| Lost password
11 users onlineYou are not loggend in.  Login
Just scheduled surgery and have questions
 1
 1
11/20/19 20:24
spalmer114 
11/20/19 20:24
spalmer114 
Just scheduled surgery and have questions

First a little information about me, I am a 49 year old male who has been battling with DC for several years. The majority of the issue is isolated to the small finger on my dominant right hand, although I have had nodules in the palm of my left hand for a few years.

I am fortunate enough to have VA medical benefits and the level of care has been very good. Through the VA, I have had 2 rounds of Xiaflex, on the same finger. The first injection was in March of 2017, which seemed to work very well, however within 9 months, my contracture had returned. Although disapointed, I elected to have a second injection of Xiaflex in March of 2018. The second time was much more painful, but it seemed to work. Unfortunately, I noticed the contracture returning a few months ago and it has steadily become worse over the last few weeks (pictures attached). I was once again referred to the Plastics Surgery Department at my VA and met with a surgeon who works at our local University hospital and also works with the VA twice a month. As soon as he looked at my hand, he immediately said that my only option moving forward would be surgery. He discussed performing an Open Fasciectomy and said he should be able to do it in 1 hour. I am not really worried about the surgery, however I am very much worried about the recovery time. He made it sound like I would be able to use my hand within a couple of days, have stitches removed in 2 weeks and go to therapy for several weeks. I agreed to the surgery and have it scheduled for December 10th.

After researching a little more, especially on this forum, the recovery does not seem as straight forward as he made it seem. I have a job where I travel all over North America selling a large piece of mining equipment. The winter slows down for me, but I still have planned travel to a trade show in late January, followed immediately by a work trip to Germany. From then on, it's a lot of time on planes visiting customers. I will have some downtime after the surgery, but only had planned on taking 2 or 3 days off after the surgery (followed by a weekend, so a total of 5 days). For those that have had the surgery, how long before you were able to grip a pen and write, use a keyboard for daily emails and other general office duties? Part of my job is working on a large piece of equipment I demonstrate, and it involves removing approximately 400 large nuts, replacing certain parts and reattaching the nuts using a large impact gun. Is it even feasible that I can be back to doing this kind of work within a couple of months? I know recovery time is different for everyone, but just trying to get an idea of what people in a similar situation as myself have experienced? I contacted the VA with more detailed questions regarding recovery, but since the doctor only works for the VA twice a month, I will need to come in the next time he is there, December 3rd, and speak with him. I plan on doing this, but I am trying to get as much as possible info beforehand.

Attachment
DC 2.jpg DC 2.jpg (6x)

Mime-Type: image/jpeg, 1.714 kB

DC 1.jpg DC 1.jpg (5x)

Mime-Type: image/jpeg, 1.813 kB

11/21/19 07:56
spanishbuddha 

Administrator

11/21/19 07:56
spanishbuddha 

Administrator

Re: Just scheduled surgery and have questions

Hi spalmer114 and welcome to the forum.

I don’t think anyone knows the answer to your question. If the surgery is limited to the pinkie, good healing, minimal swelling, no adverse events, then it’s possible to have good result and function within 2 months, but this is optimal and you will probably still be doing physio or hand exercises. Any slight set back, larger incision, swelling, infection, nerve damage, poor healing, unexpected pain delaying exercise then you can expect recovery to be longer, up to six months or more in worse cases. I would be concerned that the fast recurrence you experienced following 2x Xiaflex may indicate that surgery could provoke further progression or a flare.

I would ask your surgeon for their own experience of doing the operation and with patients recovery, and the post-op care and support provided for wound healing, including out of hours support, scar management, and hand physio or exercises. The surgeons limited availability limited to twice a month would be a concern to me unless there is a good experienced care team in place.

Best wishes SB

Edited 11/21/19 08:49

11/21/19 13:28
spalmer114 
11/21/19 13:28
spalmer114 
Re: Just scheduled surgery and have questions

spanishbuddha:
Hi spalmer114 and welcome to the forum.

I don’t think anyone knows the answer to your question. If the surgery is limited to the pinkie, good healing, minimal swelling, no adverse events, then it’s possible to have good result and function within 2 months, but this is optimal and you will probably still be doing physio or hand exercises. Any slight set back, larger incision, swelling, infection, nerve damage, poor healing, unexpected pain delaying exercise then you can expect recovery to be longer, up to six months or more in worse cases. I would be concerned that the fast recurrence you experienced following 2x Xiaflex may indicate that surgery could provoke further progression or a flare.

I would ask your surgeon for their own experience of doing the operation and with patients recovery, and the post-op care and support provided for wound healing, including out of hours support, scar management, and hand physio or exercises. The surgeons limited availability limited to twice a month would be a concern to me unless there is a good experienced care team in place.

Best wishes SB

Thank you very much spanishbuddha. I will definitely discuss this in detail with the surgeon before I commit to the surgery. He has a great reputation in the industry and I have full confidence in his ability, however going through the VA can limit direct contact with him. A lot of specialists will do rotations with the Veterans Administration, however it is typically for a short term basis. The majority of my aftercare will go through the VA and will have very little to do with the surgeons team. What I may do is get the surgery with the surgeon through the VA (almost zero cost to me) and then use my private insurance to go directly to his facility at the University Hospital for all aftercare issues. Your point about the fast recurrence after 2 Xiaflex injections has me concerned, so this will be a big point of discussion and will probably weigh my decision on if I just live with 1 deformed finger (for now), or have the surgery and hope for the best. Thanks again for taking the time to respond!

11/21/19 19:23
spanishbuddha 

Administrator

11/21/19 19:23
spanishbuddha 

Administrator

Re: Just scheduled surgery and have questions

In case you have not seen other posts on the forum about surgery, I pick out two:

A good healing outcome within weeks https://www.dupuytren-online.info/Forum_...6024&page=1

A worrying outcome in the weeks after surgery https://www.dupuytren-online.info/Forum_...1559286971.html

The latter is why you should ensure there is access to good experienced follow up care.

There are other examples if you seach or browse the forum. One more https://www.dupuytren-online.info/Forum_...2103&page=1

11/21/19 19:52
spalmer114 
11/21/19 19:52
spalmer114 
Re: Just scheduled surgery and have questions

spanishbuddha:
In case you have not seen other posts on the forum about surgery, I pick out two:

A good healing outcome within weeks https://www.dupuytren-online.info/Forum_...6024&page=1

A worrying outcome in the weeks after surgery https://www.dupuytren-online.info/Forum_...1559286971.html

The latter is why you should ensure there is access to good experienced follow up care.

There are other examples if you seach or browse the forum. One more https://www.dupuytren-online.info/Forum_...2103&page=1

Thanks again for the information, spanishbuddha! The more I read, the more I think I may just be better leaving it alone. My contracture is just now starting to interfere with some daily activities, but I am in very little to no pain most of the time. I guess I am just worried that if I let it go, it will much more difficult to potentially "fix" later on.

11/21/19 22:45
spanishbuddha 

Administrator

11/21/19 22:45
spanishbuddha 

Administrator

Re: Just scheduled surgery and have questions

spalmer114:
spanishbuddha:
In case you have not seen other posts on the forum about surgery, I pick out two:

A good healing outcome within weeks https://www.dupuytren-online.info/Forum_...6024&page=1

A worrying outcome in the weeks after surgery https://www.dupuytren-online.info/Forum_...1559286971.html

The latter is why you should ensure there is access to good experienced follow up care.

There are other examples if you seach or browse the forum. One more https://www.dupuytren-online.info/Forum_...2103&page=1

Thanks again for the information, spanishbuddha! The more I read, the more I think I may just be better leaving it alone. My contracture is just now starting to interfere with some daily activities, but I am in very little to no pain most of the time. I guess I am just worried that if I let it go, it will much more difficult to potentially "fix" later on.
Have you looked into, or consulted with a surgeon experienced in NA? Less down time than Xiaflex, couple of days, but your experience of recurrence with Xiaflex means its likely to recur again with NA. Not all case are suitable for NA, so I cant really question your surgeons call for fasciectomy and the pinky is tough to treat with any method. But NA can be useful as ongoing maintenance for any such suitable cases.

11/22/19 23:40
BRIANB 
11/22/19 23:40
BRIANB 
Re: Just scheduled surgery and have questions

Wish you the best of luck ! I would like to share the following after seeing the photo of your small finger.
My small finger at the PIP joint was contracted 95 degrees. Dr. Eaton performed N.A. back in 2009. My finger is still perfect after all these years. It is true to the best of my knowledge that it is rare that my contracture has not returned. I feel the night spints that I continue to wear after all these years played a role,along with good luck.
Dr. Eaton no longer practices,but there are other very experienced N.A. doctors,such as Dr. Pess in New Jersey..

11/23/19 19:45
mikes 
11/23/19 19:45
mikes 
Re: Just scheduled surgery and have questions

Similarly, I had a 95 degree small finger PIP contracture on which NA was performed by Dr. Denkler in Larkspur, CA in November 2006 which is still virtually perfect (knock on wood). I splinted nightly for 3-4 years, followed by a gradual tapering off with no negative effect thus far.

11/23/19 20:25
BRIANB 
11/23/19 20:25
BRIANB 
Re: Just scheduled surgery and have questions

Correction ...
Correct spelling in my previous post should read Dr. Eaton ..sorry..

12/02/19 13:36
spalmer114 
12/02/19 13:36
spalmer114 
Re: Just scheduled surgery and have questions

Thank you to everyone for the advice. I have an appointment with my surgeon tomorrow morning and will definitely inquire about the NA procedure and if I am a good candidate for it.

 1
 1
surgeon   spanishbuddha   6024&page=1   approximately   Xiaflex   recovery   contracture   surgery   questions   dupuytren-online   2103&page=1   healing   recurrence   Administration   scheduled   experienced   information   availability   1559286971   Unfortunately