Don,

Recurrence, though certainly an issue with OS, is assumed by some to be to be a *far* greater issue with NA. The question is, exactly how much greater is the rate of recurrence with NA, and considering it's *far* lower rates of side effects and ease of recovery, is it the logical first procedure of choice?

At the end of the day, I'll bet it will comes down to the individual patient and how his/her particular hand(s) and disease respond to the needle or the knife. That being said, I would argue for at least one or two attempts at NA before upping the anti. What is to be lost by this approach?

Don, Eaton did his first NA less than 3 years ago, so your recurrence is a *tad* bit faster than you thought. Personally however, I would circle the runway with NA every two or three years indefinitely to avoid another OS crash-landing. That's me. Others have one OS, walk away, and are never heard from again.

It is sobering to hear the recurrence reports now that NA has had it's first North American test. But Don, I'll bet you dollars to donuts you'd go another round with Denkler in a few years than tangle with the knife in the hopes of putting on the breaks.

And what *is* "more aggressive". Inquiring Minds (from the Dessert to the Sea) *do* want to know.

RBH

I had Charles Eaton in Florida do mine about a year and a half ago. I am in California and it was worth the trip to fly across the US to his office. His expertise is unmatched. I will do it again when the need arises again. I was more than satisfied with the entire experience.

I heard from a hand surgeon that NA should not be performed during a time where there is DC growth/activity in the hand. One should wait until there is stability. Otherwise, DC is likely to come back very quickly. That would appear to make sense since it is my understanding that NA does not stop further growth (hopefully it does not encourage growth).
Have any of you heard similar warnings about timing of NA?

Donald

Having followed the NA movement for some time I have *never* heard anyone suggest what your surgeon is saying.
What we have learned is NA should be done as soon as there is enough contraction to snap the chord. This is true even more so for the PIP, as it doesn't come back to straight as well as the MCP.

If anything, NA often disrupts Dups growth. After NA a large bump in the center of my palm was broken up and has become *completely* inactive. NA killed it (for now). Previously it was on the move.

Unfortunately there are some people who's disease is so aggressive that NA just can't slow it down. OS with skin graft is the best we have at present for such cases. However, I don't think there is a good argument for progressing directly to OS without exhausting NA first.

Get a second opinion from a CHS who is committed to NA as a first line of treatment.