these boards, true, but this bias is more or less eliminated if we follow posters who are already here and say in advance they are going to get ESWT. I'd say among this group, the statistics are nowhere near as rosy as this or that study would suggest. Regarding positive posts, many are from first-time or near first-time posters--possibly legit but still suspicious.

Regarding the skill of the doctor diagnosing and performing the treatment, I'd say, as you would, that Dr. Z is plenty skilled in these areas, and has even taught many others how to use ESWT, but my comments in the first paragraph about following the experience of posters who post in advance that they are going to get ESWT applies to him as well.

Regarding your and Europe's pro-ESWT bias, Europe seems to favor low-energy ESWT, which has been pooh-poohed here by some. Is low more or less comparable to high or not? Dr. Z, who has a Dornier, has said high energy, and Dornier in particular, is superior. Dr. Ed, who has both high and low, numerous machines, has said they all work equally well. Is this suprising? They can't both be right.

Re: Cure?

Dr. Z on 5/11/05 at 23:27 (174782)

Elliott,
I have no idea if posters here that receive ESWT are in fact good ESWT candidates in the first place.
What may or may not be helpful is to have a history question pre- eswt for posters to answer and or review. If any of the questions such as do you have first step morning pain are answered with a no this would educate the poster ot ask more questions and just maybe not have ESWT performed Here is my list of questions
1. Do you limp or have pain when you first get up in the morning or sit for any period of time
2. Do you have any back, hip , knee or ankle pain. Have you had any surgery on your lower back, hip, knee ankle or foot.
3. Rate you pain on a scale of 1-10
4. What activities is your foot pain preventing you from doing
5. How long have you had your heel pain
6. Do you have pain in your arch, ball of your foot/feet
7. Have you ever broken any bone in your foot and or ankle
8. Is there any numbness, burning tingling in any part of your foot
9 When was the last time you purchased new shoes
10 Do you Diabetes, Rhematoid Arthritic or any health problems that you can relate to your feet.
Here is a start. Please feel free to add to this short list of questions.

Re: Cure?

elliott on 5/12/05 at 00:28 (174785)

Dr. Z,

At this stage of the game, one would think you'd be more careful with your statements. One would think wrong. You say,

'Both the ossatron and the dornier reported 60% Excellent results at the 12 week FDA end point. Excellent means no pain and the ability to resume all activities without pain.'

False--on many counts. The Ossatron had four measures, some of whose criteria required an improvement of at least 50% over baseline. Yes, in some of those criteria, 60% met a specific benchmark, but that is not at all the same as 60% reaching excellent defined as no pain or limitations, even within a single criterion. If you mean passing all 4 criteria (no pain and ability to resume all activities would imply that), only 47% of the active group passed all 4 criteria at 12 weeks. To verify everything I have said, just read the Ossatron FDA study:

http://www.fda.gov/cdrh/pdf/p990086b.pdf

Now to the Dornier. One would think you'd at least have a handle on your own machine's statistics. Again, one would think wrong. One primary statistic was mean improvement in pain. For this, the mean pain score decreased from 7.7 to 3.4 at 12 weeks, a mean percent improvement of 56.5%. But that's not pain-free. In the other primary endpoint, 56.2% of the Active group demonstrated at least 60% improvement from baseline in their VAS scores, again not pain-free as you define it. Surely you must mean one of the secondary tests, namely the Roles & Maudsley scoring (the only test among them all, I may add, that attained anything more than marginal statistical significance), which explicitly uses the word 'excellent'. But here you are still wrong. 61.6% of active patients had *good to excellent* results at 12 weeks. So the stat in your statement combined good and excellent together, contrary to your claim. To verify everything I have said, just read the Dornier FDA study:

http://www.fda.gov/cdrh/pdf/P000048b.pdf

The percentage falling just in excellent at 12 weeks was not published in the FDA study. But it was published in Table 5 of the BCBS TEC assessment:

http://www.bcbs.com/tec/Vol19/19_18.pdf

You don't have to like BCBS, their writing, their motives, or conclusions, but this is specific FDA data we're talking about. And for excellent, the sham group actually beat out the active group at 12 weeks, 11 to 8 (no wonder this wasn't published in the FDA study). That says, if nothing else, that you can't boast about ESWT giving patients a total 'cure' at 12 weeks, since, based on the FDA study, it did no better, in fact worse, than the sham group in reaching excellent.

Basically, your entire statement was wrong, and as usual biased in your favor. Am I picky or are you sloppy? Well, you weren't even close. I think the burden of accuracy should be on the one soliciting patients here, a burden you clearly have not lived up to. I'm so tired of it all.

elliott

Re: Cure?

elliott on 5/12/05 at 00:41 (174787)

Dr. Z, given that the FDA study was limited to a more pristine population, i.e., it excluded patients with bilateral symptoms, previous PF surgery, diabetes, etc., and it is generally agreed that these groups are harder to successfully treat whatever the modality, I would expect that your experience would be lower than that of the FDA results, and I would not fault you for that. But you claim the same success rates as in the FDA study, despite a tougher population rightly seeking treatment. Why should this be so? Sorry, but I'm somewhat skeptical.

Re: Rob M

elliott on 5/12/05 at 00:51 (174788)

Rob M,

While I may not have a handle on exactly how effective your machine is, I like your posting style: not hiding anything, saying things up front, not saying anything that is overtly false, not overly pushy in letting people know about you. It's the right way to do it. Thanks.

elliott

Re: Cure?

Dr. Z on 5/12/05 at 01:03 (174789)

I am getting tired also. The only thing I should add is GOOD. to Excellent. I noticed after the post. Well lets make this very clear. I have seen soooooooooooooo many patient that have no pain at all in their feet from, ESWT that they would pay Dr Z to stop Elliott from giving the opinion that ESWT doesn't work and the FDA is wrong and on and on and on . The only FALSE and MISLEADING statement is how you think that I am only here to soliciting patients.
So lets clarify this statement the Dornier Epos reported an Excellent or Good results in 62% of the cases at the 12 week end point.
If you can't define Excellent or Good then don't bother reading any further cause ESWT is indicated for you.

Re: Elyse

Julie on 5/12/05 at 02:45 (174791)

To answer your question, no, I don't think posting success rates is out of line. I do think that there are questions to be asked about what constitutes success, and about how the conclusions are arrived at.

As you know, I live in England, and it's always fun (Not) to wake up in the morning and find how a thread has been rumbling on while I've been asleep. I wasn't surprised to find that this one has rumbled mightily. Elliott has joined in and Dr Z has got tired. So what else is new?

In my post responding your question about negative and postive views of ESWT, I included a paragraph about the ongoing quarrel here between the providers who believe in the treatment and have successfully treated patients, and the sceptics who continually challenge and harangue them about their criteria. I deleted that paragraph hoping to forestall a new eruption of the battle. I also hoped to forestall Elliott's automatic quibbling with almost anything I write. But guess what? Hohum.
.


always has something to say to quibble with anything I've said,

Re: Definition of cure - Dr Z

Julie on 5/12/05 at 03:00 (174792)

Yes, of course that's the dictionary definition. Another (which you'll appreciate ;)) from the Concise Oxford Dictionary, is 'relief of symptoms'. For most people, though, the word 'cure' implies permanence, and it's that aspect of the word that I was taking issue with. It's my own personal hobby horse which nobody else needs to take too seriously.

I just think it's safer not to think of restoration of health, or relief of symptoms, as permanent. If I thought of my freedom from PF as permanent, I might throw away my orthotics, wear high-heeled shoes, and stop doing the exercises that I know help maintain good foot health. If I thought of my freedom from cancer as permanent (which it may be, as I am now past the 10-year mark for breast cancer) I might ignore the importance of a healthy diet, might stop doing all the things I do to encourage an efficient immune system. And I would get a very bad shock if cancer returned, so I think it's useful to keep my mind open to the possibility that remission may not be permanent.

That's just how I feel about it. In the context of this ESWT discussion it may be hair-splitting or even off-topic. But that's the effect the word 'cure' has on me - when I hear it I reach for my keyboard.

To change the subject, what nobody has mentioned in this now giant thread, is that ESWT should shouldn't be regarded as a stand-alone treatment, but as part of a package of treatments tailored to the individual and the causes of the PF. ESWT will do what ESWT does - initiate a tissue-healing inflammatory response - but if biomechanical issues caused the PF and aren't also addressed, the PF may return.
.

Re: Cure?

Julie on 5/12/05 at 03:03 (174793)

I would be very happy with that, Vince.
.

Re: Cure?

Dr Ben Pearl on 5/12/05 at 06:21 (174798)

I have not done any statistical breakdown of my eswt patients but I would estimate about 1/ 2 of my patients have signifigant relief at about 6 months after follow up, 1 /4 have minor relief (30% or less) and 1/4 have little or no relief.

Re: Elyse

Elyse B on 5/12/05 at 08:34 (174804)

Julie, you know what I was thinking? As I said earlier I have not done the reason research on ESWT that Elliott and others have done because and this is MAJOR thing, I am a firm believer that PF is caused by tight calf muscles and biomechanics which ESWT does not address. I don't see how ESWT can fix these things. Contrary to what you might think, I do believe in orthotics and I do believe they help but I unforuntately have been unlucky in the podiatrists who have provided them to me. I also believe that strengthening the leg muscles and stretching the calf is the way to go for PF. So go figure, I cannot really get into this argument because I don't know enough of ESWT but I did appreciate that the doctor posted his success rates.

Re: UNBELIEVABLE

Elyse B on 5/12/05 at 08:36 (174805)

well as I posted above, it is my opinion and only my opinion that ESWT does not cure PF because I believe PF is biomechanical and tight calf muscles and being overweight. ESWT does not address any of those issues.

Re: UNBELIEVABLE

Elyse B on 5/12/05 at 08:37 (174806)

ha, let those posters who have had successful ESWT treatement and who ran or who were extremely active before ESWT please post if they are as active and can run. That is what I am curious about.

Re: Cure?

Ralph on 5/12/05 at 08:55 (174809)

My opinion,

If a patient history list is needed on this site then I think the doctors here need to decide if they are practicing medicine on line or just providing general medical advice.

Re: Elyse

Julie on 5/12/05 at 08:56 (174810)

Elyse, I'm copying and pasting here a post of Dr Ed's, from 20 April 2005. It puts ESWT into a broader context. The first paragraph addresses what you say in your post; I'm including the second as another view, not dissimilar to mine, on the concept of 'cure'.

Type 'treatment triad' into the search box, and you'll find other posts. Here's this one.

'The percentages will be influenced greatly by the treatment plan as a whole. ESWT is part of the picture. It treats tissue quality only. It does not treat inflammation nor biomechanics. That is why we need to discourage readers from the idea that there is one solitary cure out there. Most cases of plantar fasciitis require treatment of the inflammation, the biomechanics and, at times the tissue quality (the treatment triad). Ideally the inflammation and biomechanics should have been long addressed before we get to ESWT. For years we could only treat the first two items. ESWT gave us a tool to treat the third. ESWT is a tool, the first good one to treat tissue quality, nothing more, nothing less. Like any tool, it's success depends on how it is used. It is a rare patient that will see a true 'cure' from any isolated use of a modality (tool).

'Cures' are defined differently by different people. I consider a cure to happen when patients can go back to their occupation or lifestyle that existed before the pain. All can change if a patient changes jobs, say, from a desk job to a standing job or decides to take up running as a sport. So 'cure' is a relative concept, related to the vocation/avocations and lifestyle of the particular patient. I am not sure if the issue was lack of honesty or simply the reluctance to commit to a definition of a cure. The 80% and 90% figures often used in describing ESWT treatment outcomes presuppose, at least to most in the podiatry profession that ESWT is the final step in intractable plantar fasciiitis treatment, with the other factors already addressed.
Ed

Re: Elyse

Elyse B on 5/12/05 at 09:35 (174816)

thanks Julie. I just still feel skeptical about 'tissue quality' and not the other two. I guess I look at the postings about ESWT and they seem pretty frightening to me almost as much as the EPF surgery.

Re: Cure?

Dr. Zuckerman on 5/12/05 at 11:28 (174824)

How do you know what the typical population that we are treating with ESWT in the is in the USA. Most patients should fit the pristine population that you have identified

Re: Julie

Margaret B on 5/12/05 at 14:24 (174836)

Whee did you get your ESWT done? Was it very expensive?I live in London but dont have insurance.

Re: Julie

Julie on 5/12/05 at 16:37 (174843)

Margaret, I didn't have ESWT: my PF healed without the need for it. The only clinic I know of in London is in Chelsea: have a look at their website. http://www.physio-chelsea.co.uk/ I don't know what their charges are, but I remember someone saying a couple of years ago that it was in the region of 2-300 BP.
.

Re: UNBELIEVABLE

Ed Davis, DPM on 5/12/05 at 20:17 (174854)

Ralph:

I think that you are pulling the conversation in the right direction. I always cringe a bit when we focus on one single modality as a cure for PF.
I have asked ScottR to incorporate my concept of the 'treatment triad' into the site or book because without an understanding of this concept, we will often be pulled off track.

Please do a search on the 'treatment triad.' Plantar fasciitis has 3 components: inflammation, biomechanics and tissue quality. ESWT is used to treat tissue quality, nothing more. Most PF treatment is a multifactorial approach and we have to get away from looking for the single 'magic bullet.'
Ed

Re: UNBELIEVABLE

Ed Davis, DPM on 5/12/05 at 20:19 (174855)

Scottr:
Thanks for making the treatment triad an active link.
Ed

Re: Cure?

elliott on 5/13/05 at 08:11 (174880)

Dr. Z,

If you noticed the mistake right after the post, a self-correction would have been appropriate. Accuracy by a provider soliciting patients here is not a trivial matter. I would still like to know on what data you are basing a similar 3-month success rate for the Ossatron.

Please stop misquoting me that ESWT doesn't work and the FDA is wrong. My opinion, stated here often, is that the Dornier is helping somewhere between 1 in 5 and 1 in 10 patients, which I find somewhat disappointing overall. The BCBS paper, which I didn't see until after I had repeatedly made this statement, comes up with around the same statistics for the high-energy machines, and adds that it seems mainly to help with morning pain but not really with a return to function. All this does not necessarily mean FDA approval for the device was wrong, something I also have repeatedly said. Not to say that the FDA is infallible or that a device not FDA-approved can't work either.

elliott

Re: Cure?

elliott on 5/13/05 at 08:14 (174881)

Dr. Z,

Of the few Heelspurs patients you have treated and posted about it, I know of at least one who had bilateral symptoms and another who had PF surgery. I don't fault them for seeking such treatment nor you for providing it, but they would have been excluded from the FDA study.

Re: Elyse

elliott on 5/13/05 at 08:56 (174885)

Julie,

I can understand that you don't like certain aspects of my posting style (I don't like some aspects of yours either). But you seem to greatly downplay the quest for accuracy from ESWT providers soliciting patients, as if I'm involved in senseless arguments and that they have no responsibility to be accurate. IMO, a grating writing style is trivial compared to incorrect statements made by a provider that might entice patients, even if I get little public show of support. Even when you aided in getting an incorrect comparison pulled, you couldn't resist in the same breath a withering attack on my posts, which I thought was uncalled for there and detracted from the request.

elliott

Re: Elliott

Julie on 5/13/05 at 11:41 (174901)

Elliott, I mostly like your posting style, and I like you, though I know the feeling is not mutual. I think you are very intelligent, conscientious, and caring; and I've always wished that we could simply talk to each other here. But that has never happened. What I said in my post to Elyse is true: you do quibble with nearly everything I say. This has been true from the start, so long ago.

I do not undervalue the need for accuracy, by providers or by anyone else - quite the reverse. But in my opinion you've done your particular ESWT hobbyhorse to death. Everyone has got the idea by now, and it must be time to let it go - unless you've appointed yourself permanent Website Watchdog. If you spent half the time helping out on the TTS board that you spend haranguing Dr Z on this one...

As for my post, made months ago, that you call a 'withering attack', I'll remind you (and readers who may not remember the context) that you had been nagging me to support you in your Dr Z crusade. I did not like that, and had already asked you several times to stop. 'Withering' (if that's what it was) must have seemed appropriate in that context, and you did then stop. But I'm sorry if it upset you.

Did that post detract from my suggestion that Dr Z delete the misleading comparison from his website? I don't think so. Dr Z acknowledged what I said graciously, and said he would look into the matter. So my single intervention may have been more effective than your repeated ones.
.

Re: Cure?

Dr. Zuckerman on 5/13/05 at 12:04 (174902)

Elliott,
I can tell you that I helped alot more then 1/5 or 1/10. The statement that it doesn't help return with function is just not true.
I find this entire dialogue in the same tone as is the Earth still Flat . Well I guess that are people out there that still think that it is.
ESWT for chronic pf is being using in almost every state in the USA sucessfully. It now has a permenent CPT code and will be paid by insurance companies across the board within the next two years. It does improved the overall health outcome of thousands of patients

Re: Cure?

Dr. Zuckerman on 5/13/05 at 12:06 (174903)

Actually at one time there was a list of over one hundred patients that I treated with results posted on this board. This was removed but showed about 80% of the patients were satisfied. The treatement were done with our first ESWT machine

Re: Julie

elliott on 5/13/05 at 14:02 (174924)

Julie,

You do not undervalue the need for accuracy? Around how many times over the years have you told Dr. Z, a regular poster actively soliciting patients, that he should be more careful with his claims? (Hint: what number, when multiplied by anything, still gives you back the same number.) Apparently it's far more productive instead to repeatedly criticize the one beating a dead horse to death.

Everyone's got the idea now? So I should stop pointing out egregious misstatements but the one making them can continue to make them. Great outcome. What kind of board is this? And what about new visitors who haven't a clue?

You didn't like being nagged to intervene? Well, at least I didn't mention you by name and had others in mind as well when asking for some help from my heelspur 'friends'. And in the same breath you say you didn't like being nagged, you nag me yet again to help out on the TTS board, after I made it clear to you I didn't want to be nagged about it. No hypocracy there?

Your single intervention may have been more effective than my repeated ones? Lucky I drew you in, then. This is exactly a point I have repeatedly made, that these boards have a credibility problem if a provider who is a regular poster can repeatedly make inaccurate statements without being put into check, and if it's just one poster pointing out errors, that one poster is a troublemaker no matter how well-intentioned, and he doesn't get the incorrect statements to stop. Get a little help, or better yet, other members of the board, possibly more respected, take the initiative, and results follow without the strife.

elliott

Re: Julie

Dr. Z on 5/13/05 at 14:48 (174926)

There is an old saying . Its not what you say but how you say it . Maybe Elliott you need to take a look at how you approach your critisms and comments. Lets see if you can really do that. Maybe this is the messsage that is being delivered. Just please try to take a look. You make some very important and excellent comments but you then place uncalled for statement between the lines. Remember just the facts just the fact

Re: Cure?

Dr. Z on 5/13/05 at 14:57 (174928)

please stop misquoting me that ESWT doesn't work and the FDA is wrong. My opinion, stated here often, is that the Dornier is helping somewhere between 1 in 5 and 1 in 10 patients, which I find somewhat disappointing overall.

Re: Elliott

Ralph on 5/13/05 at 15:17 (174933)

Julie,
The rift between Elliot and Dr. Zuckerman must go back a long way and I certainly don't know the lot of it, but I will say that from the most recent conversations posted about the material in question it is my opinion that Dr. Zuckerman would not have removed the information from his website if Elliot had not continued to request it or that you had not pointed out to him that the material in question was not what he needed to be about in the first place.

I think Elliot did prove by specific documention that the comparison in question on the website was incorrect and since Dr. Zuckerman was inviting posters here to look at his website he had a responsibility to correct the error.

It's very obvious that Dr. Zuckerman believes in the machine he owns and like the other doctors that post here provides valuable information to readers while at the same time promoting or advertising their services to some extent. Nothing wrong with that, but I do see the point that Elliott was trying to make and that is if one is going to promote a product or service in accordance to the rules of this website then the statements and facts about it should it be correctly portrayed as possible.

I think this is a definite responsibility owed to the readers here whether it's ESWT machine comparisons on a website, shoes, orthotics or pain creams. I'm only sorry it took soooo many go arounds for the error to be corrected.

This post is simply my take on things and isn't meant to support any individual or demean anyone what so ever.

Re: Julie

JJ on 5/13/05 at 15:17 (174934)

Elliot,

I am tried of reading your personal attacks on Dr. Z. If you are a patient with valuable information then please give us that information. If you are a professional then please state your credentials and your information. As far as I can tell, you do not have medical training.

Your posts are too personal and only serve to undermine your questionable point of view.

Finally, if you really doubt ESWT then please leave the board. This board is for people to find information ESWT. Your posts do not provide information.

I would guess that most medical practice would not pass your standards. There are many medical procedures, few of them have double blind placebo controlled studies showing their effectiveness. Do you question all medicine?

Re: To JJ

Ralph on 5/13/05 at 15:40 (174940)

Have you posted before or are you new?

Re: Julie

Dr. Z on 5/13/05 at 15:49 (174941)

JJ

There are many times that Elliott has given this board and MYSELF valuable information I just feel that he is making this personal and it is how he does this. Most of the time I just take the good with the bad and learn and move on.
I have no idea who JJ is.

Re: Cure?

elvis on 5/13/05 at 16:25 (174950)

Dr. Z...I moved to San Diego from Chicago. In Chicago the earth is flat. In San Diego it isn't. Where does that leave us? I wonder where elliott lives!! LOL

Re: Ralph

Julie on 5/14/05 at 05:05 (174978)

Hi Ralph

Yes, the issue has a long history.

Elliott has taken issue with Dr Z on many counts, not just that single misleading conflation of statistics. He feels strongly about it, so he keeps on about it, and would like other posters to support him. I made the decision not to get involved, apart from on that single issue when it was clear to me that the comparison was misleading. Apart from yourself in recent months, no-one else has got involved either. Elliott has blamed the cowardice of others for the lack of support, but I don't think he has asked himself what effect his own confrontational posts have had.

I respect your take on this, and of course agree that statements about services offered should be correctly made, and that Dr Z's posts aren't always as clear or accurate as they might be. But I think that he is a sincere practitioner who believes wholeheartedly in the treatment he is offering. I do not believe he is a charlatan, or that he intentionally misleads people. I don't think he deserves to be regularly challenged and hauled over the coals.

This has been running on for several years, and I have tried to stay out of it, not always successfully. Elliott's attitude towards me has its roots in discussions that took place off the board a couple of years ago. I am not going to embarrass him by divulging the gist of his emails: suffice it to say that he has tried quite hard to enlist my support. He doesn't have it, for all the reasons I've given here and elsewhere in the past.

A word about why I'm here, to finish. My PF started in July 2000. I found heelspurs.com in August, and learned much that was of help. I was asymptomatic by January 2001, partly thanks to what I learned here, so I stayed on to give something back. Quite a few of us have done this, including Elliott. I'm still here almost five years later, and I value the people I've got to know in the heelspurs 'community'. I stay to give information and help in the areas in which I have some knowledge and expertise - taping, yoga, stretching, managing pain with relaxation and meditation - and I will go on doing that for as long as I can. Occasionally, when a post is made in an area about which I know something, I will try to correct misinformation and give a broader perspective. But I am not a watchdog. Elliott has taken it upon himself to call Dr Z to account, and will probably go on doing so, but that is not how I see my role.
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Re: Elyse

Julie on 5/14/05 at 05:20 (174979)

Elyse. why do you feel sceptical about tissue quality? When tissue is injured and inflamed, it degenerates, which is what seems to happen when PF goes on for a long time. Apparently, ESWT can address this aspect of the treatment triad. The theory (that by stimulating blood flow to the tissues it kickstarts the healing process) makes sense to me. So I do think it has an important role to play in the treatment of PF. But as I said before, if the biomechanical issues from which the PF arose aren't also dealt with, PF may (I would guess in many cases will) return.

I'm not a podiatrist, so I am only guessing that if ESWT won't do the whole job, correcting biomechanics may not do it either, if PF has gone on long enough for tissue to degenerate. A unified approach to treating the condition is essential.
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Re: Ralph

elliott on 5/15/05 at 06:17 (175063)

Julie,

All other differences aside, I consider private emails among parties, and even that they took place, to be just that--private, and would expect others to be equally considerate. I'm not even sure what you're talking about, but I think it's a very low blow to divulge on the internet details of private emails (and saying you're not going to embarrass me with further details doesn't exactly mitigate things). This is not the first time you've done it either: you made a negative public comment on Social recently about my emails offering you advice on back treatment. Sorry for the considerable time I took writing those emails. That you didn't appreciate them is fine. That you blabbed it all over the internet is not. How would you like it if I publicly posted the email comments you made to me?

elliott

Re: Ralph

Julie on 5/15/05 at 07:26 (175066)

Elliott

You're right, and I apologise.

Julie
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