Hi Diane,

As to the use of ultrasound, some doctors do and some don't use them with NA or Xiaflex treatment. I specifically asked the question of the doctor I went to and he said there are so many nerves and so many small nerves that are not detected by ultrasound that it is not really helpful. The Mayo people could use it to help define the cords being injected but if you can't clearly palpate a cord Xiaflex and NA are not recommended anyway. Having been involved in the medical industry let me be cynical and say doctors can be just as prone to selling services as any other profession. The Mayo people are quite professional however.

You should note that the injections should be multiple for each cord and done very slowly. I suggest not only a local anesthetic when you break the cords (or try) but also spraying a freezing solution on the area before injections. It helps with the pain. If you can palpate the cord a good doctor should be able to hit the cord and avoid nerves with or without an ultrasound. But, by all means, people should follow their own judgement and that of their doctor, have an utrasound and report back here.

As to the introduction of Xiaflex to Australia and New Zealand the best answer I could get from the Auxilium rep I talked to was "soon". He did confirm it was not available yet in those countries. Contacting, as suggested, the local distributors seems a great idea and I would suggest you have doctors inquire on your behalf as well. Doctors also have to go through a certification training and I am not sure of the timing of that process. Another tact would be to involve the government officials in your country similar to our FDA. This is best done here through elected officials like senators and congressmen and women. I am not sure about there but if the FDA approves something it is only after years of process and it should be easier in other countries. I don't think people should be allowed to suffer by a delayed bureaucratic process and I would certainly try NA and/or Xiaflex before a palmar fasciectomy. The PF should only be done by an experienced hand surgeon but I would not have a problem being a good doctor's first patient for NA or Xiaflex once they are certified.

Hope this info is helpful.

Brian

Some interesting info I received today regarding Xiaflex for anyone interested. (A copy and paste of an email I received. I have ** the docs name for privacy reasons but am happy to disclose by PM if anyone wants to contact them)


Thank you for your enquiry. Dr ** advised that he does not use Xiaflex as there is a high complication rate. Both Xiaflex and other injections do not work for Dupuytren’s disease in the fingers but only in the palm.
Our 5 year follow up is very good. The Cost is $1,200.00 injection per hand. Substance is under patent and non disclosure at the moment.

Food for thought

I wondered the same Wolfgang.

I also wonder w hat treatment would be like if NA and Xiaflex were combined together - NA first to weaken the cord, and Xiaflex to dissolve the collagen afterwards. Liken it to a lump of ice - breaking it down first before pouring hot water over the top to dissolve is more effective that simply smashing up the ice, or just pouring hot water alone... Would also mean less Xiaflex required (and the smaller amount of drug into the body, the better, right)...

I am not sure whether combining both techniques would improve the result. When doing NA first the danger might be that the cord is thinner and when Xiaflex is injected it might leak out of the cord and do damage elsewhere. Collagenase is not an enzyme that just affects Dupuytren's tissue, it might also e.g. damage joints or tendons. It's therefore important that after injection the enzyme remains confined within the cord. If the cord is pre-damaged by NA then this might be more difficult and thus dangerous.

If you do Xiaflex first why not do the manipulation? I found the manipulation not very painful because my hand was numbed. There is one situation where I could imagine that the combination of both techniques might be useful: if Xiaflex did not damage the cord sufficiently that it can be broken afterwards, it might be easier and cheaper to finally break it with an additional NA.

Wolfgang

Trigger8:

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I am glad I have found this Site as I don't know anyone else with this condition. I have had eight, yes 8, trigger fingers and in the period of surgery and stitches coming out I have developed Dupuytren constricture? with each finger but not the thumbs. The nodule is a few centremetres below the finger just where the trigger finger scar ends and then from the nodule there is a hard line of tissue down the palm of my hand. I have 2 fingers that I can no longer fully straighten. My neurosurgeon diagnosed it but said he doesn't treat it and the hand surgeon says he can 't understand why I got it.He said if he operated it would come back. I am hoping to find someone who will treat it. I know of others who have had triggerfinger and interestingly have read that both conditions are common in Scandinavien countries. Maybe I have Viking ancestors!