I like your term for Dr. Denkler. He and the other hand specialists who are doing NA and other less invasive procedures are in a class by themselves. Maybe that's what wizards are, doctors who put their patients' best interests ahead of $ and traditional "We've always done it this way." medicine/surgery.

I don't have any indications that I will need those other procedures, but it is always good for us to know the what possible treatment options are.

Just in case you don't think this is about money overall, just wait at how many people who pooh, pooh-ed NA jump on the Xiaflex bandwagon. Similar modus and similar potential complication rate (less than open) but since there is a lot of phama money to be made, it will be heavily promoted. Surgeons will be wined and dined and shown how to inject on expensive cadaveric hands at meetings across the country. Sadly enough, the procedure will cost patients more than NA (but less than open surgery) and Pfizer will promote this to insurers ensuring that they cover Xiaflex the minute it is released by the FDA. Docs, however, being horrible business people in general will not notice that their actual reimbursement will be lower for Xiaflex injections than NA which in turn is less than for open surgery. Enterprising (and risky/aggressive) primary care docs with no surgical and little Dupuytren's experience will start injecting Xiaflex (just like Hyalgan/Synvisc/Euflexxa these days) until they get a ruptured tendon complication. Pfizer stock will soar.

Eh, maybe I'm a cynic. And just FYI, those reimbursement numbers are from an area known to have pretty crappy reimbursement. I'll bet the surgeon fee for open fasciectomy in some place like Alaska or Beaumont TX is well over a grand. But the takeaway point is that the other fees (hospital/OR) are usually about 10 x the surgeon fee. The surgeon fee for an open procedure in the OR only covers your time. The surgeon fee for the office procedure is supposed to cover the cost of your maintaining a procedure room and the staff and supplies for the procedure.

Few patients know all this crazy stuff. In fact, few docs know it unless they run their own business (and the poster who was the adult child of a doc is working off of completely ancient premises - the best known docs are often cash pay only - the biz of medicine in 1970 was nothing like what it was in 1985 and both are totally different than 2009 - in fact, huge changes even from 1999 to today - ask how many docs were salaried employees +/- "production bonus" 10-20 yrs ago vs today as opposed to actual owner/partners)

Now how did I get sucked into another rant... Back to work

I see this has turned into another bash the doctors and surgeons website. Notice that out of tens of thousands of surgeries each year there are only a few complaints about Dupuytren's surgery on this website. It is easy to assume by the tone of conversation that many on this website are "plants".

Wach,

My mistake, I should have said the forum, and not the website. Examples? Just read the above comments in this thread (and others). Rather than just talking about the successes of NA, or radiation, as an alternative to surgery, there is the accompanied dig about doctors and surgeons who feel more comfortable performing fasciectomies, or fasciotomies. The derogatory comments are often made by those who have never experienced these procedures. Would you want me to list the comments? It would take some time, but it could be done.

I appreciate the information that is presented in the website. I have less of an appreciation for those who make a point of indicting hand surgeons who don't perform NA.

Hi Callie, Australia Calling, I cannot comment about US doctors, all I know it costs a lot more inth US than anywhere else. Most doctors in my experience are not in it for the money and they are not generally business minded. I was an administrator of a private hospital for some years had a lot of dealings with practioners. The forum is not anti surgery. I know about hand surgery I have had 15 hand surgeries including 4 large skin grafts. Only a couple of years have passed since these other options have become available and more widespread both here and in the US. I believe the forum has been instrumental in spreading the word and allowing patients to bring these other options to the medical practitioner. It was as the result of the forum in 2007 ,after a repeat surgery that I found Radiotherapy was an option. It was not available here in Australia and rare in the US. Most patients as I did travelled to Germany. My surgeon was horrified and I was told to expect holes being burnt through my hand as well as cancer. It is all a matter of education. In my case without the surgery -I hate to think and I was gratefull, however I now know that the first surgery started the clock ticking for the next and the next .If you are over 60yr and have your first surgery that may be the first and last. With your comment about "plants "in the forum I see no justification for the claim. Have a good day.

Edited 11/14/09 01:21