ESWT and the elbowPosted by Ed Davis, DPM on 6/26/05 at 20:01 (177347)
Extracorporeal Shock Wave Therapy without Local Anesthesia for Chronic Lateral Epicondylitis
Frank A. Pettrone, MD1 and Brian R. McCall, MD2
1 Commonwealth Orthopaedics, 1635 North George Mason Drive, Suite 310, Arlington, VA 22205
2 Department of Orthopaedic Surgery, Georgetown University Hospital, G-PHC Building, 3800 Reservoir Road N.W., Washington, DC 20007. E-mail address: (email removed)
Investigation performed at the Virginia Hospital Center, Arlington, Virginia, and the Department of Orthopaedic Surgery, Georgetown University Hospital, Washington, DC
NOTE: The authors thank James R. Boatright, MD, and David Covall, MD, for their contributions to the clinical portion of this study.
Background: The use of extracorporeal shock wave therapy for the treatment of lateral epicondylitis is controversial. The purpose of this study was to evaluate the use of extracorporeal shock wave therapy without local anesthesia to treat chronic lateral epicondylitis.
Methods: One hundred and fourteen patients with a minimum six-month history of lateral epicondylitis that was unresponsive to conventional therapy were randomized into double-blind active treatment and placebo groups. The protocol consisted of three weekly treatments of either low-dose shock wave therapy without anesthetic or a sham treatment. Patients had a physical examination, including provocation testing and dynamometry, at one, four, eight, and twelve weeks and at six and twelve months after treatment. Radiographs, laboratory studies, and electrocardiograms were also evaluated prior to participation and at twelve weeks. A visual analog scale was used to evaluate pain, and an upper extremity functional scale was used to assess function. Crossover to active treatment was initiated for nonresponsive patients who had received the placebo and met the inclusion criteria after twelve weeks.
Results: A total of 108 of the 114 randomized patients completed all treatments and the twelve weeks of follow-up required by the protocol. Sixty-one patients completed one year of follow-up, whereas thirty-four patients crossed over to receive active treatment. A significant difference (p = 0.001) in pain reduction was observed at twelve weeks in the intent-to-treat cohort, with an improvement in the pain score of at least 50% seen in 61% (thirty-four) of the fifty-six patients in the active treatment group who were treated according to protocol compared with 29% (seventeen) of the fifty-eight subjects in the placebo group. This improvement persisted in those followed to one year. Functional activity scores, activity-specific evaluation, and the overall impression of the disease state all showed significant improvement as well (p < 0.05). Crossover patients also showed significant improvement after twelve weeks of active treatment, with 56% (nineteen of thirty-four) achieving an improvement in the pain score of at least 50% (p < 0.0001).
Conclusions: These results demonstrate that low-dose shock wave therapy without anesthetic is a safe and effective treatment for chronic lateral epicondylitis.
Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
Re: ESWT and the elbowDonald Iain Scott on 6/28/05 at 05:21 (177401)
I have been treating patients with ESWT for Lateral Epicondylitis since 2003. It is important not to involve the ulna nerve when using ESWT but with the aid of the ultrasound we can stay well clear of the nerve and target the tear in the muscle
Donald Iain Scott
Re: ESWT and the elbowjohn on 6/28/05 at 06:28 (177404)
As a podiatrist, how can you treat lateral epicondylitis? In the United States, podiatrists are limited to treating only the foot and ankle.
Are there any restrictions in Australia on Podiatrists?
Re: ESWT and the elbowRalph on 6/28/05 at 09:11 (177410)
I think you may be wrong about Podiatrists treating only foot and ankles.
In some states, I think they are allowed to treat up to the knee, but not including the knee.
I could be dead wrong, but I believe Podiatric treatment is regulated state by state and some states allow them to treat the entire lower limb up to the knee, but not including the knee. If this isn't the case yet, I believe it was an idea that Podiatrists were working toward.
Re: ESWT and the elbowDr. Zuckerman on 6/28/05 at 09:25 (177413)
If could be the Canadian model where the referring physician is either an MD or DO and the treatment is done by a certified technician.
Re: ESWT and the elbowjohn on 6/28/05 at 11:43 (177422)
Either way, the elbow is a long way from the leg and certainly isn't within the scope of podiatry. Dr. Scott has his own machine so I assume he is doing the treatment and not refering it out.
Back to my question, is the treatment of the elbow within the scope of podiatry licenses in Australia or are Australian podiatrists limited as they are here in the US.
Re: ESWT and the elbowDr. Zuckerman on 6/28/05 at 12:30 (177425)
Could be referring in. In Canada the MD or DO refers the patient with a prescription for ESWT for a specific part of the body, ie plantar fascia, CLE, Patellar Tendinosis, Achilles Tendinosis.
I am willing to be that a podiatrist doesn't have a liscensure to treat Elbows in the world including Australia but I am sure that Scott will give us the down under reply.
PS: I see the Canadian Model being what will eventually be the USA model. The patient will first go to his physician and then a prescription for ESWT will be written for a specific part of the body
Re: ESWT and the elbowRalph on 6/28/05 at 13:59 (177431)
Personally I can't see Orthopedic docs. refering their patients to Pods to provide treatment to other parts of the skeleton other than foot and ankles.
Podiatrists have been arguing long and hard to get approval in many states to treat up to the knee and Orthos have been fighting back about that being their territory so to speak.
A tech may end up providing the treatment in contrast to Dr. Zuckerman saying that only experienced doctors can provide good treatment,but I think the treatment will be done in locations other than a Pods office.
My theory is that the Orthos will refer to their own 'kind' through referal or a provider will wheel up in their mobile unit to their office for treatment and a tech will do the actual treatment. Patients will be collected and treatment provided to several patients on the same day.
It will be interesting to watch though to see if Orthos allow Pods to treat their patients elbows. Techs yes, Pods no. I think it's their nature not to give 'territory' away. As you said the elbow is a huge jump from the ankle.
Re: Question for Dr. Zuckerman ESWT and the elbowRalph on 6/28/05 at 15:17 (177435)
Question Dr. Zuckerman, do the doctors in your group do the actual ESWT treatments for their own patients or is a tech traveling with the mobile unit doing the treatments?
Re: ESWT and the elbowRalph on 6/28/05 at 16:30 (177438)
In addition, I would think licensure would have to be changed in order for Pods to treat other parts of the skeleton even if they got a referal from an Ortho. Currently, I don't think it would be legal for a Pod to treat any other part of the skeleton other than that which they have been licensed by his/her state to treat.
I think if a tech is doing the treatment in one of the mobile units the ortho would be the guy signing off on it and overseeing the treatment. Certainly I'd like to think he would be the one providing the anesthesia if it were necessary. One would think he'd play some role in treatment besides just making the referal to a tech in a mobile unit. I think ultimately he would be responsible party for the ESWT treatment on skeleton
parts Pods are not licensed to treat.
Re: ESWT and the elbowDr. Z on 6/28/05 at 17:54 (177443)
This isn't about podiatrists doing ESWT on the elbow. Your theory is reality . Excellence pulls up to the orthpedic and or podiatrist office and treatment is performed by the tech under the supervision of the treating orthopedic and or podiatrist doctor.
I wear two hats. I just happen to be a podiatrist that is also a very good ESWT technician for all parts of the human body. I have many orthopedic doctors using the services of Excellence Shockwave Therapy. We treat patients in offices, mobile treatment Centers and ASC's.
I have trained many techs, podiatrists, and orthopedic doctors. This is very rare but back to Scott . I can see where he treats Elbows and shoulders. He knows ESWT from his experience with treating foot and ankles
Re: Question for Dr. Zuckerman ESWT and the elbowDr. Z on 6/28/05 at 17:54 (177444)
It is both
Re: ESWT and the elbowDr. Z on 6/28/05 at 17:57 (177445)
I am talking about the future of ESWT not the present. There will be centers with trained ESWT technicians who can give local anesthesia if needed. When will this happen some day in the future. The physician would be prescribing the treatment and the center would be the procedure. There
probaby will be schools that train
Re: ESWT and the elbowRalph on 6/28/05 at 19:09 (177448)
But in reality Dr.Z they are not refering to you as a Podiatrist, but rather just using your unit. You're seen as a tech if you happen to be playing tech that day providing the treatment yourself, but the good old Ortho is still in charge or as you posted you're working under their supervision.
You're situation is rather unique because you put on two hats, Pod and Tech and are willing to be either depending on who comes calling.
Either way is a win situation for you because you're still paid and the bottom line is payment not what role you happen to be playing that day.
Re: ESWT and the elbowRalph on 6/28/05 at 19:23 (177449)
Because of socialized medicine I think Canada or Australia view Podiatrist in a different light. Orthos I think are given the status of being a speciality field and not everyone I bet gets to see an Ortho for minor things. There are two many people with serious conditions requiring the expertise of an Ortho that something like P.F. is more than likely treated by Pods or Clinics.
This past week end I was reading a Toronto paper and by the end of the year a group of doctors is suppose to be starting a private clinic. Its in response to the two tier health system that Canadians seem to be asking for. The article said that for an initial $2500 patients would have access to a doctor 24/7. In addition they would pay another $250 per month I think to have immediate access to a specialist and medical testing like PET scans and MRI's that they are currently put on waiting lists for.
I don't know how much outcry there is in Canada about their system, but apparently there must be enough that these doctors see a profit in providing Canadians with more immediate medical care.
I'm certain for everyone that likes their current system their are others that dislike it and I'm certain we've heard both sides from friends that live there. I think you have to be in the situation before you can know for certain.
Re: ESWT and the elbowDr. Z on 6/28/05 at 20:36 (177453)
Both the good old orthopedic doc and podiatrist are the doctor in charge that day. The bottom line is knowing what you are doing and giving the best care possible.
Hey are you trying to get a job.? IF you like people and have your green card up to date call me for an interview. Hey the only problem might be is me calling me hey Ralph over the there. or hey Ralph how sweet it is
Re: ESWT and the elbowDonald Iain Scott on 6/29/05 at 00:23 (177461)
Since qualifying as a ESWT therapist in 2003, I have had 3 Orthopeadic Surgeons sending me their patients for ESWT first. I have a minimum of 60 G.P's and 2 Radiologists referring to me and. I even have QANTAS (Airline) Workers Compensation referring to me.
Yes the shoulder and elbow is a long way from the foot, but for efficient bipedal locomotion we must have an efficient arm swing. Any restriction in the upper body is translated to the lower extremities and vice versa.
We must be holistic in treating our patients, referring on when I see other problems in the body has others in the medical profession referring their patients to me for Podiatric and ESWT related treatments.
As a Podiatrist I treat patients for their Podiatric needs.
As a ESWT therapist I treat their ESWT Needs.
My Qualification are on the Wall of my surgery for anyone to observe.
By the way, I also have qualifications in Fitting and Machining, Diesel Fitting, Hydraulics and Pneumatics, 4th Year Mechanical Engineering.
I added it up one day, I have had 29 year in Educational Institutions.
I have dabbled in computers since the early 70's but could not get my head around fortran or cobalt.
I am restoring a 1927 Chevrolet truck 20% finished
Donald Iain Scott
Re: ESWT and the elbowElyse B on 6/29/05 at 05:11 (177465)
Ralph let me get this straight, you are telling me 'vans' pull up to doctor's offices and patients go into a van for treatment by a 'technician' performing the ESWT treatment? I am aghast that any patient would 'agree' to being treated by a technician and not a doctor and going into a van. Yikes.
Re: ESWT and the elbowDr. Zuckerman on 6/29/05 at 08:03 (177468)
I tried to explain this but I think you have done a much better job. There are very qualified ESWT tech such as yourself that also have an excellent medical background. In the USA it is similiar to going for an MRI with Dye injection . The nuclear tech does the invasive procedure and the testing.
Re: ESWT and the elbowDr. Zuckerman on 6/29/05 at 08:08 (177469)
This is Ralph's theory. So don't worry it all in your mind at this point. There are very qualified tech in all branches of medicine. Every get your blood drawn ?
My theory is that the Orthos will refer to their own 'kind' through referal or a provider will wheel up in their mobile unit to their office for treatment and a tech will do the actual treatment. Patients will be collected and treatment provided to several patients on the same day
Re: ESWT and the elbowEd Davis, DPM on 6/29/05 at 10:33 (177486)
Shhh! Don't let Elyse find out that ESWT works and is almost painless.
Re: ESWT and the elbowEd Davis, DPM on 6/29/05 at 10:34 (177487)
Re: ESWT and the elbowEd Davis, DPM on 6/29/05 at 10:36 (177489)
We should make you an honorary member of ASMST (www.asmst.org).
Re: ESWT and the elbowDr. Zuckerman on 6/29/05 at 10:44 (177491)
Re: ESWT and the elbowElyse B on 6/29/05 at 11:04 (177495)
very funny, not how I want my medical treatment in a van by a technician. But that is only me..... You cannot corrolate that to a person who draws blood at least I would not.
Re: ESWT and the elbowDr. Zuckerman on 6/29/05 at 11:07 (177496)
How about a fully equiped 35 foot unit that is customized for ESWT treatment for a staff, physician and tech.
My goal is to make sure that all ESWT tech in this USA are certified, trained and educated in the use of ESWT.
All ESWT is the USA is under the direct supervision of the treating ESWT physician
Re: To Elyse ESWT and the elbowRalph on 6/29/05 at 12:56 (177507)
I'm going by what Dr. Zuckerman said in his reply to my question.
'Re: Question for Dr. Zuckerman ESWT and the elbow view thread
Posted by Ralph on 6/28/05 at 15:17
Question Dr. Zuckerman, do the doctors in your group do the actual ESWT treatments for their own patients or is a tech traveling with the mobile unit doing the treatments?
Posted to Category: ESWT
Reply to Message # 177435
His answer: 'Re: Question for Dr. Zuckerman ESWT and the elbow view thread
Posted by Dr. Z on 6/28/05 at 17:54
It is both
Posted to Category: ESWT
Reply to Message # 177444
My guess is that the doctor administers the anesthesia and the tech performs the ESWT treatment. Have a look at Dr. Zuckermans Excellence Shockwave website. There was a picture of his mobile unit on the website and a description of what the patient would experience.
What I'm trying to say is that if Orthos are refering patients out for ESWT treatment on elbows they are refering to people who could have a Podiatry licenses or for that matter could be Barbers, but they are as Dr. Scott said for all practical purposes seen as wearing a different hat because they also hang ESWT tech licenses on their walls. Everyone providing the treatment has successfully completed a ESWT training course and is licensed or certified more than likely to provide this treatment.
They are seen as a tech who is providing the ESWT treatment no different than a tech that would be performing a CAT scan and giving the dye injection if one is to be used. All that matters is that they have had the training and are certified or licensed what ever the facility requires.
I know of nothing that would restrict a Podiatrist, Ortho, General Praticioner, etc from becoming a CAT scan operator or an ESWT Tech. They simply have to take the classes, pass the exam if one is required and secure the licenses, deplomas or certification required.
If you were refered for a CAT scan and a Podiatrist/CAT Scan Tech happened to be person doing them the day that you arrived for your scan he would be simply the tech of the day. The doctor didn't refer you to a Podiatrist for this treatment he merely wrote the RX for you to have a CAT scan at the facility of your choice or in your health plan. If the tech is a Podiatrist, or an Ortho, or a Nail Tech it doesn't matter as long as they are qualified to perform the test and the facility has accepted them on staff as qualified personal.
So when you think about it it's possible to have a Dog Catcher by day provide a CAT scan by night or even ESWT because they are qualified to do both and simply work two jobs.
Re: To Elyse ESWT and the elbowRalph on 6/29/05 at 13:20 (177509)
And there is nothing wrong with being a Dog Catcher. It's an honest profession needed in most every community and personally I'm glad they exist. I was merely using the name as an example. I could have used
Exterminator, Lawn Service Person, Brain Surgeon, or Air Conditioner Repair person. All are hard working people and all are needed and respected for the contributations they make to making our life better.
Re: To Elyse ESWT and the elbowDr. Zuckerman on 6/29/05 at 13:24 (177510)
It takes both the physician and the tech to do the techincal portion of the treatment. Each has their specific role during the treatment process. Both are looking and studying the treatment as the progress moves forward.
If it is the treating ESWT physician that will tell the tech to treat the lateral band of the plantar fascia if needed.
I wouldn't want to do the treatment with technical assistance from a certified ESWT tech.
Re: To Elyse ESWT and the elbowElyse B on 6/29/05 at 13:26 (177511)
sorry Ralph this does not seem to me to be on the same par as giving a CAT scan or a blood test. I cannot explain my reservations about this, I guess I just don't know enough about ESWT but the thought that a podiatrist is not performing it creeps me out. In any case, I am available to perform brain surgery tomorrow as I have had training in carving and dissecting a frog.
P.S. there is NO WAY I would see a podiatrist for an elbow issue. That is beyond nuts.
Re: To Elyse ESWT and the elbowRalph on 6/29/05 at 13:57 (177512)
Who does the actual ESWT treatment at the Pain Free clinic in Canada? Are they all licensed Podiatrist?
Re: To Elyse ESWT and the elbowRalph on 6/29/05 at 14:14 (177513)
Personally I think techs provide the treatment more often than we'd like to think it happens for P.F. It may not be to your liking but I bet it happens. Think about it. Dornier sent out their techs to train Podiatrists and Orthos that purchased their machines.
We've read on this site that the focal point for the Dornier is very small and the focus of the treatment is at the insertation point for treating P.F. A simple ink pen marking would certainly keep a tech aimed at the correct location.
In addition, the FDA apparently set the treatment protocol so if that protocol is followed all the tech has to do is keep the machine aimed at the target and follow the FDA protocol settings. I think the treatment sounds more complicated that it really is.
My guess is that Orthos in the states will never refer their patients with shoulder or elbow problems to a Pod for treatment. If they refer patients it will be to a facility or provider that is doing ESWT and not to a specific 'operator/tech' who may or may not be a Podatrist.
Re: To Elyse ESWT and the elbowDr. Z on 6/29/05 at 14:50 (177515)
I wouldn't see a podiatrist for an elbow issue either.
Re: To Elyse ESWT and the elbowDr. Z on 6/29/05 at 14:53 (177516)
Podiatrists???? They are ESWT techs that local podiatrists and orthopedic doctors REFER to for treatment of an already diagnosed condition such as CLE or PF.
Re: To Elyse ESWT and the elbowRalph on 6/29/05 at 15:55 (177520)
Dr. Z do you mean for diagnosis only, but once that has been done by an Ortho you see no problem allowing a Podiatrist to provide ESWT treatment for the elbow or shoulder condition?
Re: To Elyse ESWT and the elbowDr. Z on 6/29/05 at 16:24 (177521)
This is the Canadian model and I see this as the future of ESWT treatments. You will be referred to a center with techs that will do the treatments.
I really haven't though about whether the tech is a podiatrist or dog catcher or whatever. This is a model that seems to work in Canada and bring down the cost of treatment to the public.
Only time will tell so it is only potential speculation. If a podiatrist or even a General Practice medical doctor wants to open and own an ESWT center I see no reason why he can't so only as he is trained and certified
Re: To Elyse ESWT and the elbowelvis on 6/29/05 at 16:49 (177524)
Hey, I stayed at a Holiday Inn Select last night. I can administer ESWT!! LOL These threads are getting a little bit crazy.
To the gal who thinks it's crazy not to have a DPM administer ESWT.....DPM after your name doesn't mean you know what you are doing. For this type of specialized procedure you should want someone with EXPERTISE in the procedure which may or may not be the doctor. Which person would you want to administer ESWT to you:
1. A certified tech who has done it 3,500 times before
2. Or a DPM who has administered ESWT 42 times?
Next time you go to your doctor and he wants to give you a shot politely decline and ask for the nurse to do it. they are usually much better at it.
Re: ESWT and the elbowDonald Iain Scott on 6/30/05 at 00:40 (177548)
Thank you, I would be honoured, but it should go before your organization.
Re: To Elyse ESWT and the elbowElyse B on 6/30/05 at 06:15 (177550)
Elvis frankly I would rather have neither a DPM nor a technician perform ESWT. Not enough data there for me to believe that it is the cure for PF. Additionally, a 10 foot pole is not long enough to keep aDPM away from my elbows. What right thinking person would let a DPM care for their elbows or shoulders for that matter?
Re: To Elyse ESWT and the elbowelvis on 6/30/05 at 09:59 (177559)
You don't understand what's going on. Podiatrist and ESWT technician. Two totally separate people/jobs. If a person is a podiatrist and also an ESWT technician then they can do both jobs. If the ESWT certification allows for administering ESWT to the elbow then what's your problem.
If you come down on the side that says that ESWT is not a proven therapy then God Bless you that's your opinion and right to come to that conclusion. ESWT has hepled many people with pf with no down side except some temporary pain. There is no guarantee that any medical procedure or medication will work 100% of the time. So you have a choice -- continue with the conservative treatments or have surgery. Surgery has much more risk involved and I don't believe is as effective as ESWT from what I have read. Maybe one of the doctors can say what they think the difference is between the succes rate of pf surgery vs ESWT.
Re: ESWT and the elbowDr. Z on 6/30/05 at 20:33 (177605)
I am the president you are now a member! My first decree
Re: To Elyse ESWT and the elbowSally R. on 7/01/05 at 01:29 (177621)
You really seem to have it in for podiatrists.How many negative posts have you made about that profession on this site? Enough is enough. Maybe you shouid ask your questions to one of the orhtopedic surgeons that regularly posts here. Podiatrists are just as busy but there are some who are dedicated to their craft enough to put up with the abuse you dish out.
A little bit of knowledge is dangerous. You admit to know little about ESWT so why don\'t you do yourself and every here a favor and educate yourself. There is plenty of good information in Scott\'s heel pain book and at the new organization, ASMST at http://www.asmst.org . A little bit of knowledge is dangerous.
Re: To Elyse ESWT and the elbowSally R. on 7/01/05 at 01:34 (177622)
Bashing podiatrists again huh? I bet you don\'t even know that podiatrists dissaect the entire body in gross anatomy and know as much about the elbow as a general practitioner but not as much has an orhtopedic surgeon.
My brother is a podiatric physician and he probalby knows a lot more about the muman body than you know about the legal profession.
Re: ESWT and the elbowSally R. on 7/01/05 at 01:39 (177623)
A technician that is trained to draw my blood can be trained to do ESWT; maybe not as good as a podiatrist. Do you have any idea what goes into the training of a podiatrist? What did your training involve?
PS Stop tallking out of ignorance and do some real research by going to http://www.apma.org or http://www.acfas.org .
Re: ESWT and the elbowSally R. on 7/01/05 at 01:41 (177624)
Gee Donald, a podiatrist getting referrals from an orhtopedic surgeon. What does Elyse think about that?
Re: To Elyse ESWT and the elbowSally R. on 7/01/05 at 01:48 (177626)
I meant \'human\' body. It is late adn there is not spell check on this site.
A secretary, I am not. I am a sistero f a podaitric physician and a nurse working the late shift, forced to spend more time doing paper work than seeing patients to protect ourselves from the vureaucrats and the attorneys. You do work for an attorney, don\'t you Elye?
Re: To Elyse ESWT and the elbowElyse B on 7/01/05 at 05:21 (177628)
SALLY WHO ARE YOU? Can you name me one orthopediac surgeon who regularly posts here? Sally are you a podiatrist, do you work for an ESWT company. With all due respect, the doctors on this board know that I value their commitment to this site? Additionally, it is my opinion and my opinion only that I am not interested in ESWT treatment, additionally, why would you put down my decision never to have a podiatrist treat my elbows? They have no training above the knee.
Re: ESWT and the elbowDonald Iain Scott on 7/01/05 at 08:17 (177632)
To the Executive ASMST.org Thank you very much.
Donald Iain Scott
Re: To Elyse ESWT and the elbowElyse B on 7/01/05 at 09:14 (177635)
Sally, Why are you getting personal? Who are you?
Re: To Elyse ESWT and the elbowEd Davis, DPM on 7/01/05 at 12:57 (177651)
Perhaps you need to call the director of my residency program to see how much training I had treating arthritic elbows and knees in my residency program while doing my rheumatology rotation. Unfortunately, 22 years has gone by and Dr. David Naschel, MD, rheumatologist extraordinaire and my mentor in rheumatology may no longer by at the Washington, DC Veterans Administration Medical Center. I certainly have as much knowledge about elbows as a family practitioner but not as much as an orhtopedic surgeon.
Sally told you that her brother is a podiatric physician so why are you doubting that she says who she says she is. How do we know you are who you say you are?
Re: To Elyse ESWT and the elbowEd Davis, DPM on 7/01/05 at 12:59 (177652)
Who started the attacks on a profession on this site? It was not Sally.
Who is Sally? Who is Elyse?
Re: To Elyse ESWT and the elbowEd Davis, DPM on 7/01/05 at 13:05 (177653)
I understood that we had an agreement about no personal attacks and perhaps you did not feel that that agreement extended to my profession. Well, my profession does mean something to me. Again, I feel very sorry that you may encountered some 'bad 'apples' in my profession but they do not represent the profession as a whole nor the majority of the profession.
Is it unreasonable to ask you simply to do more research on ESWT via the varying sources: the heel pain book, http://www.asmst.org , http://www.ismst.org , the internet? Once you have read through that material, lets then have an intelligent discussion of the issues.
Re: To Elyse ESWT and the elbowElyse B on 7/01/05 at 14:35 (177658)
so do you regularly treat orthopedic issues in your podiatry practice? I am confused are you an orthopedist or a podiatrist and do you regularly treat orthopedic issues such as hip flexors, plica, ITB, frozen shoulders? You are telling me that orthopedists send you patients for knee problems?
No one is doubting that you have studied ananotmy but how could you in good conscience treat orthopedic problems other than the foot? I await your explanation? I have had knee surgery twice and I have never nor my 120 running teammates been referred to a podiatrist for my knee issues. Additionally, I have never heard of a person with 'tennis elbow' seeing a podiatrist. Correct me if I am wrong.
Re: To Elyse ESWT and the elbowEd Davis, DPM on 7/01/05 at 14:44 (177662)
No I only treat what I am licensed to treat which is the foot and ankle. It does not mean that i don't have training other parts of the body.
Re: To Elyse ESWT and the elbowEd Davis, DPM on 7/01/05 at 14:48 (177663)
By the way, you are making assumptions that I am treating in violation of my license. Do we have to go down that road again?
Re: To Elyse ESWT and the elbowDr. Z on 7/01/05 at 14:52 (177665)
What's his number?
Re: To Elyse ESWT and the elbowElyse B on 7/01/05 at 15:12 (177668)
Ed I am not attacking your profession, once again you misunderstand me. I have stated over and over that I have reservations about having a podiatrist treat an elbow or a knee isn't that reasonable? Why is that so complicated? I believe that podiatrists are the place to go for feet not elbows or anything else.
Would you have any reservations about going into a van for treatment of a medical condition? I guess we just don't do that in NYC. Vans don't puill up on 42nd Street and dole out medical attention.
Re: To Elyse ESWT and the elbowElyse B on 7/01/05 at 15:53 (177672)
why are you so defensive Ed? I never suggested in any which way that you are violating your license I just asked a simple question and thank you for answering. It seems to me that there are questions on this board about podiatrists treating other areas of the body than feet and ankles so why would my question be invalid?
Re: To Elyse ESWT and the elbowRalph on 7/01/05 at 17:23 (177676)
Their may not be medical Vans pulling up in NYC, but I think folks have been known to tap on 42nd Street:*
Re: To Elyse ESWT and the elbowDr. Z on 7/01/05 at 18:27 (177680)
I see Dr. Ed just explaining to you the facts about Podiatry and the education nine up to 12 years of education. and then you take this and go on and and on.
This all started with Dr. Scott talking about Elbows and my discussion with the future of ESWT and ESWT centers such as already present in Canada and then you start with a podiatrist do elbows. No one ever stated that Podiatrist treat elbows.
As the movie goodfellows goes you insulted podiatry just alittle just alittle and we all know what happen to Billy Batts. Sometimes it best to say nothing if you can't say anything nice at all. If you don't know the movie rent it you might have some fun its a classic. adn maybe a little note saying you are sorry
Re: To Elyse ESWT and the elbowEd Davis, DPM on 7/01/05 at 19:03 (177685)
You have basically asked me if I practice in violation of my legal license. I hardly think that my response is being defensive. You know very well, if you are in the legal field, what a podiatrist is licensed to do and not to do.
Re: To Elyselvis on 7/01/05 at 20:15 (177692)
I run in San Diego and I have heard of people getting ESWT. I also am considering it. Both DPMs and orthpedic surgeons have recommended it as a next logical course in my treatment. Please get off your high horse about DPMs treating elbows and whining about traveling ESWT machines. You show your ignorance of the subjects and total failure of understanding simple concepts that have been explained to you. You sound like the kind of person that ends up running alone :-(
Re: To Elyse ESWT and the elbowRalph on 7/01/05 at 20:18 (177693)
I'm not certain that she would know what a podiatrist is licensed to do or not to do because authorization is granted by each individual state.
I've run into people that think Podiatrist and Orthopedic surgeons are one in the same because Podiatrist can and do use the word 'Orthopedic' when advertising. Their use of the word is restriced, but it can be used and because of this folks think the two type of doctors are the same. This in itself can be confusing to patients.
I certainly think she would know that you can treat feet, but that could be the limit to her knowledge.
You know someone that does filing for a law firm can say they are in the legal field. That doesn't make them wizards of the law and medical professions. I give her the benefit of the doubt.
Re: To Elyse ESWT and the elbowEd Davis, DPM on 7/01/05 at 20:26 (177697)
That is understandable but you may be unaware of the context in which Scott Roberts had to erase an entire thread on the social board in which Elyse seemed to imply that I was engaged in illegal activities based on ignorance. At some point, I simply cannot accept ignorance be used as an excuse for the accusations made by Elyse. I think that a poster has an obligation to do some basic research before making statments on an international forum which call into question, the legality of the actions of a named practitioner.
Re: To Elyse ESWT and the elbowRalph on 7/01/05 at 20:39 (177702)
I don't think everyone here hold your same prospective on the thread that you are speaking about. I for one thought she was being led down the path to self destruction and you were leading the way. In short she was being bated.
That was my take on the situation. Your's is obviously different. Personally I didn't feel that Scott R. had to erase anything. You were the one requesting erasure and hinting over and over that it be done immediately. If he did it it was at your request or maybe he was just cleaning the board.
As far as I'm concerned that thread and anything including ' personal feelings' about it is in the past. It's gone.
Re: To ElvisRalph on 7/01/05 at 20:45 (177704)
I really think that you've researched your choice to have ESWT. When its done I hope like Walkinggirl that you will provide periodic updates so we all can follow your recovery.
I think she is doing a great service to the board by documenting her post ESWt journey. I look forward to the day that she tells us she if truely pain free. The same goes for you. Good luck. Wishing you a speeding recovery.
Re: To Elyse ESWT and the elbowEd Davis, DPM on 7/01/05 at 20:54 (177705)
It may be gone now but not before numerous people saw the following:
Re: End of Topic view thread
Posted by Elyse B on 6/15/05 at 12:55
THANK YOU RALPH.
Yes I have had ART and tranverse friction massage, PT and the whole treatment triad. If the good doctors would read carefully, I always posted with 'in my opinion and my opinion only.' I said ESWT was not for me but I never said that it did harm to others. I believe that the posters on this board and the readers of this board can see that it is my opinion and my opinion only about what I think about ESWT. Everyone should do their own research on whether ESWT is good for THEM.
Now when the good doctors say that they can 'guarantee' to cure me if I went to Seattle, that frightens me because we all know that there is no 100% cure rate for ESWT and that I believe is passing out false information.
Posted to Category: Social / Support
Here is an accusation that doctors are 'passing out false information.'
I don't know who Ralph is and i don't know who elyse is but many people know who I am as I have identified myself and have been on this site for about 4 years. Two instances have now been brought to your attention of Elyse implying, at best, that I, a practitioner with a reputation to protect, has, in some way breaking the law or trying to break the law. I don't think that leaves a lot of room for interpretation.
Re: To Elyse ESWT and the elbowEd Davis, DPM on 7/01/05 at 21:05 (177707)
If you can only see one thing. Every time I and Dr. Z have had to defend ourselves from personal attack or defend our profession is time taken away from time that we had volunteered to answer questions on the 'Ask the Doctors' board. Before Elyse, we have had to spend hours dealing with similar types of individuals. Do you want us doing that or helping to answer questions to people with foot problems?
Re: To Elyse ESWT and the elbowRalph on 7/01/05 at 22:08 (177711)
Ya know what Dr. Ed. playing defense might be just part and parcel of the job that you have undertaken when you and Dr. Z made the decision to volunteer to answer questions on Scott's site.
There are risks with everything even volunteerism whether it's volunteering to babysit someone elses child, serving food to the poor, or even answering questions on any internet site whether your own or someone elses. There is no known protection accept accept the way that you choose to think about it. There will always be people that rub you the wrong way not just here, but in all facets of your work and life.
Only you can decide if your time spent here is worth what you preceieve as agravation and or view as personal attacks. When and if it becomes too much you have an out. You hold your head high and walk away or merely stop posting.
I learned a long time ago how we view something is personal and may not have any truth or substance to what others are feeling or thinking. We cannot change the world and the people in it, we can only change how we react to things that take place around us. We choose how we react.
Every day that I wake up I choose whether that day will be a good day or a bad day. This is how I look at life. How I live that day and the choices I make whether responding to others around me or simply selecting what I will eat are my choices and make that day what I choose it to be. When I do this I'm in control of my life. When I allow others to bother or upset me I'm allowing someone else to determine how I live and feel that day. I choose not to do this.
Here is a book that I'd recomend for you ' Loving What Is' by Bryon Katie
Katie says' It's not the problem that causes our suffering, it's our thinking about the problem'
Re: To Elyse ESWT and the elbowDr. Z on 7/01/05 at 22:17 (177712)
You are absolutely correct Ralph about choices. I wish life were that easy
Re: To Elyse ESWT and the elbowEd Davis, DPM on 7/01/05 at 22:38 (177714)
I think we have some choices to make.
Re: To Elyse ESWT and the elbowEd Davis, DPM on 7/01/05 at 22:42 (177715)
Well maybe New Yorkers are too proud but patients all over rural America had lined up for renal lithotripsy (ESWL) when the mobile van pulled into their home town.
Re: To Elyse ESWT and the elbowElyse B on 7/04/05 at 09:31 (177789)
thanks Ralph. Must say I am history on this board, not interested in continuing these discussions and I am sure the doctors will be happy to seeme go. I wish everyone luck in dealing with their feet and great success to the doctors with ESWT.
Re: To Elyse ESWT and the elbowRalph on 7/04/05 at 12:02 (177796)
Bye Elyse sorry to see you go. Think about coming back from time to time and let us know how your doing. Good luck with your recovery and may you enjoy running for many years to come.
I find myself glued to the T.V. watching Lance and the tour. T.V. coverage certainly allows one to get terrific shots along the entire route. I think it's such an exciting race and admire the guys on those bikes. What atheletes. To me everyone of them is a winner. I'd never be able to be on a bike seat that long let alone go the entire distance. I wonder how they feel at the end of each day?
Sometimes I find myself yelling at the people along the route to move back. My wife reminds me that they can't hear me. It's funny but it still slips out at times. I just don't want one of those fools to cause any of the riders injury.
Take care and enjoy the summer.
Re: To Elyse ESWT and the elbowElyse B on 7/04/05 at 19:55 (177813)
thanks Ralph I will stop in from time to time. Today is the first day of Marathon training for the 2005 NYC Marathon. 18 weeks of it. I am going to give it a try and see how the feet hold up. So far I can get to about 6 miles and feet start to ache sooooo only time will tell if I can make it to the finish line in November.
Re: ESWT and the elbowEd Davis, DPM on 7/07/05 at 08:52 (177996)
Please consider joining ASMST. We could use the help of someone of your caliber.
Re: To Elyse ESWT and the elbowEd Davis, DPM on 7/07/05 at 17:17 (178018)
Technically ESWT is not difficult to learn. Give it a few years -- if someone accidentally hits a nerve trunk there will be a movment for stricter licensing controls. We are a nation of regulations and attorneys -- no offense to the groups mentioned. If a technician performs ESWT in my office, it is done under my strict supervision or by myself if I use the Sonocur.
Re: To Elyse ESWT and the elbowEd Davis, DPM on 7/07/05 at 17:18 (178019)
Re: To Elyse ESWT and the elbowRalph on 7/08/05 at 09:04 (178048)
You might be looking at their 'first' case. Did you see this recent post?
She had documented nerve damage 3 months after her ESWT. Apparently it wasn't there before. Attorney, Attorney where art thou, Attorney?
Re: ESWT questions for Dr.'s view thread
Posted by Jennifer on 7/06/05 at 23:27
Thanks for the responses. My doctors don't think it is RSD. I'm under the care of a really good anesthesiologist for pain management. I had documented nerve damage 3 months after the ESWT - not present before. My new podiatrist speculates the inflammation may have caused it. The pain is very localized, and skin color and temperature normal. The bony edema was present 3 weeks after the ESWT - I have not had xrays since the procedure - but know my bone density was excellent just prior to the procedure, as I did have xrays several times of both feet, and no arthritis or thinning was present. The MRI report in October, 3 weeks post, said moderate bony edema of calcaneous, and MRI in May said same thing. My doctor thinks it could take a long time to heal. It's been very frustrating. We ruled out every possible underlying medical condition not to do the procedure - I was so much better off before.
Posted to Category: ESWT
Reply to Message # 177985
Re: To Elyse ESWT and the elbowEd Davis, DPM on 7/08/05 at 12:25 (178056)
Perhaps. Although the exact casue of RSD is controversial. I had seen a 17 year old girl develop RSD in 2003 after a simple ankle sprain. It may be a hard case to prove. Theoretically, RSD is more likely if a nerve trunk is hit although that would need to be shown in court. Hitting a nerve trunk is unlikely (although anything is possbile) if a doctor is stricltly supervising the procedure. One would have to show that the doctor perhaps left the room for a cup of coffee while the tech mis-aimed...
PS I will take a double espresson and finish the unfinished list of references on the http://www.asmst.org website in the next week or so.
Re: To Elyse ESWT and the elbowRalph on 7/08/05 at 12:41 (178058)
I'm leaving her situation and all the speculation that goes with it to the poster that has this problem. I have no idea how difficult or undifficult it may be to prove if neglience was a factor in her treatment. If she wants to pursue it with an attorney that would be up to her, but she shouldn't wait too long if that's something she wants to consider.
She'd probably know right away if she had a case or not.
Re: ESWT and providers in WyomingPati on 7/09/05 at 15:03 (178099)
how do I found out if there are any orthotripsy providers for my area?I ahve the physician to do the procedure but our former ossatron provider no longer sevices Wyoming. Thanks,Pati
Re: ESWT and the elbowDonald Iain Scott on 7/10/05 at 01:53 (178119)
Could you email me privately I am happy to join.
I will send a quick email to your office.
Donald Iain Scott