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One hand done, when to start RT on the other hand?
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11/20/2013 20:10
callie 
11/20/2013 20:10
callie 
Re: One hand done, when to start RT on the other hand?

I am curious about your brother's surgery? What were the results?

11/21/2013 03:53
JohnG 
11/21/2013 03:53
JohnG 
Re: One hand done, when to start RT on the other hand?

tgm1327:
... a hand doctor who (no surprise) did not even mention RT. He works in a major university hospital (Georgetown) which also has a prominent cancer center, so I am reasonably certain that hospital could handle both the hand physician marking the spread of the disease in my left hand, and the radiation oncology dept treating the hand. Does this sound like an advisable approach? I'm assuming there may be some advantage, if both a hand surgeon and RT doctor are involved, in having both located in the same hospital?

Yes, that's exactly the approach I used, with a hand surgeon and RT doctor who were both located at the same major university hospital.

First I consulted with the oncologist, who actually suggested an appointment with the hand surgeon.

When I then met the hand surgeon, he had no idea what I wanted from him since I was the oncologist's patient, so it was up to me to take leadership in the situation. I presented him with photos of ink markings on patients' hands as made by Prof S to indicate nodules and cords and asked him to mark my hand similarly. So the hand surgeon palpated my hand, and instead of marking the individual cords and nodules he opted to just draw a box to define the perimeter of the treatment area that he suggested. He used a simple ball-point pen. That appointment with the hand surgeon lasted only a couple of minutes.

The next thing I did was go to the restroom and thence wash my hands, and I realized what a mistake that was -- the ink was partly washed away, only a couple of minutes after it was drawn! As soon as I got home I then photographed my own hand, using a iPad, before the ink washed off any more.

About a week later, I had the second appointment with the oncologist, who needed to define the "field" or treatment region. By this time the surgeon's ink markings were long gone, so it was a good thing that I had photographed the ink when it was fresh. The oncologist made the photo life-size, and then he re-drew the ink lines that the surgeon had drawn many days earlier. (Amazing that people get paid a big fee for this service.)

After that, the "field" was established, and everyone in the oncology clinic could proceed with the routine that they normally use for their cancer patients. All in all, it worked.

So my suggestion is that if your RT doctor doesn't know how to palpate to define the treatment "field," then do as you suggested and visit a hand surgeon. But I suggest that you bring three things that you provide at the surgeon's office: example images showing the kinds of markings you want, a camera to photograph the ink markings on your hand before you wash it, and a pen that you like, too -- a "Sharpy" brand marker would be good.

Edited 11/21/13 06:00

11/21/2013 12:21
tgm1327 
11/21/2013 12:21
tgm1327 
Re: One hand done, when to start RT on the other hand?

callie:
I am curious about your brother's surgery? What were the results?

My brother had DD for several years, untreated (as his MD told him there was nothing to be done until a problem developed). After maybe 4 or 5 years of the disease, he very rapidly developed a severe contracture in one finger. He had quite extensive surgery done by a physician in Chicago he was quite pleased with. Apparently the surgery was in several areas of his hand, and took quite a bit longer than they thought it might. (He said they had to extend the anesthesia more than they thought he would need.)

This was maybe 4 years ago or so. He had a bit of a challenge in recovery and did some PT on the hand to regain functionality. As best I know, he now has pretty much full functionality in that hand, so sign of DD in the other hand (unlike me), and he was very pleased with the physician he used.

Edited 11/21/13 14:23

11/21/2013 14:43
callie 
11/21/2013 14:43
callie 
Re: One hand done, when to start RT on the other hand?

That is good to hear. My surgery in 2002 was an equal success. It is almost impossible to tell that I ever had Dupuytren's in that hand.

11/22/2013 16:56
bstenman 
11/22/2013 16:56
bstenman 
Re: One hand done, when to start RT on the other hand?

In my case the extent of Dupuytren's in my other hand was misdiagnosed and I had XRT done in Essen on both hands. Catching the less advanced Dupuytrn's in my other hand seems to have halted the disease 100% in that hand, speaking now 6 years later. My left hand was helped less by the XRT as I was told to expect at the time of the XRT as the disease was much more advanced. Same applies to XRT for cancers where the rarlier the treatment the better the outcome.

Absolutely nothing is gained by delaying XRT and the greater the delay the less likely sa favorable long term outcome. It is a trivial procedure as it is being done for Dupuytrn's and lower risk than a tooth extraction but feared for some reason ny many people. The doage is a tiny fraction of what is given to someone with cancer and the radiation is limited to your hands at the dermal level and not like the deep penetration done with cancer treatment - there is no comparison in risk.

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