My experience with the anesthetic and NA by Dr. Denkler was that the numbing was not so deep that I could not feel it getting close to the nerve. I was informed to that I might feel some sensations/pain and to tell him as he might be getting close to a nerve. I did feel "something" and told him which let him know that he was close to the nerve. I did not feel anything when the cords snapped, but I did hear them.
I think Dr. Eaton, from what I have heard, is an excellent choice for NA. I also think that Dr. Denkler is. There are others that are highly rated by people on this website. Thankfully, there are more and more doctors doing NA and are highly regarded by their patients.

I just had a Xiaflex procedure last week. I had a slow-moving case of Dupuytren's that affected only the PIP of my left ring finger. The contracture had been developing over the past 5 years or so, and had pulled my finger down to about a 45%-from-straight angle. I had seen three hand surgeons over several years, each of whom told me that my only real choice was traditional surgery. NA was not an option; the cord was in an unusual place (off center, toward the side of the finger) and so was too close to the nerve for NA. But once Xiaflex got FDA approval, I went to see a hand surgeon who was also qualified to do the collagenase injections. Given my unusual case, he told me that if it were his finger, he'd probably have a slight preference for traditional surgery, but he thought I was a good candidate for Xiaflex and was willing to do it. He would just have to be very careful about avoiding nerves and ligaments with the injections.

Well, the long and the short of it is that I had it done and it looks like a complete success. After a couple of weeks waiting for the Xiaflex to be delivered, I went in last Thursday to have the doctor do the injection into three parts of the thickened cord. The injection was painless, though there was some tenderness and substantial swelling in the hand by evening (plus a little pain and swelling in the armpit, which is apparently a common side effect). The next morning I went in, he numbed my hand, and did the manipulation (no audible snap, but he says he felt it give at a certain point). That part was also painless. I've had to wear a splint (45 minutes on, 15 minutes off) for a few days, but after seeing the physical therapist yesterday, he says I can cut down to wearing it two hours per day (but all night for the next four months). Now, four days later, the swelling and pain are all but gone, I can straighten the finger completely, and the big lump below the PIP joint is gone. No physical therapy necessary. Considering that surgery would have involved 2 months of twice-weekly physical therapy, I'd say this qualifies as pretty miraculous. The physical therapist was flabbergasted. (I was his first post-Xiaflex patient)

Of course, long-term problems could develop, but as of now, I'm a pretty avid advocate of the collagenase injection.

I'll try to remember to post progress reports. My case of Dupuytren's seems less aggressive than some cases I've read about here, so recurrence, if it happens, might be slower, too. Or so I'm hoping.

By the way, my insurance carrier is Blue Cross Blue Shield (CareFirst), and as far as I know, they're covering the whole thing. The specialty pharmacy that handled the Xiaflex shipment called me several times to tell me that my co-pay would be zero, but I'm waiting to see if BCBS has any unpleasant surprises in store for me...

jimh:

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This is sounding better all the time.

My real reservation about Xiaflex has been that the MD would just do an injection, and it would either work, or it wouldn't; and if the injection wasn't sufficient to let the cord be snapped, well that's just too bad. Whereas an MD doing NA will try to persist, and will keep cutting at the cord, until he succeeds.

moondanc:

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Have you read any reports of Xiaflex not working--I don't think there have been that many reports of it but i could be wrong and I guess it could depend on something unusual in a person's body chemistry. However, if injected properly and in the correct place, it's hard for me to imagine the cord would not "dissolve"-- AFAIK the injection amounts are fairly standard.

That said, and not to rain on anyone's parade, in the Xiaflex study my PIP joint easily straightened--it just didn't stay straight past 14-16 months. PIP joints tend to be the easiest for Xiaflex (and NA if I'm not mistaken). If one can get it covered by insurance I'd probably go ahead but if I was paying out of pocket, I'd wait for more reports on how long it lasts and absolutely make sure there aren't adverse effects such as accelerating the disease.

Diane

Edited 09/22/10 03:16