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NA IN SEATTLE - NOT
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10/25/09 06:50
JHuang 
10/25/09 06:50
JHuang 
Re: NA IN SEATTLE - NOT

I wanted to clarify the recent chain of postings on my charges for performing a Needle Aponeurotomy. Most NA providers who charge "$500-$700" per finger are accepting CASH only for their procedures, rather than accepting insurances, that is the only way a "set amount" can be designated for any surgical procedure. NA is covered by most insurances, so the amount you pay would be dependent on your insurance deductible plan. If you have good insurance, your out-of-pocket fees may be minimal. On the other hand, if you have a high deductible or 20% co-pay, it would be expensive. I understand the frustration and fury over the exorbitant fees that come with doing procedures in the Operating Room.

The surgical fees are NA at UW are no different than other providers. In fact, the current UW surgical fee is around $800 for the ENTIRE HAND, not $8000. The $8000 quote includes all UW facility fees and nursing charges for performing these in the Operating Room. Insurance reimbursement is only for one fee, regardless of number of fingers. So, providers charging PER FINGER are actually charging more.

I previously did these in the Operating Room because there was no mechanism/procedure room at the University of Washington in the Orthopaedic clinic. I have now arranged for the ability to perform NA in the clinic setting at my Bellevue office, as there is a procedure room there. Phone number (425) 626-7777. Again, the current surgical fee set by UW is around $800. UW accepts all insurances. Your co-pay would be based on your insurance plan.

Hope this clarifies things!!

10/25/09 21:12
jimh 
10/25/09 21:12
jimh 
Re: NA IN SEATTLE - NOT

$800 is comparable to what I paid the surgeon at Mayo.

10/27/09 07:46
CaptainMorgan 
10/27/09 07:46
CaptainMorgan 
Re: NA IN SEATTLE - NOT

I am new to the site and have also been searching for NA expert in Seattle area. After some calling around, a Dr. William B. Ericson (Montlake Terrace and at Evergreen on East Side) confirmed back to me through his assistant, Maureen, that he does perform NA. I have not yet got an answer on how many he has performed. I am still working on confirming his reply. For price comparison, Dr. Terrance J. Barry (trained in Paris), Hialeah, Fl. charges $600 per hand + $200 per consultation for NA.

Edited 10/27/09 07:47

10/27/09 23:06
bfmcleod

not registered

10/27/09 23:06
bfmcleod

not registered

Re: NA IN SEATTLE - NOT

Update on NA practitioners in Seattle: On second round with Dr. William B. Ericson's office, his assistant indicated to me on the phone today that he has been practicing in Washington for 5 years after moving from the east coast and that, "he has been performing NA for 18 years". I asked for clarification since the procedure seemed to have been invented in Paris in 2003 by Dr. Lermusiaux at the Hopital Laribosière. The response was that the procedure has been around a long time but, "only recently popularized". I could not get a quote for the procedure without an appointment. Does anyone else have any experience with Ericson Hand and Nerve Center? I could not get an answer on how many NA's Dr. Ericson has performed. I understand he performs the procedure at Evergreen Hospital. I am not sure if he performs the procedure at his office in Montlake Terrace and there is no information on his website concerning NA. His assistant explains that this is because NA is a, "non-invasive" procedure.

10/27/09 23:36
ruby2zdy 
10/27/09 23:36
ruby2zdy 

Re: NA IN SEATTLE - NOT

After your post, I called Dr. Ericson's office. His receptionist says he's been doing aponeurotomy for 18 yrs, and I asked how many he'd done. She repeated that he's been doing it for 18 years. I said "OK, but he could have done one 18 years ago & claim he's been doing it for 18 years". She said "He does them every week". Then I asked if he did it as an office procedure and she said no, that it was a surgery and had to be done in a hospital OR. I said I had seen it done (on video) as an office procedure on several people and that's how I wanted it done, that there was no need to go through the risks of total anesthesia, finding someone to bring me up there (Kirkland), take me home, stay the night, and for me being out of it for 24 hrs. We went through several iterations of "Well, then, maybe you should find someone else to do it" and "I'd appreciate it if you'd tell Dr. Ericson that a patient has asked him to reconsider doing it as an office procedure" and "He's not going to reconsider" (!). I finally said "This is like asking someone to reconsider getting a telephone in 1920 instead of sending messages by courier". She replied "He's not going to reconsider" and I hung up. At least Dr. Huang is reconsidering doing it as an office procedure.

Oh yes. I asked if he treats Dupuytren's with radiotherapy and she said no.

Dr. Huang: If you're reading this, I'm asking you to please look into radiotherapy, or talk to UW's radiation oncologists (the area of medicine where this is usually done) to see if any of them would consider treating Dupuytren's contracture since for patients in the early stages, this appears to be the most successful treatment. Thank you.

So there we are. It looks like the closest RT clinic to me is in Boise. Because of a family situation, it would be very difficult for me to spend a week in Boise.

10/28/09 00:44
jimh 
10/28/09 00:44
jimh 
Re: NA IN SEATTLE - NOT

I first read about NA in '97 and it was already well established in Europe by then. I think it orginated in the 80s. Maybe someone else has more detailed information.



10/28/09 00:50
Randy_H 

Moderator

10/28/09 00:50
Randy_H 

Moderator

The Definitive Information:

Dr. Eaton was personally instructed on this method by Dr. Lermusiaux and his colleagues in 2003. Dr. Eaton was the first physician to offer this procedure in the United States.

10/28/09 00:57
ruby2zdy 
10/28/09 00:57
ruby2zdy 

Re: NA IN SEATTLE - NOT

I made a mistake in my last post. I referred to Dr. Kline in Boise as doing radiation therapy. He does needle aponeurotomy. I am now looking for someone to do radiation therapy because my DC is in the early stage(s).

Someone in one of the Dupuytren's fora asked how could you tell if DC was just beginning. The DP that there's no doubt about is in my LH, where's there's a boomerang-shaped bump, and tightening of the middle and ring fingers, although I can still lift all my fingers off a table top. I've been stretching them twice a day for maybe a month, and I believe I'm staving off having them pulled down to my palm, and the boomerang seems to be getting softer.

In my RH, in the same place as in my LH, I've found a proto-bump. I can see it as a slight hillock, but I think the only other people who would even been able to see it are fellow DC victims and DC doctors. I stretch those fingers too, even thuogh they're not tight.

10/28/09 01:44
CaptainMorgan 
10/28/09 01:44
CaptainMorgan 
Re: NA IN SEATTLE - NOT

jimh and Randy H, your are correct, I did a little more research and it appears the first vestiges of Needle Aponeurotomy were evident in 1822 and perfected in France in the 1970's. Info on this can be found at http://plasticsurgerysf.com/dupuytrens/ including probability of recurrence following NA. I still dont understand the lack of info available from Ericson Hand and Nerve Center since they say they have been doing NA for "18 years".

10/28/09 08:31
JHuang 
10/28/09 08:31
JHuang 
Re: NA IN SEATTLE - NOT

The first surgical release for Dupuytren's was done in 1822 in Britain by Sir Astley Cooper, which was a percutaneous technique similar to NA. However, most hand surgeons adopted an open technique to remove all diseased Dupuytren's cords to prevent recurrence. Lersimaux, a rheumatologist in Paris, popularized the current NA technique. Charles Eaton, MD learned the technique and brought it back to the US in 2003. It has gained momentum recently. NA is simple to perform, but there are techniques and pearls to performing NA well. Most surgeons can do a limited NA release in the palm for milder contractures. However, only a few surgeons do a extensive release with NA well (ie. Eaton, Denkler, Benhaim....) who are properly trained. I did my training during my fellowship with Dr. Benhaim. Depending on the disease pattern, some patients are not candidates for NA and need an open release.

Radiotherapy has been proven to be effective in earlier stages in slowing down progression. Although rare, there are concerns for complications of any radiation therapy (development of malignancy or cancer, scarring in the hand/finger, nerve irritation, etc..). Many hand surgeons do not refer patients for radiation therapy due to concerns for these rare but serious complications.

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