Last Monday, I had an appointment with Dr. Katerelos. My hand was thoroughly palpated again. The MRI showed no evidence of DD in any area outside the thumb and forefinger area. He marked the area to be radiated to include thumb, fore finger, middle finger for margin, and the palm underneath all 3 fingers. I pointed out dimpling in my palm under the ring finger as an indicator of DD I asked him about having the wider margin to include the ring finger. He felt no nodules or cords and the MRI did not show anything. He said he trusts my analysis with my experience with my other hand and this hand over the last 3 1/2 years, so he mapped the field to extend the margin to include the ring finger. The field included all joints of the thumb and forefinger but carefully checked to insure that it did not include the nail bed even though it is done from the palm side. The field included the Metacarpal joint and PIP joint of my ring finger.

Dr. K laughing described the RT as going into he DNA of the misbehaving cells and telling them to stop. He didn't use those exact words, but it was an equally non-technical description. The progression of Dupuytren's Disease in my first/right hand was extremely more aggressive in comparison to my left hand as DD in my left hand has remained almost entirely in the thumb/forefinger for well over a year.

After the mapping, the metal plate was made, and I had the first radiation treatment less than 2 hours later. The technicians were very thorough and precise. At Scripps, I stood and held my hand on the metal shelf. Here at Loma Linda, they had me lie down. Given a choice, I chose to have my hand over my head rather than down by my side because it was more comfortable for me. One tech covered me with 2 blankets and had towels put under any area that would make me more comfortable. Besides keeping me from having hypothermia, I felt very pampered. :-) One tech had on 4 layers herself. The AC is very efficient!

Using the plastic sheet that had the outline of my hand and radiation field marked, they carefully positioned each finger then firmly taped down each finger and thumb so that they would not shift. The little finger was taped down outside the radiation field. Dr. Katerelos came in, checked the placement based on the map, and gave the OK. The techs put the bolus over my hand, then did the radiation. It took about 2 minutes for the machine to warm up and less than a minute for the RT.

The same process was done Wednesday and Friday except Dr. Katerelos did not check, and it only took about 15 minutes for wrapping me in the warm blankets :-), positioning, and treatment. I will see Dr. K tomorrow. I will have RT Monday, Wednesday, and Friday this week then the 7th and final treatment next Monday. I have no signs of dryness or anything at this point.

I have complete confidence in my doctor, the facility, and this RT. Since the protocol that Scripps used of 10 x 2Gy = 20Gy over 2 weeks stopped the progression of the very aggressive disease in my right hand, I have no doubt that this protocol of 7 x 3Gy = 21GY over 2 weeks will be effective.

Any questions?

I didn't ask. Dr. Tripuranini also deliberately avoided the nail. It's obvious that the nail bed is different, so I suppose that's the reason. I don't understand how radiation would affect the nail bed tissue differently.

On another note, I asked Dr. K if he planned to do research. He said there is such an increase melanoma that is so aggressive that he feels compelled to research that. With obvious concern and compassion, he said he had a patient whose melanoma tumor continued to grow even while he was doing everything known to stop it. He lost that patient. He understands Dupuytren's disease can be debilitating, but he is regularly faced with melanoma patients and it is a fatal disease.

As much as I would love for him to research DD, I understand. I signed a form to share info for research, so as he does more and more RT for DD, information will be gathering. It is a teaching university and they do a lot of research. Maybe some grad student will do research on it inder Dr. K's guidance.

Luba, Don't know until it is submitted. They looked at Scripps billing codes, etc. and don't see why Medicare won't cover it, but no one every knows for sure.

They were quite sure it will be covered and didn't see the need to sign the papers saying I would pay if insurance didn't. LLUMC policies require that paper be signed that I'll pay if insurance doesn't . I figure what I may have to pay won't be worse than Scripps was, and these people are on top of it and getting documentation/justification for why it should be paid in preparation to appeal if Medicare doesn't pay. Scripps didn't bother to appeal.

Looks like we'll know if Medicare will or will not pay. They paid for the actual RT, the big ticket item, but not for the radiologist. Absolutely NO logic to that. I couldn't have gotten the RT if the radiologist didn't prescribe it. Duh!