I'll join this discussion...I had surgery on my left pinky in October of 2011 and NA on right hand in Dec 2012.
My left pinky, after surgery, is back to about a 35 degree contracture because of the scar tissue. Since that was my first "treatment" for any of my DD problems I decided to check with Dr. Denkler about some NA possibilities.

Saw Dr. Denkler last month and he worked on my right hand for about an hour. Because I don't have real distinctive cords but do have lots of little nodules, Dr Denkler would have preferred using Xiaflex but said he would see what he could do with the NA because my insurance (Kaiser) doesn't cover NA or Xiaflex. He was able to get more release on both fingers than I was thinking he could. He also said that he thought that he could do some work with Xiaflex to straighten out the left pinky that is is crooked because of the scar tissue from the surgery.

My pinky looks pretty straight but he wasn't completely satisfied with my index finger, though it is better. I had the work done on 12/6 and both fingers are still swollen a bit and don't bend very well. I'm hoping they'll improve when the swelling subsides.
Anyone else experience this kind of recovery time with NA? I know mine will be different than those that had a distinctive cord to work on. He also thinks that he can get more release on my stubborn right index finger with Xiaflex.

My fear, no matter which option I use, is stirring up more trouble by "disturbing" this stuff.

Kay

Minimally invasive treatments, like Xiaflex or NA, won't stir up much and don't create much scar tissue.

Wolfgang

kay:

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My fear, no matter which option I use, is stirring up more trouble by "disturbing" this stuff.

Kay

kay:

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...my insurance (Kaiser) doesn't cover NA or Xiaflex.

Thanks hammer,

While I knew that NA can be difficult if not impossible when scar tissue from previous Open Surgery is present, I did not know that Xiaflex has been shown to get around this problem. That makes sense because with NA you have to physically rip the Dups cords with the needle and previous scar tissue can incase them making it hard to do. That’s great. Your experience is quite valuable.

I still would submit that with virgin hands, NA is just as effective. And yes, there has been some hope and discussion that Xiaflex would seal the ends of the broken cords (where NA does not) leading to lower rates of recurrence. That is still unproven.

My NA from 10 years ago is holding just fine. It would be great if it could be established through head to head studies that there is a significant difference between NA and Xiaflex in rates of recurrence. So far all we have is the German assessment that backs up my assertion of NA's equivalence and perhaps superiority.

The question must be asked, why has Xiaflex leap forged over NA in it's availability in the US while in Europe NA remains king? (There are about 50 MD's who offer Xiaflex within 50 miles of me, where NA has peaked at only a few) I suspect that while Europe had already accepted NA’s value, it is still only catching on in the US. Therefore the US was still ripe for the persuasive influence of the extensive marketing behind Xiaflex. But the previous knowledge of the cost and effectiveness of NA made Europe immune to such influence. That goes back to my point that it was Marketing that gave Xiaflex acceptance in the US. What happened in Europe supports this opinion.

Like Wolfgang I'm grateful that Xiaflex is available to make up for NA's shortcoming in cases like yours. I can also see that with the world rushing to Xiaflex in the US, NA's further expansion is probably doomed. Eaton himself has given up the cause. I wonder if he saw the writing on the wall????

Go to https://www.xiaflex.com/locator.php and look for doctors near you in the US. It's clear that Xiaflex has blown NA away. But not for reasons of safety, effectiveness, recurrence or cost.

For further reading on Xiaflex's history and triumph: http://www.nytimes.com/2010/03/16/busine...ed=all&_r=0

Hey Dave,

In time there will be fewer and fewer patients with previous surgery as Xiaflex (or NA) becomes the first order of business for new Dups patients. Open Surgery will be reserved for when Xiaflex fails. That will be unusual. Therefore Xiaflex's apparent advantage over NA will become a non-issue.

However, I concede that Xiaflex's success will probably render NA moot as well. It doesn't matter that NA is superior to Xiaflex for virgin hands at a fraction of the cost. It doesn't matter for the reasons I have already posted. My 10 year journey as an NA patient advocate has nearly run it's course. Sadly patients and insurance companies will now pay significantly more than need be. They will not be given a choice. That is the way of things, but an important eye opener for those who have been watching and are informed. Europe will save money as it goes the other direction in the NA vs Xiaflex competition for first line of defense against our common disease.

At the end of the day my fight was against needless Open Surgery which now most patients will thankfully avoid forever. Either way we all win. I'd gladly pay $4,000 for Xiaflex over Open Surgery any day! But I wont. I'll pay the $1,000 for NA and spend the rest on Scuba in the Caribbean!