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Sonorex in San Diego

Posted by elvis on 5/13/05 at 01:09 (174867)

I got a recommendation from a friend for a sports medicine group in San Diego. I talked to their podiatrist tonight. I told him a brief history of my pf and he said that if he confirms pf on examination that I would probably be a good candidate for ESWT. Here's what he said about ESWT:

Energy, energy, energy..that's what counts. He was a teacher for the Ossatron company and went around teaching doctors/technicians. He got good results with the Ossatron. He now uses Sonorex only. He said that if he uses the FDA approved protocol then I would get no benefit whatsoever because the energy is not high enough. He apparently uses an off-label protocol and delivers as much or more energy as Ossatron depending on the circumstances. He said that the Sonorex machine has an energy control knob and that he cranks up the energy. He uses no anesthsia whatsoever not even a local. He likes the fact that he can get biofeedback from the patient and get into the areas that are most sensitive. I asked him if it hurts and he said that he starts out slow (#1) then goes to #2 until there is a numbing feeling and then #3 where the numbing increases, then # 4 and finally #5 which is the highest setting on the Sonorex. He said that this graduated increase in energy and the consequent numbing avoids the need of a local. He said the Dornier took a hit based on a recent published paper but he didn't go into details.

His thoughts on the way the industry came to the situation it's in is that Ossatron's business model required a high energy, one treatment protocol that required anesthesia and that everyone would do it, the insurance companies would pay and it would be a win, win situation for everybody. The way he sees it is that the energy is the biggest factor and the Sonorex business plan provides the same or more energy at a much lower cost. His protocol administers the same or more energy than the Ossatron. The guy charges $500 per treatment and he pays the royalty to Sonorex. He said that most of his patients get 2 treatments. Very few get complete relief from 1 or need 3.

I'm calling his office tomorrow and am going to see him with my MRI pictures ASAP. If he thinks that I am a good candidate then I'll have him do a treatment right then and there if he can fit it in. For $500 it's worth a try. Comments and thought appreciated.

Re: Sonorex in San Diego

Dr. Z on 5/13/05 at 02:26 (174874)

So what is the total amount of energy at one treatment? . Two treatments.? You need at least 1000 mj/mm2 of total energy . The Dornier FDA protocol is 1300 mj/m. I am not sure of the width of the blast path for the sonocur but the Dornier is 2.9 mm. Maybe Rob from Canada or Dr. Ed can give you more information on the techinical aspects of the Sonocur.
I do know with the new FDA approved Orthospec that one of their conclusion was that low energy in a single treatment had poor results. So yes you do have to get into a high range of energy for better results. About 17% of the patient in the Orthospec study had to STOP treatment due to too much pain in their high range of energy without any anesthesia. Not sure how many had pain during the completed treatments.
This will cost you at least $1000- $1500 dollars. I am not really sure what you are looking for with a ESWT treatment plan so its hard to give you advice on what machine , where to go etc.

Re: Sonorex in San Diego

Ed Davis, DPM on 5/13/05 at 13:22 (174918)

elvis:
I am not aware of nay literature that goes against the Dornier machine. It sounds like he does what I do at times: use the Sonorex off label at maximum power in order to deliver one treatment intsead of 3. What is his name? I would very much like to talk to him.
Ed

Re: Sonorex in San Diego

Ted on 5/13/05 at 14:17 (174925)

I am also interested in his name as well. $500.00 seems like a good deal. I am in North Cali and going down to SD would not be as bad as going to Canada. Sounds like a good option. Let me know how it goes.

Re: Sonorex in San Diego

Dr. Z on 5/13/05 at 14:49 (174927)

Why do you think it is $500 dollars and the treatment is done. It is my impression that you will probaby need a second treatment at a miminium.

Re: Sonorex in San Diego

elvis on 5/13/05 at 16:20 (174949)

Thanx for all of the replies.
1. No, I expect the treatment to be at least $1,000 not $500. He said I would most likely need 2 treatments and possibly 3. He was upfront about that. What I'm looking to get out of this is no more pain and be able to get back running. And yes I WILL run more marahtons (i hope!! LOL) Those are my goals. Dr Z, the thing that looks attractive to me is to at least get one treatment of ESWT and see how I handle it.....all for $500 with no traveling anywhere. Since it's my left foot I could even drive myself to the office. The United Shockwave podiatrist (also local) offered the Dornier for $800 where United would assume fighting it out with Blue Cross PPO. My orthopedic surgeon in LaJolla has offered me an Ossatron treatment with no general anesthesia for $3,100. Since I am a cheap ba&*rd I'm going with the new guy! LOL No, but really I think the Sonorex is definitely better than the Ossatron option and the Dornier is a close 2nd to my pick. See discussion below of my office visit.
2. He said he would give total energy at least equal to the Ossatron protocol for one high energy treatment. He threw around numbers by I didn't write them down.
3. The group is Oasis Sports Medical Group. The podiatrist I saw was Dr. Kent Feldman. Here's a link to their phone and address. I couldn't find a website:

http://www.google.com/local?q=oasis+sports+medicine&hl=en&lr=&rls=GGLD,GGLD:2003-52,GGLD:en&sa=X&near=San+Diego,+CA&radius=0&latlng=32715278,-117156389,5432694950141040328

4. Ed....that's exactly what he does. He starts low and progessively ratchets up the dose as the numbing of nerves starts. End result - he doesn't use any anesthesia.

I went and saw him today. I was quite impressed and feel comfortable in his care. You doctors have always said that that is an important factor. The outfit is a Sports Medicne only office. It is huge....the whole 2nd floor of a good sized building. Lots of patients hobbling around in the office! LOL Here's what he did/said:

5. We chatted. I brought (1) a timeline documenting my running and treatments so far and (2) a list of supplements that I take. He looked those over.
6. He examined my foot...prodded the heel, range of motion, strength of foot, etc.
7. Lately, my symptoms have changed. I am getting much more pain in my lateral metatrsals and stiffness in the foot below my ankle. Because that pain was getting much worse in the metatarsal area it seemed that the heel pain was subsiding a little. In fact I'm sure it has been at least with respect to the mornings and early afternoons. The bad pain is definitley appearing later on in the day. Here's a typical day. Get out of bed and it hurts like a female dog (in deference to the word police !! :-). Afer one or 2 minutes the pain subsides substantially and then within 10 minutes it feels pretty darned good but not totally void of pain. It feels this way up until the early afternoon and then it gets tender on the first few steps when I stand up from my desk. In the evening if I sit down to watch a program it hurts quite badly on the first several steps. Repeat the following day. You get the idea.
8. He looked over all of the stuff I brought in (Velcro boot cast, night splint, orthotics).
9. He had me stand up and told me to relax. He then lifted my big toe on the effected foot. He muttered a 'a hah... little bit'. He then made me stand in my orthotics and he did the same thing and said 'little better'. He didn't elaborate.
10. He told me that he was pretty darn sure he could easily get rid of the pain in my metatarsals with a cortisone injection. He thought that it was highly likely that that pain was due to limping and putting undue pressure on the outside of my foot. He said he wanted to tape my heel and see how it feels after 3 or 4 days. He thinks it may subside with this (i assume) because it's already seemed to subside recently. Anyway he thought there was chance that the taping may help and then we could avoid the ESWT.
11. He then injected my metatrasals with a combo of 2 steroids one short or intermediate acting and the other long acting (i think they were dexamethasone and methylprednisolone but I can't remember for sure). There also was some local anasthetic in there to. It hurt like a female dog....much worse than the heel shots I've gotten - i think because the heel shot goes in quick and this one took a minute or 2. It seemed like about a half hour! Yikes But it does feel better now.
12. He then taped my foot and said to wait for Monday to see how it is. On Monday we'll talk about ESWT in more detail.
13. I asked about his experince in ESWT and he said that 10-15% of people don't respond well. He has done only 2 plantar fasciotomies in the last 18 months so he is really happy with the ESWT.
14. He is trying to get chosen to do an FDA study on growh factor injections (APC autologous platelet concentrate). He said he would soon know if he will participate.
15. Overall I was very happy with the visit. I'll report back next week.

Re: Sonorex in San Diego

Ralph on 5/13/05 at 21:15 (174961)

Hey Elvis, I wish you luck if you try the treatment and I hope you get some real relief. Glad you found a doctor you connect with and trust.

Re: Sonorex in San Diego

Dr. Z on 5/13/05 at 22:53 (174968)

Elvis,

You know I like the Dornier. Lets us know the results.

Re: Sonorex in San Diego

elvis on 5/13/05 at 23:20 (174969)

I had a business dinner tonight and after 2 1/2 hours of sitting in a restaurant I had no pain in my foot when I got up. It did feel funny (heavy feeling) and I suspect it was due to the local anesthetic in the cocktail mix that was injected into my lateral metatarsal joints. Of the 2 1/2 cc, one cc was local anesthetic. I guess I'll find out in the morning. He did the tape protocol that's Scoott's favorite except that he went around the whole foot from the Great toe to the little pinky and then went across the bottom with 3 sections of tape. At the end he put one around my whole foot at the base of the toes. He hopes it will last till Monday. I think it's way too ealry to tell what's gonna happen here.

Re: Sonorex in San Diego

Dr. Z on 5/14/05 at 08:52 (174984)

Elvis,
I had a patient just recently that came to me with heel pain. After my examinatio I determined that she an what is called an neuroma. that was also present and may contributing to the heel pain. She was referred for ESWT. After treating the neuroma the heel pain when away. Good luck

Re: Sonorex in San Diego

elvis on 5/14/05 at 20:21 (175040)

Thanx Dr Z. Would an MRI identify a neuroma? My guess is it would. There was no mention of it in my MRI report whihc said 'mild inflammation at the insertion site with subtle bone marrow edema' -- pretty standard stuff for pf. I think I have a pretty classic case of pf.........runner all my life and started running marathons at age 47. Did 8 marathons from Dec 2001 - Dec 2004. I guess it's my own fault.

An upate: I slept with my pf night splint. got up at 4am to let my dogs out. Hardly any pain. Went back to bed and got up with very little pain. Went through the whole day with a pain level of 1-2. Hardly hurts at all. Maybe others here should have a podiatrist or other health care professional tape thier foot because when I taped it I got some relief but not like today. I'm cautiously optimistic.

Re: Sonorex in San Diego

Ralph on 5/15/05 at 12:19 (175080)

Elvis,
My MRI never showed my neruoma, but an ultra sound did. I thought that was interesting because they seem to use MRI for so many things today.
I bet the ultra sound was cheaper too.

Re: Sonorex in San Diego

elvis on 5/15/05 at 12:28 (175081)

I've had an ultrasound too but the pdiatrist never mentioned a neuroma.

I'm having another great day today. Very slight pain. With the exception of when I had my cast, the last 2 days have been the best 2 days in well over a year.

Re: Sonorex in San Diego

Kat C. on 5/19/05 at 13:07 (175323)

Interesting. I also went to see Dr. Feldman. He told me the same thing as far as taping, and then orthotics. First time he taped my feet, it felt okay for about 2 days, so he concluded that custom orthotics would help. He never even had me walk around, check my gait, look for pronation, etc. I paid $250 for custom orthotics. Basically, they feel like a hard piece of plastic in my shoe. When I called back and said, well, thanks but I still have pain, then his assistant said the next step is ESWT at $750 per foot, probably twice per foot. And no insurance doesn't cover it because they still consider it experimental. I finally ended up having a fasciotomy by an orthopedic surgeon who specializes in foot/ankle injuries. I am 5+ weeks post-op, and can't decide yet if I'll ever be rid of this depressing pain. Maybe I'll just sign up for a foot transplant!!

Re: Sonorex in San Diego

Ed Davis, DPM on 5/20/05 at 12:50 (175363)

I would hope that our feet are worth at least $750 a piece. Sonorex can be done for less if one is willing to travel. This site alone has lots of information on how to obtain ESWT as cost effectively as possible although the amount of information can be difficult for a sufferer to digest and make a decision on.
Ed

Re: Sonorex in San Diego

Kat C. on 5/20/05 at 13:33 (175371)

'Worth it' - yes. Feasibly affordable for me - no. Not on a single income of $50K, a mortgage, and raising two kids in so cal. I'm happy to have my medical benefits provided by my employer; without them, I'd be bankrupt many times over by now.

Now, if the insurance carriers would get on board and provide even partial coverage for ESWT, then we'd be getting somewhere.

Re: Kat C

elvis on 5/23/05 at 13:21 (175549)

I pick up my ortotics next week. I've had orthotics for about 15 years but none of them have been as hard as the ones that Dr. Feldman uses. When i first started using them they also hurt but by doing a 'baby steps' break-in period they were easy to get used to. The first ones I had back in Chicago were leather and they were really comfortable but maybe not as efective I suspect. I only have one of those left. My dog ate the other one!

Re: Sonorex in San Diego

Ed Davis, DPM on 5/24/05 at 17:53 (175648)

Kat:
We all wish the insurers would cooperate. Keep in mind that while they may cover surgery, add your co-pay, deductible plus time loss from work to see what those costs really are. Your health insurance does not really care about your lost work as they are not paying for it.
ed