RE: Anodyne

[Guest guest]

While true that Medicare will not cover its use (and I presume you're not really

thinking of billing a patient for use of their own unit), you CAN bill for

adjunct physical therapy (e.g. the aquatic therapy or land-based therapy). Most

programs that use Anodyne use it for patients with diabetic peripheral

neuropathy --- again, not charging for the Anodyne but billing for the

accompanying aquatic or land based therapy. The theory is that exercise +

calcium + L-Arganine = nitric oxide. In theory, Nitric oxide (NO)is carried by

red blood cells into small blood vessels, is released, and helps to dialate said

blood vessels. In patients with diabetes, the bond between RBC's and NO is

strong, or " sticky " and the Anodyne helps to break the bond so that the NO can

be used by the endothelial cells. Despite the fact that there are one or two

continuing education providers extolling the virtues of using Anodyne for this

purpose, and the theory may be strong . . . the evidence-base is sorely lacking

with respect to Anodyne reversing the effects of DPN. Even the outcomes

" research " conducted by these providers is highly suspect, as no control groups

exist in the unpublished, non-peer reviewed, non-IRB approved trials touted in

the courses --- meaning that we have no way of knowing if it was the anodyne,

the exercise, or tissue heating that produced the effects of improved sensation.

In theory, L-Arganine, calcium, and exercise would be required for healing to

occur.

Similarly, although I personally have seen positive effects with Anodyne used

for wound healing, (again, despite a lack of well conducted peer-reviewed

evidence in the literature) the clinician must consider if the building blocks

of NO exist (e.g. L-Arganine, calcium, and exercise), because without the NO, in

theory, Anodyne won't have an effect. In other words, if the patient is

bed-ridden, NO conversion would theoretically be sub-optimal, resulting in

substandard Anodyne effect as there is not much NO to be bealed away from RBC's

for endothelial cell use. In such cases, I would wonder, if it might be

possible to spray NO and then apply Anodyne.

M. Ball, PT, DPT, MBA/PhD Doctor of Physical Therapy - Carolinas Medical

Center - Northeast, Concord, NCAssociate Faculty Member - University of Phoenix

MBA Program, School of Graduate Business and Management, Charlotte, NC

To: ptmanager@...: noreen_e_v@...: Fri, 9 Jan 2009

19:15:17 -0500Subject: Anodyne

Group, I have a resident in an SNF who has his own Anodyne Unit and wants

therapy to apply it daily for " circulation " . He has 3 unstagable open areas on

his heel and wants the anodyne applied directly to the wound ( over cellophane

wrap). My staff and I are NOT familiar at all with Anodyne therapy or the

indications, contraindications, protocol to use with this diagnosis or

effectiveness of this treatment. Any help or guidance you can provide would be

appreciated! Also I believe that Medicare WILL NOT cover this treatment..

especially for an ongoing " chronic " condition. Is that true? Noreen

Vollmer,PTDirector of Rehab ServicesLutheran CareClinton, NY [Non-text portions

of this message have been removed]

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[Guest guest]

,

Thak you very much for your input. This gentleman is essentially bedridden

and has refused all skilled and maintenance level therapy that has been

attempted. The Anodyne is somthing his daughter wants.... he doesn't seem to

care either way. As it turns out the unit is about 4 yrs old and he has not used

it in about two years. The wound care nurse at the facility is not really

excited about using this , especially since the dressing must be removed , etc.

At this point it looks like something that would be of little benefit and more

potential harm than good. Plus with none of our therapists familiar with this, I

feel we would need training before we attempt it. Our administration is also not

comfortable with the use of his " home unit " as it is not the professional model

and states clearly on the literature that it is for " Home or Nursing use " . The

nurses here want NOTHING to do with it and since it has " therapy " in the name..

they want it to be our problem...... ah you gotta love health care politics!