Your question is to compare NA and surgery, but cost and insurance participation is the factor you initially mention.
Though Xiaflex is more expensive than NA, isn't surgery the most costly.
I posted "Xiaflex Success" updates & pics in this forum for my case, and was lucky my insurance paid a portion. It's all good so far, but only 6 months old. It was my pinky (90deg) with cord and big nodule maybe similar to yours.
So if you decide surgery, then Xiaflex should still be on the table.
Thanks Mary. In speaking with my doctor -I am going to wait for the Xiaflex. He really feels that I will have the best results and at the rate my contracture is progressing insurance should cover in 3 to 6 months. Trying to learn to be patient.
Not mentioned but most important is the advice of a doctor with experience with BOTH Xiaflex and NA. Some parts of the hand are easily treated with VA, which is cheaper and where recovery id 10x as fast as with Xiaaflex, and other areas of the hand where nerves run and where Xiaflex is the safest treatment as the enzyme does not affect nerve tissue.
Twice I have had treatments which combined Xiaflex injections with NA (oerformed at the same time as the manipulation and cord release) and Dr. Denkler has the experience with all forms of treatment to decide when and where to use one or more forms on a particular patient's hand(s). There were other hand surgeons and physicians authorized to do the injections located much closer to my home but I have gone to Dr. Denkler in Larkspur, CA because he is the best.
XRT is for minimizing the progression of the Dupuytren's and NA and Xiaflex are for treating the damaged tissue. I had XRT done on both hands as well as NA in 2007. In 2011 I had NA and Xiaflex done on one hand and repated these two treatments in July and November of 2013. Once I qualified in 2013 for the Xiaflex I could get multiple treatments so long as there was a 30 day interval between injections. I would recommend a 90 day or longer delay for the second treatment in a calendar year as the healing and full recovery from the Ciaflex takes many months, unlike NA where my hands were fully recovered within a few days.
Regardless of cost I much prefer NA which took one visit and 40 minutes at the doctor's office and removing the bandages two days later as compared to what has been my experience with Xiaflex treatments.
I had about 70% contracture in my little finger. Tried NA, which took about two hours of severe pain, and relapsed after a month, then had two tries of Xiaflex. In both tries, the surgeon was unable to break the cords. So now I am more swollen than before and have recurring pain, which was not present at all prior to the procedures. So now I will try the open surgery in one month.
In brief, I think with heavy cords and severe angles, it makes sense to go right to surgery. Perhaps the xiaflex works better in less severe cases. It was an expensive and painful waste for me.
I had Xiaflex 3 weeks ago for my middle finger and ring finger. In my case, it was very easy for the doctor to "snap those chords", which I thought were very thick. He said if I see him climbing up on the table, I would know the chords were difficult. We'll see how long the improvement lasts -- I seem to have some nodules in my fingers too, but my hand easily lays flat on the table, and I am now able to stretch my fingers over more than one octave on the piano. Regarding cost, I think Xiaflex has a special program to assist patients (victims) with no insurance, or who can't afford the copay (I'd give the Xiaflex people a call if I was interested in this option, but couldn't afford it). I go back to the doctor next Tuesday, to see what he thinks about the results.
Thank you all very much for your input. I am lucky that my doctor is there region's specialist in Dupuytrens and experienced in NA, Xiaflex and surgery. I see him on March 4th and he has stated that he will write up my info for insurance a bit more aggressively. It sounds like with all things there is no guarantee in any of the procedures and I will go with his recommendation first. If it doesn't work then I will opt for surgery at that time
I had my Xiaflex injection on Wednesday, April 30th and the manipulation yesterday. I am so glad I did it. My hand is still enormous but the relief I felt when the chords were broken was so worth it. I didn't have any skin tears so very lucky there. I was so apprehensive as to the amount of pain during the injections and manipulation that the actual event was relatively easy. My right pinkie finger was at 56 degrees and getting in the way. We shall see how it progresses.
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