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2nd time around
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03/19/2005 23:45
miriam 
03/19/2005 23:45
miriam 
2nd time around

Hi all

how many of you ahve been to Dr eaton TWICE already?

I've jsut returned form FL 2 days ago.

First time had NA on BOTH hands.

This time had NA on only one hand and
it was NOT FUN !

First time was a breeze- this time it hurt quite a bit, but them Dr Eaton ssays I'm more sensitive than most....
ucky me!

My hand is all back and blue (palm and back of hand too)
Anyone with similar reactions?


Of course I'll go again, butI'm just curious . My second time was only 11 months after the first procedure. Lucky me again;I have the galopping type versus the slow progresion type.
Oh well- I'm sure surgery is worse and I'll keep going. Wish there were an MD willing to do this in WA.

I have begged the docs at the University of WA to do this- They all refused!
Can u beat that? Looking forward to some replies.
Thanks- Miriam



03/20/2005 23:24
Anon

not registered

03/20/2005 23:24
Anon

not registered

There are six doctors in North America who do NA

Dear Miriam,

AS you know, Dr Eaton and Dr. Zidel are also NA practitioners. Then there is Dr. Bourland.

1) Dr. Eaton FL
2) Dr. Zidel FL
3) Dr. Pess NJ
4) Dr. Denkler
5) Dr. Bourland
6) Dr. Spacek Quebec Canada

03/20/2005 23:24
Sean 
03/20/2005 23:24
Sean 
2nd time

Anon,
You say, "AS you know, Dr Eaton and Dr. Zidel are also NA practitioners."

Unless I read her post incorrectly, I think Miriam did have NA twice in the last 11 months.

Miriam, what did Dr. Eaton say about having surgery? Did he leave the choice up to you? Or did he say that surgery might be appropriate? Does he even mention surgery? Do you have a splint with the NA procedure?

03/20/2005 23:33
Anon

not registered

03/20/2005 23:33
Anon

not registered

Yikes

Dear Miriam,

Twice in 11 months? Through the postings here, myself and others have noticed that people with the more aggressive form of DC appear to have DC at a younger age - meaining rate of reoccurance. This isn't scientific evidence just observation.

Please tell us more about you and your hands. What age are you? What was your age of onset? Have you had surgery before? Are you diabetic? Have you had frozen shoulder....basically, can you tell us about your medical history so we can get a better grasp?

Thanks,
Anon

03/21/2005 23:17
M Roberts

not registered

03/21/2005 23:17
M Roberts

not registered

to ANON: Add Dr. Binhammer, Toronto

You missed out on Dr. Paul Binhammr in Toronto on your North American list.

03/21/2005 23:58
Randy H.

not registered

03/21/2005 23:58
Randy H.

not registered

The Data?

Miriam:

I believe that what you are saying is that at your present rate of growth you will need to have NA done about once a year. That's a lot, though some may need it even more often than that. How far did you let it go in terms of degrees of contraction before you went again? Did Eaton give you a target range of degrees before you pulled the repeat NA trigger? I'm at about 35 degrees starting from *0* about 18 months ago. That's fairly aggressive. It's a PIP so I figure the sooner I do it the better chance of coming back to near Zero.

You know, the *biggest* issue with NA is, and will continue to be, it's rate of recurrence when compared to Open Surgery. Safety doesn't appear to be an issue when done by someone who knows what they're doing. We've *got* to have reliable data so people's decisions can be better informed. Sean, is there accurate data on average recurrence rates after OS? Things like the % of hands with regrowth after 1 year/2years/3....10 years...etc? Also, generally repeat surgery will be put off until contraction is >45 degrees, whereas NA is elective at >25 or so and might be done *sooner*. For that reason it may be *hard* to compare Apples to Oranges when the Orange crop (NA) can finally be well quantified. The French report is fuzzy, saying only that recurrence is >50% for *both* after 5 years. Admittedly that could mean OS = 51% and NA = 99%. Not good (but acceptable for the likes of *me*). What are the *actual* average OS recurrence numbers against which NA will need to be judged? To say NA has a *High* or *Higher* rate or recurrence is helpful but not *nearly* accurate enough to know it's true value or lack thereof. Is there good OS data to compare it with?

03/21/2005 23:20
Sean 
03/21/2005 23:20
Sean 
second time

Randy H,
I think it will always be difficult to make the comparison's between fasciectomies and NA, because DD is different with most people. I do think there are studies which compare fasciectomies to fasciotomies (which would include NA). I think that is the data which is the basis for the feeling of higher recurrence for fasciotomies (and thus NA).

The comparisons are difficult because fasciotomies are generally done on the easiest situations, whereas fasciectomies are done on most all situations including the most difficult.

03/21/2005 23:39
Randy H.

not registered

03/21/2005 23:39
Randy H.

not registered

Just the Facts M~sq~am

If you mean "difficult" in terms of number of fingers, degree of contraction, PIP joint involvement, there are some fairly difficult before & afters shown on Eaton's sight. (It really amazes me how far some people let this thing go before seeking treatment). And no question, NA is a "type" of fasciotomie, but due to it's much lower invasiveness it may be in a class slightly apart (yes, debateable). But what I'm getting at is "all thing being equal" (all data from hands where both procedures are possible).

See, eventually we will have *good* controlled studies on NA. Recurrence, being it's weakest link, will be the most scrutinized by the medical community who will owe it to *us* to evaluate the data. Will not OS be the base line against which this modified form of fasciotomie *must* be judged? The "*feeling* of higher recurrence" (as you put it) will, at some point, need to get down to *hard* comparative numbers. I've just never heard what the hard numbers for OS actually *are*. Everyone is different yes, but at least we need the statistical *average*. If you're going to play the Ponies you need to know their *handicap* (maybe not the best choice or word) :-(

As we've now both pointed out, the data will be hard to come by for a variety of reasons. That's too bad because can you think of anything more significant to evaluating NA's comparative value? We all know the Up Side (yes, some of have made sure of that!). We've got to know the *real* Downside as well. Not someone's guess or opinion that will always be subject to human bias.

03/21/2005 23:44
Randy H.

not registered

03/21/2005 23:44
Randy H.

not registered

The Right Question?

Sean,

I addressed that post to *you* because no one seems to be able to pull out hard to find data as well. However, if any members of our Surgical Community can point us in the right direction that would be appreciated as well. Am I asking the right question?

03/21/2005 23:56
Sean 
03/21/2005 23:56
Sean 
DD

I think it is the right question. Dr. Eaton perhaps knows the data because on his website he says that recurrence is probably higher with NA than a fasciectomy. I agree with you that the tradeoff would still favor NA (or a routine fasciotomy) even if recurrence was somewhat more rapid with NA. It is just difficult to make a blanket decision for everyone given the different situations for everyone. For me it will be a tough decision for my next procedure, because my hand seems perfect, three years after surgery. For you, it is an easy decision because of your experience.

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