I had NA first done on both my hands in 2007 followed within a month by XRT. After 2 years I needed a new procedure for my dominant hand. I waited for the Xiaflex to go through the trials and be approved for general use and then scheduled an appointment with Dr. Denkler who had performed the NA in 2007. Due to restrictions on dose and coverage by my insurance company I could only have a partial release of the cords with the Xiaflex solution. Within 18 months my dominant hand was again very constricted.

Last week I had the Xiaflex injections performed on Monday by Dr. Denkler and returned on Thursday to have the hand "manipulated" which is a cute euphemism for bending the hand and fingers backwards until there are multiple releases. On Thursday with my hand numb from the lidocaine, Dr. Denkler first did the manipulation and for the areas that had not released he went after with a NA procedure.

I went to Dr. Denkler for the first Xiaflex injections as I correctly believed he was in the best position to judge whether NA or Xiaflex would be better for my hand. Based on the location of the contractures he stated that Xiaflex as safer and less likely to result in nerve damage. Having Dr. Denkler perform the second Xiaflex injections was doubly beneficial as he could see where the enzyme would be effective and areas where NA would be safe and effective and do a combination of the two procedures.

This is in stark contrast to the doctors I contacted for the first Xiaflex injections who were on the approved physicians list of the company that produces Xiaflex. The other doctors had no experience with NA and all but one had treated less than a half dozen patients. At that same point in time Dr. Denkker had treated many hundreds of patients using NA and more than 100 patients with Xiaflex.

The first time with Xiaflex my hand became badly swollen to the extent that I had the skin cracking on my palm and on my fingers and this resulted in a much longer recovery period. The second time I experienced much less swelling and had no skin cracking anywhere. One thing that I started doing with the second Xiaflex treatment was using cold compresses wrapped around my hand to help with the swelling and improve circulation in the treated areas.

Oddly this is not recommended by anyone as far as I could find. I sent an email to Dr. Denkler who responded very quickly stating:

"It is my understanding that the enzyme is neutralized within about 12 hours after the injection by the body's defense mechanisms i.e. white blood cells and proteases. The swelling and bruising is the aftermath of the battle. So ice should be fine now."

In effect I could have started the cold treatment the day after the Xiaflex injections and this would have promoted a faster recovery and healing and reduced the pain I experienced. The Ace cold packs that are about 10" long and 4" wide and 1/2" thick (230mm x 100mm x 13mm) are inexpensive and work very well in that I can wrap them around the treated hand and provide cooling to the entire hand.

I have had PT performed by trainers with experience working with pro atheletes and they have used ice to treat injuries and told me that by reducing swelling it encourages blood flow to the damaged tissue cells and the removal of waste products and so promotes faster healing and recovery. At least in my case this has been true with the Xiaflex treatment of my hand.