Cryosurgery
This is a thread posted in category: . . View All Heel Pain CategoriesPosted by Ralph on 12/16/05 at 09:48
Posted by Dr. S . Goldstein on 12/16/05 at 11:26
Posted by Ralph on 12/17/05 at 11:02
The damage to a nerve could be caused by injury, accident or sometimes planned treatment to help eliminate pain. Both cold and heat can be used depending on the goal and of course the FDA's approval of the treatment for that specific purpose.
In the lower stages the nerve signals would be more or less interrupted rather than completely destroyed.
The higher the grade number the less chance the nerve will regenerate. Sometimes in the middle range the nerves may regenerate but not in the proper pattern. I immediately thought about stroke patients.
Reading about this certainly brought more admiration for Hand Surgeons and Neurosurgeons and other doctors who's job it is to reconnect or repair nerves.
Posted by Dr. S . Goldstein on 12/17/05 at 12:33
Posted by Ralph on 12/18/05 at 17:24
Cryosurgery. I think at one time Dr. Wishnie said he was one of 7 doctors doing this procedure, but by the number of websites I found that is no longer the case.
The sales staff for Cryosurgery equipment must have done one heck of a sales job.
Posted by Dr. Wishnie on 12/18/05 at 17:34
Posted by Dr. Goldstein on 12/18/05 at 18:46
Dr. Goldstein
Posted by Dorothy on 12/18/05 at 19:29
The only thing I know about this "cryosurgery" is what I've read here, but I'm glad to hear of anything that helps anyone. Do you have some personal knowledge or experience with this procedure that causes you to make a statement that is subtly disparaging when you say "The sales staff for Cryosurgery equipment must have done one heck of a sales job" ??
Since I do not have any personal knowledge or experience with it, I would not make any statement about it, but your comment sounds to me as if you are skeptical or sarcastic about it. Can you say what your knowledge or experience with it is?
The idea of freezing nerves is a little, well, unnerving to me but when I read of the pain that people here have from nerve problems, I can imagine that freezing nerves might be attractive.... Do you know something to the contrary?
Posted by Ralph on 12/18/05 at 21:38
I certainly didn't mean to be sarcastic at all. I just thought it was interesting that I was able to find sooooo many Podiatry websites offering this new treatment. To go from 7 doctors when Dr. Wishnie introduced himself and Cryosurgery to us to so many in such a short period of time means to me that Manuf. Reps talked to many doctors and obviously sold them a machine or perhaps they made the contact at a medical convention. Either way there are a lot more doctors providing the treatment now. Maybe several doctors share machines like they do with ESWT too.
What really surprise me was a letter by a doctor in Podiatry Management saying that he'd been using Cryosurgery to treat neuromas since 2003. Since it was just brought to our attention this year I thought it was a brand new podiatric treatment for Neuromas and P.F., but I guess it old.
Some of the letters published in Podiatry Management pointed out that there are no long term or double blind studies published for Podiatric Cryosurgery for either neuromas or P.F.. I got the feeling that many DPM's would like to move toward evidence based medicine and are attempting to do so when they introduce these new treatments by producing their own published studies.
Cryosurgery used in other medical fields has been documented in accepted medical journals and appears to work well. My own personal feeling based on what I'm reading is that cryosurgery treatment for neuromas will show real positive results, but I don't feel the same way yet when it comes to treating P.F. so I guess that I'm HALF skeptical at this point in time.
In the right hands and performed for the right reason Cryosurgery looks very promising.
Here are the letters that I was refering to. They were published this year. You should visit Podiatry Management when you have time. Lots to read. The first two letters were part of a discussion about providing evidence based studies and could it be done for Cryosurgery.
03/25/2005 David E. Gurvis, DPM, David Zuckerman, DPM
Double-blinded Studies and Cryosurgery and ESW Therapy
RE: Double-blinded Studies and Cryosurgery and
ESW Therapy
From: David E. Gurvis, DPM, David Zuckerman ,DPM
They can, and recently have, blinded surgical
studies. It took guts on
the part of the surgeons and the patient, and
hospital administrators
(and probably the medical ethics committee). In
the study, they proved
(with sham surgery) that arthroscopic knee
chrondroplasty and sham
arthroscopic chrondroplasty had statistically
identical results as
measured by pain and functioning.
The study was done with all the required paper
work. Patients knew
they would have one or the other. The surgeon,
upon entering the OR, was passed a sealed
envelope, indicating real or sham surgery was to
be
performed. In the sham surgery, the standard
incisions were made, and sutured, without the
insertion of the arthroscope. Post-op care was
the same in all cases.
Possibly, can this ever be done with the
cryosurgery? It has been done
with the shock wave studies.
David E. Gurvis, DPM
Avon, IN
I agree with Dr. Weil that we need to move to
what is called evidence-
based medicine. It is here and our profession
must becoming part of this new and important
method for treatment efficiency evaluation.
Double blind, randomized , multi-center studies
are the gold standard that we should aim for. It
is possible to use this standard with cry
therapy. There was a study with arthroscopy knee
surgery when they did the actual incision. With
cryotherapy all you would need to do is place a
fake band aid over the fake incision and that
could be sham.
My point is that we need to stop looking for
excuses for this type of testing and think of
ways to actually do the testing. Is this
difficult? Yes. Can it do done. Absolutely. We
will look
back at this someday and think how could I ever
do a procedure without
some level of study. Cryotherapy and ESWT are
two treatments that can be done very easily.
Let’s not fight it
David Zuckerman, DPM
Woodbury, NJ
07/23/2005 Brian Richman, DPM
Cryoablation (G. Stephen Gill, DPM, MBA)
I have been performing cryosurgery procedures
since Sept 2003 with great results. It's about
80 % successful for neuromas, recurrent
neuromas, excessive scar tissue, plantar
fasciitis, Achilles bursitis, hypertrophic
scars, nerve entrapment, and fibromas. The
company is Cryotech 1-800-616-2796 PO Box 1868
Villa Rica Georgia 30180. They have two types of
machines the Cryostar and the Cryopac. If you
have any questions please feel free to call me
at 1-801-825-4709 or e-mail me.
Brian Richman, DPM
Layton, UT
Posted by Dr. S . Goldstein on 12/19/05 at 11:05
Posted by Ralph on 12/19/05 at 12:28
Why do you think there was less interest when it was introduced in 2003?
As popular as ESWT is, there are still people that need to travel to find doctors that do the procedure and with fewer doctors offering cryosurgery people would need to travel greater distances to get this treatment.
It's a GOOD thing that you continue to do seminars or many people may never see this treatment in their own home towns.
Posted by D. on 12/19/05 at 15:25
Thank you for your many informative posts.
Are you financially involved with the company that sells the machines beyond being paid to train other podiatrists?
Thx.
D.
Posted by Dr. David S. Wander on 12/19/05 at 16:33
The problem is not with cryosurgery or with Dr. Goldstein, it is often with the doctors that are quick to jump on the bandwagon of new technology. As I'm sure Dr. Goldstein will recall, podiatry has been through a lot of "new" technology over the years including various non-invasive vascular testing, silicone implants, Keragen/collagen injections, EPF, ESWT, etc. There are doctors like Dr. Goldstein that are dedicated and attempting to help patients that have been through a series of failed treatments, and there are the other doctors that are simply opportunists that see cryotherapy as a new fangled way to make money. It happens in all fields of medicine. It's not always the best doctors that have the fanciest toys. Unfortunately, it's those doctors that abuse the technology and ruin it for the legitimate doctors like Dr. Goldstein. I've seen it in my practice when new surgical procedures are introduced with new forms of instrumentation and hardware and surgeons that shouldn't be using the equipment go in over their heads, and I see the patients a year later and have to take the patient into surgery and reconstruct the mess that the last surgeon left behind.
Although the technology isn't new, it's relatively new to podiatry. And as all newer technologies, it will eventually be over-utilized by a certain amount of doctors that will see it as a cash cow and will unfortunately prey on vulnerable patients. Hopefully, Dr. Goldstein will be able to weed some of those doctors out during his training sessions, but it's inevitable and unfortunate.
Posted by Dr. S . Goldstein on 12/19/05 at 16:35
Posted by Dr. S . Goldstein on 12/19/05 at 16:38
Dr. Goldstein
Posted by Dr. S . Goldstein on 12/19/05 at 16:40
Dr. Goldstein
Posted by Ralph on 12/19/05 at 17:16
Speaking about bad apples I had my first accupuncture treatment today and I'm very skeptable about this dude. Besides the needle treatment he wanted to do UV light therapy on some of my blood then return it to me.
Well this sent up a BIG red flag. I'd never heard of such a thing and my first thought was how much blood and what what it going to be put in for the UV light treatment and just how much bacteria would be returning to my body through my own blood which was suppose to be injected back into me after the light treatment.
He got a BIG NO THANK YOU on that treatment and he's seen the last of me. I'm not sure I even like the accupuncture either.
This sounds like quack medicine to me. Have you ever heard of such a thing? I wonder if any readers have had this done or heard of it.
Sorry to be off topic, but this treatment really took me by surprise.
Posted by Dr. David S. Wander on 12/19/05 at 17:22
Posted by Ralph on 12/19/05 at 21:47
The patient in the next room got the treatment I turned down. I heard the doctor tell his nurse to draw his blood. Glad it wasn't my blood. This action surprised me because this guy was an Ob/Gyn for many many years chief of that dept at his hospital. He retired and has been doing accupuncture for over 25 years.
My former neighbor told me about him, but my first visit is now my last visit.
You're right it sure sounded like voodoo to me. I didn't want any blood infection. That was the first thing that came to my mind.
Posted by Cyndi on 12/27/05 at 15:01
Mine certainly was not!
I have seen this list somewhere else also, I believe it was a link easily accessiable.
Posted by Ralph on 12/27/05 at 15:28
The list of doctors provided is simply a list of all the doctor in the U.S. and Puerto Rico that provide crysurgery at this time. It says nothing about them being good or bad. It simply tells the reader what doctors are providing that treatment.
Posted by Dr. S . Goldstein on 12/27/05 at 17:48
Posted by Ralph on 12/28/05 at 11:52
Could you give more specifics on the training offered. How long is the training course and does the training doctor actually do any procedures during course etc.
Posted by Dr. Goldstein on 12/28/05 at 14:44
Posted by Dorothy on 12/28/05 at 17:37
I think the question you answered and addressed to "Dorothy" was actually a question posed by Ralph. This long thread has "To Dorothy" in its subject line which may be confusing. I hope Ralph sees your answer.
Posted by allison Mcgrath judge on 3/21/08 at 08:07
Posted by Cindy M on 3/29/08 at 11:26
