Sherwood & others:

Without question, Michael is correct. There are cases where Traditional Invasive Surgery is preferable to NA. These are the small number of cases where NA is powerless to correct a contraction. An example is as Mike stated: Dups growth in "diffuse patterns". For NA to be effective a discernible cord must be present that, when weakened by the needle, may be ruptured by stretching the finger back in a straight position. No chord to snap...............no NA.

The same is true with knee surgery and heart surgery. There are cases where orthoscipic surgery and angioplasty simply don't give sufficient access to the tissue that must be corrected. Then, and only then, is the more invasive procedure even considered. No one can deny that these very effective less invasive procedures are considered by doctors and patients to be minor medical miracles. When the proven advantages of NA eventually overwhelm the current state of medical ignorance, NA will take it's rightful place along side open surgery as the initial treatment of choice.

No one has their chest cavity opened up until doctors first determine that angioplasty will be insufficient. Because of their current ignorance regarding NA, American Dups surgeons go *immediately* to the invasive surgical option. If you as a patient elect to go along with them, that is certainly your choice. However, the logic of such a choice flies in the face of the overwhelming trend toward less invasive procedures in all of medicine, and the solid proof that NA is both safe and very often highly effective. The ongoing debate regarding the possible increase in reoccurrence rates with NA is made moot do to NA's almost immediate rate of recovery and it's infinite repeatability.

Yes, depending on how you define "success", the vast majority of Open Surgeries (Fasciectomy) are considered successful. However, by way of analogy, announcing the success of an Open Heart Surgery to clear a blockage or two when a simple angioplasty would have done the trick would be nothing short of folly.

I have a question: can NA be used on Dups tissue growing on that band-like tendon connecting the base of the thumb and the palm? I'd guess that NA'd be good only for cords, but maybe someone out there knows for sure.

Thanks, MML

I had surgery on October 28 and my palm was pretty well sliced up. The cut into my ring finger didn't heal and I had a skin graft which eventually fell off for the most part. Everything is pretty well healed now and I've had 7 sessions of hand therapy which I am continuing at home. I can't make a fist with my left hand and continue to exercise and work on it. Is there a grip that I can make or get to help me grip a golf club? Any views as to how long this thing will take to get back to normal, if ever? The surgeon told me I'd be back on the golf course in 3 to 6 weeks...ha. Now he is telling me that my hand will be healed in 9 months to a year. Any input would be much appreciated.

I spoke with a hand surgeon at my Kaiser center about NA today:

Q: Had he heard of NA?
A: Yes, I wasn't the first to ask him about it.

Q: What did he think of it?
A: He hadn't researched it thoroughly, but what he knew of it didn't make sense to him. NA leaves Dupuytren's tissue, which simply grows back. According to him, NA has a 100% reoccurance rate.

(My comment: the crux of making the NA/fasciectomy choice might revolve around the rate at which your Dup's grows. If it grows quickly, you might be better off with a fasciectomy, as the chances are far higher that reoccurance will be prevented and you won't have to keep coming back at frequent intervals. If it grows slowly, then NA might be the way to go, because recovery time is so much quicker, and the slow growth means you have a period of years before you have to go back for another one.)

Q: Is there anything to prevent one from having a fasciectomy after having tried NA?
A: No.

Q: Does manual activity have any effect on Dups?
A: No.

Q: Are there any known dietary factors which either speed or slow the progression of Dups?
A: No.

Q: What did he know about Collegenase?
A: Still in clinical trials, but even if it gets to market, it would have to be used with great care. It's dangerous, can even dissolve tendons.

Q: Did he know anything about experiments with cancer treatments used against Dups, e.g. tamoxifen, 5-flouroucil; or FibroGen's FG109?
A: No.

Q: What did he know of the studies indicating an increased risk of mortality associated with stage 2 Dups?
A: He considered himself pretty current, but he had never heard of such a thing, and it didn't jive with his experience. But he laid no claim to being an epidemiologist.

Then we had an extended discussion of this last point, possible flaws in the studies, possible confounding factors like smoking, alcohol, or diabetes, more pragmatic comments like 'why worry if there's nothing you can do about it', etc. In short, he couldn't really respond knowledgeably to this question, but on the whole he was skeptical. It is interesting that the possibility of increased mortality is not discussed (or even known) in clinical circles.

- MML

I second that. I'm sure others will agree that we should all be pushing our surgeons/others for more answers as Michael has done so well. Don't know about his claim that there is a 100% recurrence rate with NA.