To Gary Evans: Lighten up a bit. I think it is obvious to all that read these forums that you have an agenda, so don’t be so defensive when someone calls you on it. You do however, raise some interesting points, and I enjoy you sharing your research with the forum, biased though it may be.

To Kristen: What a great post. Informative and witty…..and I agree with all your points, except maybe for bopping Gary upside the head. I personally have been to Europe twice for NA. Once to Paris two years ago (I posted about my experience in June 2000 under the heading “French Connection”), and once recently to Switzerland. Absolutely no recurrence after the first procedure performed by Dr. Badois (55 degree contracture of the ring metacarpophalangeal joint right hand), and hopefully an equally successful result from the procedure performed by the very affable and competent Dr. Rapapport in Yverdon. (90+ degree contracture of the PIP joint little finger right hand).

To Others: Regardless of what Gary has stated, NA performed on a digit with 90 degree contracture IS a viable alternative to surgery. The PIP joint that Dr. Rapapport treated is at present about 5 degrees and I have little doubt it will be perfectly straight after wearing my splint for about a month. I have before pictures and intend to post those along with the after pictures on my website in about a month. Will post the URL here for those that are interested. If it recurs…so be it. I will look upon it as another wonderful opportunity to see a part of Europe. For those concerned about the expenses, I suggest you read other posts addressing that issue in these forums. As a dentist, I factor in the time I would have to be out of the office with traditional surgery as a *huge* expense. With NA I am able to start treating patients immediately. Of course, your mileage may vary.

One other point that I have not found mentioned elsewhere. After the NA performed by Dr. Badois, I noticed that after a period of a couple of months the remaining parts the cord that was severed simply were resorbed by the body. I feel this is important. I am sure it does not occur in all cases, but the fact remains that once the whole of the cord was severed, in my case, the remaining pathologic tissue simply disappeared. I could envision some interesting research emanating from this phenomenon.

Mike,
My question again, Why NA instead of a local fasciotomy that severs the cord only and is not invasive and is an "in and out procedure" with a local anesthetic? It does exactly the same as NA. It is done everyday in the U.S. Simple procedure. Simple question. What about that question causes anger and denouncement of the medical establishment in the world? Do you also think the AMA is a worthless group of people? Do you also think hand surgeons around the world are incompetent? Is it just with Dupuytren's that they are incompetent or are they that way with all hand surgeries?
I am not promoting having a local fasciotomy, because I don't think it is as good as a limited fasciectomy. I am not promoting a limited fasciectomy either, but it is the most common procedure worldwide for Dupuytren's.
Gary

Mike,
It is a procedure used all of the time for older people who, in the opinion of a surgeon, should not go through an invasive surgery. It is also done when recurrence in older patients is not usually a problem. Remember, the later in life a person needs surgery for DC, the greater the chance that their first surgery will be their last. When the surgeon looked at my hand (90 degrees contracture), he said he was tempted to "pop the cord" right then. He was not completely serious at that time, but it was then that he told me that it was standard procedure for older patients. It was his belief, after doing this for over 30 years, that the local fasciotomy wasn't as good as the limited fasciectomy for a younger person because of recurrence.

No, I am not a Doctor, nor am I associated in any way with the "incompetent AMA". I am a person who had a limited fasciectomy 10 months ago on a finger that was 90 degrees contracted and is now 0 degrees and no different than before I contracted Dupuytren's.
Gary

Here's a good discussion of the various procedures (and some unpleasant photos):
http://www.emedicine.com/plastic/topic299.htm

I think the main advantage of NA over a fasciotomy is that NA is so minimally invasive that there's no scarring - so recovery is trivial, and the procedure can be repeated if necessary. A fasciotomy is a surgery, although less extensive than a fasiectomy.

Response to Mike K. and Gary

Mike – Nice to hear from you again. Your post a couple years ago was one of the many factors I considered when deciding between surgery and NA; in fact, I still have a printed copy of it. The fact that you are a medical professional and thoroughly investigated the options made a lot of us sit up and take note.

Gary – Nowhere did I bash U.S. surgeons. I have great respect for their skills and the board certification process. I stated clearly that they all gave me the straight poop on what I am up against and I simply chose not to avail myself of their skills. The one that read all the literature on NA, watched the videotape and then called to give me his educated opinion on the procedure has my greatest respect and appreciation.

As for trips to Europe not being available to “average” people, I beg to differ. I couldn’t be more average. You implied that I must be wealthy; tragically, this couldn’t be farther from the truth. I’m a librarian, for crying out loud. You’d be hard pressed to find a career requiring a Master’s degree with crappier salaries. “Librarians who fly the Concorde” is an extremely small club. I flew round trip last month (in a seat designed for an anorexic eight year old) for $564 on Air France. The very adequate hotel room was $130. Those with less of an aversion to cold weather than I can fly between now and March from the east coast of the U.S. for as little as $300. Forty years ago, trips to Europe were only for the wealthy; thankfully that has changed.

I now make a solemn vow to everyone on this forum that I will NEVER again respond to one of Gary’s posts. Kristen