http://www.dupuytren-online.info/Forum_English Forum for Dupuytren's contracture - Last posts Forum for Dupuytren's contracture forum_please_dont_reply@dupuytren-online.info de http://www.dupuytren-online.info/Forum_English/board/dupuytren-na-experience-in-spain-0_347.html
I haven't heard of any NA doctor in Spain or Portugal but Southern France shouldn't be a problem. Have a look at http://assoc.pagespro-orange.fr/f.badois...tml/gblist.html . This page lists a lot of doctors in France, already sorted by region.

Wollfgang

Edited at 07/24/08 17:44]]> Thu, 24 Jul 2008 17:43:30 +0200 wach http://www.dupuytren-online.info/Forum_English/board/dupuytren-na-experience-in-spain-0_347.html
I live on the Costa Granadina, Spain and wonder if anybody has had experience of Needle Aponeurotomy in either Portugal, Southern France or Spain. My finger flexion is in the early stage so I hope to have it dealt with this Autumn.

Thanks in advance

Martin]]> Thu, 24 Jul 2008 16:23:08 +0200 martinog47 http://www.dupuytren-online.info/Forum_English/board/dupuytren-na-in-the-uk-0_20_3.html
NA removes no tissue whatsoever. Therefore higher rates of recurrence are to be expected, especially among those with more aggressive disease. For them NA is not indicated and is of little value. However, for the majority of new patients the French have found that repeated NA is all most new patients will ever need. It is on *that* expectation that millions are being spent on FDA approval of Collegenase. It too removes no tissue and it's statistical rate of recurrence should therefore be similar to NA. No clinical data yet exists. Too new. However, if something far less invasive than full OS were not desperately needed, why would drug companies risk millions on a treatment that surgeons would ignore? (Why most still ignore NA is another topic altogether....don't get me started. :-)

This disease is simply hard treat and those with the most aggressive cases have the hardest time with that cold hard fact. At present skin grafting is the best fire break. NA, Collegenase and even full OS aren't enough.

In spite of random reports of individually helpful nutritional and/or applied medication, no non-surgical treatment has been found to work for a majority of people.]]> Thu, 24 Jul 2008 08:45:05 +0200 Randy_H http://www.dupuytren-online.info/Forum_English/board/ledderhose-does-exercise-help-or-exacerbate-ledderhose-1_35.html Thu, 24 Jul 2008 01:47:28 +0200 jim_h http://www.dupuytren-online.info/Forum_English/board/dupuytren-na-in-the-uk-0_20_3.html
Thanks for replying. It is good for everyone to have reports of treatment whether good or bad.

It is such a shame that NA did not work for you. Perhaps it is due to you being young as your surgeon said.

I am pleased to report that the NA I had on my left hand is still good after almost two years.

My right hand is not the best but the biggest problem is the PIP joint on my little finger which does not respond to NA.
My local hospital has a surgeon who does several small cuts on the finger and then cuts the cord in each place. That does
not sound as drastic as full blown surgery so perhaps I will look into that when I need something doing.

Hope all goes well for you.

Marjorie]]> Wed, 23 Jul 2008 19:26:28 +0200 marjorie http://www.dupuytren-online.info/Forum_English/board/dupuytren-finger-splints-0_237_2.html
http://www.biomedcentral.com/1471-2474/9/104/abstract]]> Wed, 23 Jul 2008 19:14:50 +0200 kdenkler http://www.dupuytren-online.info/Forum_English/board/dupuytren-finger-splints-0_237_2.html
Clinical effectiveness of post-operative splinting after surgical release of Dupuytren's contracture: a systematic review


Splinting after contracture release for Dupuytren's disease of the hand is widely advocated. The purpose of this systematic review was to evaluate the quantity and quality of evidence regarding the effectiveness of splinting in the post-surgical management of Dupuytren's contractures.

Methods: Studies were identified by searching the electronic databases Medline, AMED, CINAHL and EMBASE.

Studies were included if they met the following inclusioncriteria: prospective or retrospective, experimental, quasi-experimental or observational studies investigating the effectiveness of static or dynamic splints worn day and/or night-time for at least 6 weeks after surgery and reporting either individual joint or composite finger range of motion and/or hand function. The methodological quality of the selected articles was independently assessed by the two authors using the guidelines for evaluating the quality of intervention studies developed by McDermid.



Results: Four studies, with sample sizes ranging from 23 to 268, met the inclusion criteria for the systematic review. Designs included retrospective case review, prospective observational and one controlled trial without randomisation.

Interventions included dynamic and static splinting with a mean follow-up ranging from 9 weeks to 2 years. Pooling of results was not possible due to the heterogeneity of interventions (splint type, duration and wearing regimen) and the way outcomes were reported.

Conclusions: There is empirical evidence to support the use of low load prolonged stretch through splinting after hand surgery and trauma, however only a few studies have investigated this specifically in Dupuytren's contracture. The low level evidence regarding the effect of post-operative static and dynamic splints on final extension deficit in severe PIP joint contracture (>40 degrees) is equivocal, as is the effect of patient adherence on outcome.

Whilst total active extension deficit improved in some patients wearing a splint there were also deficits in composite finger flexion and hand function. The lack of data on the magnitude of this effect makes it difficult to interpret whether this is of clinical significance.

There is a need for well designed controlled trials with proper randomisation to evaluate the short-term and long-term effectiveness of splinting following Dupuytren's surgery.

Author: Debbie Larson and Christina Jerosch-Herold
Credits/Source: BMC Musculoskeletal Disorders 2008, 9:104]]> Wed, 23 Jul 2008 19:12:08 +0200 kdenkler http://www.dupuytren-online.info/Forum_English/board/dupuytren-na-in-the-uk-0_20_3.html
It's fair to say I don't check this forum too often, but here is an update for you, if you are still interested.

The NA in my right hand was fairly successful at the time, but as I think I said, I didn't want to get my hopes up regarding recurrence. Sure enough, my right pinkie and ring finger are very much on the move.

Since I last had NA in my right hand, my left hand got a lot worse too. In January of 2008 I had a fasciectomy and skin graft on my left hand. This was recommended by Mr. Bainbridge, and also another plastic surgeon in Edinburgh (where I live). It's not pretty, but 6 months on it seems pretty stable. 6 months after NA on both hands I could "feel" the recurrence (hot, itchiness etc.). My left hand has not yet exhibited these symptoms.

As a result of that, I'm not planning any more NA for my right hand, after the one round I have had already. Particularly in my little finger, the full fasciectomy and skin graft seems the best solution, and I plan to have my right hand done in the winter.

Hope you are having success with whatever treatments you choose. Certainly in my case, NA is no magic bullet. My surgeon in Edinburgh told me that in younger cases, such as mine, the best outcome is through a skin graft. The repeated NA I had in my left hand made her job a whole lot harder - there was only so much she could do to straighten my finger due to the repeated scarring that was present under the skin.

regards,
Michael

]]> Wed, 23 Jul 2008 16:43:38 +0200 Michael http://www.dupuytren-online.info/Forum_English/board/other-therapies-need-advice-2_28.html
Dr. Penny Snead in San Francisco or Dr. Kuhn in Boise are two people that are relatively close to you. The travel expense would be far less than what people, including myself, incurred going to Essen Germany. I would suggest doing whatever it takes to get the XRT as it appears to be effective in halting the disease when caught at the early stages, but is not effective once severe contractures occur (though it may still benefit other parts of the hand or the opposite hand). The longer you wait the less effective the XRT is likely to be a viable option for you.

I believe I would have been far better off if I had received XRT when I first noticed the contracture. Unfortunately my GP, Dr. Dawn Motyka recommended acupuncture (at her office) and I was too ignorant at the time to appreciate how bad her advice was and how much additional damage would result from the delay in receiving proper treatment.

]]> Wed, 23 Jul 2008 01:45:37 +0200 bstenman http://www.dupuytren-online.info/Forum_English/board/dupuytren-radiation-in-us-0_318_6.html
What is unique about Dr. Seegenschmiedt is that he has been personally meeting with patients and palpating their hands and feet for more than a decade. He has often seen people at the very early stages of the disease. Contrast that with the USA X-ray technicians that have never dealt with a Dupuytren's patient before you or maybe one or two. The surgeons that have been performing NA procedures for the last year or two have only seen patients at the advanced stages where a contracture is so debilitating that people seek surgery.

I had Dr. Denkler examine both my hands and if I had been able to find a local oncologist to manage the XRT I doubt very much that I would have had my right hand treated and yet actually the hand showing the least progression of the disease was the one that therefore would benefit the most from the XRT.

I realize I am a sample of one, but many medical studies have shown that the more often a procedure is performed by a particular doctor or institution the better the chances of a successful outcome and there is a much lower incidence of complications.

Unlike a melanoma where the medical practitioner can look at sample pictures there is no way other than direct hands on experience for a doctor to feel the extent of a disease like Dupuytren's.

My treatment covered 80% of my hands. If I was going to get XRT without the benefit of a Dupuytren's experience doctor I would try to get XRT for 100% of both hands or feet to be sure that the necessary areas were treated. Someone may know why only a portion of the hand received the XRT. I would be interested in the reasoning involved.

Bruce]]> Wed, 23 Jul 2008 01:10:53 +0200 bstenman http://www.dupuytren-online.info/Forum_English/board/ledderhose-does-exercise-help-or-exacerbate-ledderhose-1_35.html Tue, 22 Jul 2008 17:26:15 +0200 pixi http://www.dupuytren-online.info/Forum_English/board/dupuytren-radiation-in-us-0_318_6.html I was told here in Australia 12 months ago by an Oncologist 'That the Germans are the WORLD LEADERS in the treatment of non malignant disorders by radiotherapy. ' I went to Germany and am very happy with the results.
It is hard to get the medical fraternity to accept change.]]> Tue, 22 Jul 2008 09:55:40 +0200 newman http://www.dupuytren-online.info/Forum_English/board/dupuytren-radiation-in-us-0_318_6.html
Are the Germans that far ahead or more knowledgable than anyone in the US?]]> Tue, 22 Jul 2008 09:29:48 +0200 MIRUCA http://www.dupuytren-online.info/Forum_English/board/ledderhose-afraid-of-a-non-ledderhose-foot-surgery-1_28.html
How did your surgery work out? Was there an effect?]]> Tue, 22 Jul 2008 08:56:56 +0200 miruca http://www.dupuytren-online.info/Forum_English/board/other-therapies-radiation-2_16_5.html
I'm so glad you got in touch with Dr. Kuhn! That must have been the same day that I called to schedule my radiation with her...I was telling the receptionist that I was really glad I could get the radiation treatment in the US and I asked her whether they get a lot of people there from out of state, and she said she'd just been on the phone with a guy from Atlanta. Funny! Best of luck to you getting this to work for you in Atlanta.

Megan

Edited at 07/22/08 07:38]]> Tue, 22 Jul 2008 07:36:14 +0200 Megan http://www.dupuytren-online.info/Forum_English/board/dupuytren-dupuytrens--age-0_309_5.html
At present I have two very visible nodules in the right foot, a smaller one in the left and a knuckle pad on my right hand. He and another doctor both felt my palms and could feel nothing except for a mild thickening of the fascia in the right hand, but Dr. Goode said that it was not necessarily related to DC--could be my rowing . I have no nodules. Their opinion: watch it and come back in the new year. He also recommended I have the knuckle pad removed as it could lead to arthritis. I was really hoping to just get the RT done and not have to go down the surgical route, but the doctors explained that given my age it is better to put off treatment for now. He emphasized that he was not unsympathetic but that each case must be weighed individually, and I can appreciate that. So I guess I'm back to wait and see.]]> Mon, 21 Jul 2008 20:34:49 +0200 pixi http://www.dupuytren-online.info/Forum_English/board/dupuytren-tendons-stuck-in-scar-tissue-0_346.html Mon, 21 Jul 2008 18:15:17 +0200 guest http://www.dupuytren-online.info/Forum_English/board/other-therapies-systemic-enzymes-2_27.html
You cannot understand how an enzyme can impact Dupuytren's but that is exactly what the collagenase treatment entails with the one difference being injection of the enzymes instead of them being taken orally.

At this point in time no one knows what causes Dupuytren's in the first place so it is not possible to make an exact determination of what will or will not work in terms of long term treatment to halt its progression. Their is good research on the efficacy of XRT but nothing else of which I am aware.

Much of the accepted medical wisdom was at one stage strongly dismissed by the established medical community, such as the recent acceptance of the role of two types of bacteria in stomach ulcers. Bacteria did not make sense to 99.9% of the medical community but one Australian doctor kept on with his theory which is now widely accepted.

People are willing to blindly take statins or diabetes medications based on far less understanding and research. Why is it so hard to accept systemic enzymes, even if they are not being hawed by a big pharma company. My concern would be the side affects of any systemic approach as such treatments affect the entire body and in ways not fully understood or appreciated (as with statins).

I have personally witnessed the complete failure in treating juvenile arthritis by the medical experts, first using aspirin and later drugs with severely damaging side effects when Dr. Jacobson of the Oregon University has produced highly beneficial results with the injection of DMSO, long feared by the medical community and dismissed by the drug companies as they could not patent and thereby profit by its use.

I have tried various dietary supplements an "it can't hurt so why not give it a try" basis and so far been unsuccessful. But I see no real harm in trying different approaches so long as it does not delay consideration of other treatment options such as XRT.]]> Mon, 21 Jul 2008 01:16:51 +0200 bstenman http://www.dupuytren-online.info/Forum_English/board/other-therapies-collaganase-injection-treatment-2_24_2.html
Without the local during the NA procedure I could envision patients moving their hand in response to the pain and this would seem likely to actually increase the risk of nerve damage with this procedure.

In part I understand that with nerve dense locations medical practitioners have to weigh the pain from injecting a pain killer against the pain caused by the procedure. Sometimes it may be a trade off. Other times doctors may be more interested in saving time by not having to wait for the anesthetic to take effect.]]> Mon, 21 Jul 2008 00:53:51 +0200 bstenman http://www.dupuytren-online.info/Forum_English/board/dupuytren-radiation-in-us-0_318_6.html
Just thought I would mention that if you are taking statins for treating high cholesterol that these drugs affect the entire body and can help the heart while damaging other parts of the body that rely on cholesterol for proper nerve function. Medical research shows that statins reduce the chance of a heart attack for only one person in 10 among those taking these drugs. But the big pharma companies make literally billions in pushing these drugs and doctors are worried about being sued by a family member because 1 of their 10 patients dies from a heart attack and the doctor did not proscribe a statin. As a result 90% of the people taking statins as proscribed by their doctor have not benefit whatsoever and yet are subjected to potentially serious and possibly permanent side effects or complications.

Doctors worry a lot more about being sued than about the side effects involved even with patients where there is little probability that the drug will provide any health sustaining benefits. If you have had a heart attack you are in the 10% group that should take statins. If your immediate family members died of heart attacks in their 50's you also would be most likely in the 10% group. Otherwise you are already dealing with one debilitating disease as it is and should really consider whether the very probably serious side affects from these drugs (affecting about 60% of patients and often with permanent damage) makes sense in your situation.

The American way of providing health care has resulted in our collectively spending twice as much as any other country while providing a at birth life expectancy that is surpassed by 46 other countries according to the WHO, and for women age 60 the life expectancy in this country is worse than that of 16 other countries, including some third world countries. Based on this evidence I would surmise that the drug centric approach to health care may be severely flawed and people should be cautious in accepting a doctor's prescribed drugs for their ailments. The FDA's own studies have shown that 95% of the time the choice of drug proscribed by doctors are influenced by cash payments made directly to the doctors by the drug companies that manufacturer them.

]]> Mon, 21 Jul 2008 00:31:35 +0200 bstenman