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hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??
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01/14/13 05:19
potter 
01/14/13 05:19
potter 
hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

Hi All,

Time for me to go get something done about the contractures and trigger fingers I've developed over the past few years... prevarication if ever you saw it, or maybe just frightened about the pain side of things...! :(

It's wonderful how you think nothing of getting DC sorted when you're young, but now I'm stuck on Warfarin and have a heart doctor who took a sharp intake of breath when I asked him if I could come off this for a week or so..... and I guess that kind of closes my options down a little!

I know Xiapex is contra-indicated for anyone taking warfarin, and from previous experience don't think I'd want to go the surgery route - so anybody know where NA stands in the grand scheme of things re blood loss - and what the indications are for somebody having this while still on warfarin?

Thanks!

Potter

01/14/13 08:31
Seph 
01/14/13 08:31
Seph 

Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

Potter; I have had NA three times on one hand and two on the other. Two different Paris doctors who knew what they were doing. I have heard others on this site talk about skin tearing but I don't understand this as I don't see how it would be possible with the process used by the doctors that I have seen.

In my case virtually no blood loss. Certainly not more than you would get from a series of spaced injections. The process takes 20 minutes or so then the hand is bandaged to prevent infection while waiting for the punctures to close over but not to aid in repair. One doctor put bandaids on the puncture spots then a flexible sticky tape over that while the other used gauze and a dry bandage.

Seems to me that NA would be a relatively safe course for you. You will need to discuss the anesthetic with the doctor as I told they vary this for people with certain medical conditions.

01/14/13 22:30
bstenman 
01/14/13 22:30
bstenman 
Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

The doctor who is concerned about you staying on Warfarin is partly concerned about your health and partly about their own liability should you develop a complication or die from a blood clot while off this medication. You can be sure that if you needed heart surgery the same doctor would not hesitate to take you off the Warfarin prior to the operation.

At a certain point we all need to be responsible for ourselves and do what we feel is best for our bodies and ourselves. As you admit the Warfarin has been a very convenient reason to avoid a possibly painful medical procedure.

The NA process is less painful than getting a filling in a tooth. There is less than 30 seconds of pain while a local anesthetic is injected into your hand and the rest of the procedure you will not feel and in my case there was no pain afterwards. For me the healing time was two days.

The person performing the NA is a surgeon and should be able to give competent advice regarding how long to be off the Warfarin before and after the procedure. I would start with getting that information and then discussing it with your doctor.

01/15/13 09:17
Randy_H 

Moderator

01/15/13 09:17
Randy_H 

Moderator

Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

The greater the contraction the less NA (or Xiaflex) can correct it. Do NA with an experienced hand surgeon ASAP. This is a no-brainier. You are actually doing irreversible damage to your hand by delaying. God Speed.

01/15/13 12:51
dannyboy 
01/15/13 12:51
dannyboy 
Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

Randy_H:
The greater the contraction the less NA (or Xiaflex) can correct it. Do NA with an experienced hand surgeon ASAP. This is a no-brainier. You are actually doing irreversible damage to your hand by delaying. God Speed.

Hi there and apologies for hijacking your thread,...but i really dont know what to do about the dupuytrens that i have in both of my hands,..pictures below of right hand but its the same in the left;

I live in Kildare in Ireland and there doesnt seem to be much information about this although my local GP has said he would refer me to a private clinic for an assessment,....i really dont know where to turn to ?

Attachment
Dupy 1.jpg Dupy 1.jpg (48x)

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Dupy 2.jpg Dupy 2.jpg (39x)

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Dupy 3.jpg Dupy 3.jpg (33x)

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01/15/13 13:56
spanishbuddha 

Administrator

01/15/13 13:56
spanishbuddha 

Administrator

Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

dannyboy:


I live in Kildare in Ireland and there doesnt seem to be much information about this although my local GP has said he would refer me to a private clinic for an assessment,....i really dont know where to turn to ?
dannyboy

Welcome, you really need to see a hand surgeon specialising in Dupuyten's and has some experience in Xiapex, NA and (of course) surgery. I'm not sure if this is possible for you, but a hand surgeon who just does surgery, is not going to give you advice as to whether Xiapex or NA are possible for you at your stage of the condition.

01/15/13 23:52
Randy_H 

Moderator

01/15/13 23:52
Randy_H 

Moderator

Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

Dannyboy

You are at a 90 degree contraction, but NA can still help you. I have seen American doctors work on worse. While it will never be fully straight you will fair better than with Open Surgery. Invest in your hand and get to France to have this done unless you can find an NA surgeon in England. Avoid Open Surgery

Edited 01/15/13 23:56

01/16/13 03:07
callie 
01/16/13 03:07
callie 
Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

I think that is a misleading statement, "While it will never be fully straight you will fair better than with Open Surgery".

My little finger was more than 90 degrees and my finger is as good as before Dupuytren's, and that was eleven years ago. The person who just did RT on my other hand had similar surgery on his little finger 20 years ago and his finger has zero contraction. Surgery can often have very successful outcomes

01/16/13 06:13
Randy_H 

Moderator

01/16/13 06:13
Randy_H 

Moderator

Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

If dannyboy's contraction as shown in his pictures were the MPC (closest to the hand) there would be a far better statistical chance for full straightening. Unfortunately the 90 degree bend is in the PIP joint which, especially in the little finger, is much harder to correct. It's one of the smallest joints in the human body.

Dr. Charles Eaton: "For the Proximal interphalangeal (PIP) joint contractures, the realistic expectation is improvement, not perfection. PIP contractures due to isolated cords in the fingers have been reported to improve an average of 50% after surgery"

http://dupuytrens.org/How-Effective-is-Surgery.html

Pub Med:

"The average loss of extension of the proximal interphalangeal joint that resulted from these cords was 46 degrees, and surgical excision of the involved cords resulted in an average improvement of 24 degrees (53%)."

http://www.ncbi.nlm.nih.gov/pubmed/3968392?dopt=Abstract

While anything is possible in this world, the then sitting president of the American Society of Surgery of the Hand told me very clearly that with surgery he could not straighten my PIP joint 100%. He gave it absolutely no chance. My contraction was only about 45%. Sure enough it corrected about 50%. NA and OS have similar outcomes.

From time to time we have all mislead through ignorance. I try hard not to. I think the above references show that my statement is in good company.

Edited 01/16/13 06:21

01/16/13 14:47
dannyboy 
01/16/13 14:47
dannyboy 
Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

Thank you all for your prompt and informative replies,..

I have made an appointment to see a specialist hand surgeon at a private hospital in Kilkenny on the 24th January next,...i will see what he says and also discuss other treatments such as NA before making a final decision,... i am resigned to the fact that i must get something done as soon as possible,..i cannot put on a pair of gloves now !

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