Susan,

One more voice to add to the legion of pro NA proponents. I am EXTREMELY adverse to all things medical (but do what I deem I absolutely have to). After watching my small finger contract to 45, then 60 degrees, then 90 degrees over some 5-10 years (no visible modules or chords - at least not that I noticed), I began researching my symptoms. Self-diagnosis ultimately led me to be fairly certain that I had DC. Further research led me to discover the NA alternative to open hand surgery. Still cautious, I went to a leading hand surgeon who instantly confirmed my diagnosis and recommended surgery. When I asked him about NA, he told me that he was aware of it but was not interested. Shortly thereafter, in November of 2006, I flew up from LA to SF to have Dr. Denkler perform NA. This turned out to be one of the best decisions I've ever made and best medical encounters I've ever experienced. In my case, the procedure took about 30 minutes and involved some intense (but short) pain (associated with the injections of the anesthetic rather than the snapping of the cord(s)). The procedure was performed on a Friday afternoon. I took a cab back to the airport (could easily have driven), and flew home the same evening. Zero (absolute zero) after procedure pain. Kept the hand elevated for a few days as instructed. Went back to work on Monday morning. At the doctor's recommendation, I did see a hand therapist for a few months, and took to wearing a night splint (still do - loosely fitted at this point). The NA reduced my contracture ("PIP" - which can be difficult) from 90+ to as little as 15 degrees. As far as I can determine, the NA is "holding up" 100% thus far (although I have now noticed what I believe to be some nodules).

In short (or long?), I would heartily recommend that you seriously consider NA if you have DC and associated contracture.

NA MAY have a slightly higher recurrence rate than traditional surgery but is SO MUCH less invasive, with FASTER recovery and (probably) less risk of complications. From what I've read so far, NA is also less painful, more effective, and less expensive than Xiaflex portends to be. NA tends to run about $700-800 (if one finger). Fortunately, my insurance covered it although I was of course out of pocket for airfare, tax fare, etc. WELL worth it!!!!

Lori, Luba, Randy and others who think NA is the thing to try first, I wholeheartedly agree!

Susan who has to make the decision, it is not an easy decision. I went through the same thing, "What should I do?" I had NA then RT. I'm still pleased with my decisions.

Very interesting investor analysis and whil I agree with most of it, I have 2 issues with the conclusions

1. The analysis refers to the "inability to convince physicians of equivalence or superiority to surgery". In general you'll have a hard time convincing a surgeon of the superiority of a non-surgical treatment. However, you'll have a lot less trouble convincing ME, a patient who's already had 2 surgeries. This report completely whitewashes a major downside of surgery - the extremely long, inconvenient and tedious recovery process. In the end, isn't it the patient who should decide which treatment is better?

2. The authors rate FDA approval only a 50% probability. Clearly they were wrong, and in fact I don't think there was ever much doubt. That tends to reduce their credibility somewhat.

In general though, I think they're right and in particular, it's clear that Auxilium is trying to price Xiaflex too high.

Randy,
Isn't the key really to get to the GPs and other practitioners who refer for treatment? My doctor, physical therapist for other ailments and dermatologist have seen with their own eyes what NA did for me and know it was a cake walk as far as recovery.
I showed my podiatrist, who I saw for a toe nail problem, but I could tell she really wasn't interested, especially after I mentioned that there are alternative treatments for Ledderhose's.
I'm on a mission to let every possible doctor in my town know. Wish I knew how to reach groups of them.

That is the wholesale cost, not retail which would be about a 25% markup, and that comes to a stunning $ 4,062.50 per vial. The average person is going to need two vials per CORD which brings it up to a whopping $8,125. I just don't see any insurance company paying that cost. Does anyone have that kind of money to spend without getting any money back? And what if you have multiple fingers/cords affected by Dupuytren's?