DP or Trauma |
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12/17/2005 23:13
woodskier3not registered
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12/17/2005 23:13
woodskier3not registered
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DP or Trauma
I have symptoms the same a DP, but I am certain that my condition was triggered by overusing my hand. I have a history of rockclimbing, skiing, motorcross, guitar and work in a production setting.
How many people out there are like me?
My feelings are that not much research has been put into figuring out how we end up with this infliction.
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12/17/2005 23:03
Stage Onenot registered
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12/17/2005 23:03
Stage Onenot registered
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Both
Hi; lacking details. this is conjecture; most of us had a precipitating event (trauma.) Thereupon we noticed nodules and eventually chords, then contractures. In my case I believe that I have a genetic predisposition that involves an over reaction to healing/repair conditions involving palmar tissue. This condition is referred to as Dupuytren's Contractures. Associated conditions are Ledderhose (foot/sole,) and Peyronies (male genitalia.) Bottom line: the trauma "surfaced" a condition already existent in your body. Absent the predisposition, trauma would have resolved without nodules, chords, contractures. NA is the appropriate intervention. Hand surgery is indicated for advanced conditions. The injury or work conditions did not "cause" the injury. Read up on Radiotherapy, Cryotherapy, etc., then contact an NA Doctor and resolve the contracture for 2-4 years with a benign intervention that takes 30 minutes and cost $200-$1,000 depending on the where and when details. Read up on this, and ask more questions. Then, get NA. I did. Good luck!
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12/18/2005 23:41
Wolfgang Wachnot registered
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12/18/2005 23:41
Wolfgang Wachnot registered
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other causes?
Not every nodule in the palm is due to Dupuytren's disease. Specifically with rock climbing heavy use of the hand might e.g. cause ganglion cysts. Generally it might make sense to exclude other causes before deciding for a specific Dupuytren therapy.
Wolfgang
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12/18/2005 23:14
Stage Onenot registered
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12/18/2005 23:14
Stage Onenot registered
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Differential Diagnosis; es tut mir Lied.
Good point Wolfie; I also had a ganglionic cyst totally unrelated to my DD/DC. Fortunately, I have a competent Internist who diagnosed the Duputrens. He referred me to a Plastic Surgeon; equally fortunate, my internet investigations led me to L'hopital Lariboisiere and the 30 years success with NA for DD/DC. Wolfgang is advocating radiotherapy. I am sure he is sincere; meanwhile, the world's best authority remains: Dr. Jean Luc Lemusiaux in Paris, France. My surgery was successfully completed by Dr. Badois in 2003. Dr. Badois is a long time staff member and protege of Dr. Lermusiaux. I use X-Rays daily in my occupation. Personally, I would "wait and see" before I had my nodules/chords irradiated (colateral damage.)
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12/19/2005 23:19
Wolfgang Wachnot registered
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12/19/2005 23:19
Wolfgang Wachnot registered
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therapies
Hi Stage One, I am sorry if I created the impression that I am advocating radiation therapy. I participate in this forum because Dupuytren e.V. wants to inform on available therapies. I post things when I believe I can add value, specifically with regard to NA I am certainly less knowledgeable than most people on this forum, that's why I write more often in connection with other therapies.
The advantage of radiation therapy is that it can stop Dupuytren before it grows big (why wait?). When it is big, NA steps in. Radiation therapy is for stages N and N/I, NA (in my opinion) for stages I - II, maybe III. No competition between those therapies.
With regard to collateral damage of radiation therapy it is certainly true that not only the Dupuytren cells are being damaged. But the damage to the other cells seems to be minor. I personally had 3 radiation therapies (the first one 20 years ago) without any severe side effects (by the way, I myself had worked in radiation physics for quite a while. No I am in the software business, less dangerous). Still, shielding of the not affected parts of the hand makes a lot of sense.
Wolfgang
Wolfgang
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12/20/2005 23:07
Karlnot registered
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12/20/2005 23:07
Karlnot registered
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Rock Climbing
Rock climbing can trigger Dupuytren: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16118302&query_hl=8&itool=pubmed_docsum
@ Stage One: "Wait and see" with radiotherapy? Wait for what and then see what? Everyone knows how Dupuytrens progresses, if you have the nodules, the affected fingers WILL bent sooner or later (if you don't die early enough). Radiotherapy can, if you are lucky, HALT the progression of Dups, NOTHING more. Its far away from being a cure. I wouldnt want to wait until my fingers are bent because the longer you wait, the less effective is RT (see studies). Collateral Damage? Please look at Dupuytren-post-op pictures from people with multiple cords removed from their hands, THATS what I call "Collateral Damage"!
Just my 2 cents.
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12/21/2005 23:08
Stage Onenot registered
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12/21/2005 23:08
Stage Onenot registered
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Rock Climbing therapy
Good luck Karl. I will have Chord NA once or twice in my lifetime. Meanwhile you can read up on osteo-radio- necrosis and ponder the dose related effect. Every approach requires pioneers. I admire your willingness to venture into new modalities. Radiotherapy does not cause cancer. That said, why does it seem to work? Perhaps because the radiation damages the tissue and stops proliferations of fibroblasts. How does the beam discern between normal and abnormal tissue? That is the collateral concern; short term gain versus long term options. Open surgery remains if NA fails. My concern is about lost opportunities (if any)subsequent to radiotherapy. My initial remark mentioned a Urologist who found brachytherapy (radiation seeds)minimized future options in prostate surgery. My "wait and see" is not about intervention, merely about radiotherapy. Have NA at 30 degrees and the radio results may be more convincing five years later. Have your nodules irradiated now and we will have something to evaluate. You can have satisfaction that you were a pioneer and "right." Meanwhile, I prefer to "wait and see." If I need open surgery, I will still have viable tissue for the CHS to work with. Hopefully, you and Wolfgang will just have dry hands and never need further intervention. I think it is too soon to tell. I do wish you well. Viel Gluck!
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12/21/2005 23:28
Wolfgang Wachnot registered
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12/21/2005 23:28
Wolfgang Wachnot registered
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comments
Hi Stage One,
As we all agree it is up to everyone himself to decide what route to go. Without advocating any specific therapy, just three comments on your recents post:
1. you indicate the danger of osteoradionecrosis as result of radiation therapy. According to e.g. eMedicine (http://www.emedicine.com/ent/topic579.htm) "ORN (osteoradionecrosis) is rare in patients who receive less than 60 gray (Gy) radiation therapy. Reports exist of ORN in patients receiving less than 60 Gy and more than 50 Gy, but these cases are extremely rare." - Radiation therapy for Dupuytren typically uses 30 Gray, additionally fractioned into 10 therapies with 3 Gy each and a six weeks recovery period after the first 5 sessions.
2. radiation therapy does not affect later NA or surgery, irrespective of what might be the case in prostate surgery.
3. radiation therapy for Dupuytren is not new, there is about 30 years of experience in Germany.
I already agreed in an earlier post that damage of surrounding tissue is inevitable. That's why only the Dupuytren affected part of the hand (with some fringe) is radiated. The question is whether the damage is too heavy to allow this kind of therapy. Published long-term results don't indicate this (e.g. http://www.springerlink.com/(pbfu3m55xe4naqut5rodta45)/app/home/contribution.asp?referrer=parent&backto=issue,4,8;journal,50,78;linkingpublicationresults,1:103711,1 - scroll down for the English text). Personally I believe that surgery does more damage.
Wolfgang
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12/22/2005 23:45
Stage Onenot registered
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12/22/2005 23:45
Stage Onenot registered
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Immer Forvarts
ORN involves bone. Soft tissue is a separate concern. Statistics about ORN are interesting when one focuses on bone. I raised the point because the topic includes considerations about co-morbid factors; i.e. soft tissues. Radiotherapy of the hand does not involve ORN. Reading about ORN exposes a reader to sequelae and co-morbid consequences of the radiation therapy. Life threatening illnesses warrant intervention; side effects are warranted when life is saved. Dupuytrens is not cancer. Radiotherapy may be an improvement upon NA. My point is. proceed by all means. I am eager to learn about the results long term. For the present, a very benign alternative exists, and, it does not preclude other modalities. When RT achieves the longitudinal success and lack of downside, I might consider it myself. Personally, I imagine that Ledderhose suffers might have more interest than the DD/DC population. Bottom line (cost benefit analysis:' where and how much does it cost. Nodules, chords, contractures? Just what is RT "treating" and why (eg. nodules.) And, finally, just what are the future side effects of irradiating one's hands over how many visits over how many years. If you can, please provide the tables of X patients recceiving Y treatments over Z years, etc. Meanwhile, it is an interesting topic about a treatment that has limited application in the affected population (cost/benefit.) The prostate analogy:inadequate healthy tissue remained (after Brachytherapy) to perform subsequent,minimally invasive therapy. (Everything got fried in the process.) Are you suggesting that RT "only" targets nodules? Chords? Clearly, we are on separate paths. I agree to disagree. I am pleased for you that you have a personal success and only "dry skin" to show for it. For 200 USD I had my contracture released in a 20 minute procedure 2 years ago and anticipate repeating the procedure again in 2-4 years if indicated. Open hand surgery will remain a viable option if I ever need it: no "fried tissues" only severed connective aponeurosis tissue. I have done about 10,000 "blind" injections, so I have no trepidations in that regard.
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12/23/2005 23:20
Stage Onenot registered
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12/23/2005 23:20
Stage Onenot registered
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Niemal Zuruck
http://www.chemcases.com/2003version/nuclear/nc-14.htm
The topic is erudite for myself and others; I offer this link as one of many introductions to the world of Rads, Rems, Grays, and Sieverts. I suggest that everyone educate themselves about radiation therapy (a very valid therapy) and its side effects. Early stage DD/DC is a nuiscance at best. I believe that Wolfgang is implying that earlier intervention (i.e., not waiting for 30 degree contractures) precludes advancement/progression of DD/DC. Perhaps,that is true. Time wil tell. My concern is, at what cost, financially, and physically. Does irradiated (30 Grays) tissue present a less than optimal surgical site for advanced cases? I do not know. I do no that NA will correct Stage One, Two and many Three cases. Fours are problematic. RT may work very well with minimal sequellae. Na is gaining acceptance after 30 years of success; perhaps RT is next. Call me cautious; I prefer to "wait and see" about ionizing energy solutions for relatively benign conditions. Perhaps I am influneced by the actinic keratosis sites where my youthful sunburn occurred. That was somatic damage; Just what is the mechanism for RT and why bother with nodules? I have no vested ineterest. Does Wolfgang sound much like Sean did? Please keep us posted. We are all interested in advancements that work long term. "Cures" will most likely be gene therapy and off in the future. Either way, have your hands sliced or fried; you need not suffer the debilitaing effects of DD/DC. Let us know if you figure out exactly how many Rads. Rems, Grays, Sieverts, Joules, etc, are involved in individual cases and what the long term consequences are at a somatic and molecular level. We are all very interested.
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