I guess by the 'traditional surgery advocate', you mean me, but the title is inaccurate.

In reflecting on the hand surgeon's comments after having interviewed him, I guess I am less than satisfied with a couple of his responses - less by their content than by the feeling that he hadn't really really given them much thought; or, on the issue of mortality, even been aware of it. Granted, there is probably more BS, hysteria, and crackpottery on health issues than any other, and physicians have to filter it out; but a filter is just as broken when it excludes good stuff as when it lets in bad stuff.

Now, his point about reoccurance seems to me to have validity, though I don't know if I believe '100% reoccurance' with NA. Dups tissue is self-propagating, and it stands to reason that if a procedure leaves some actively growing tissue in the hand, contracture is going to reoccur. Of course, Dup's growth does sometimes cease on it's own, regardless of procedure.

But by his own admission, trying NA certainly doesn't preclude one from resorting to fasciectomy later, and to me that's a crucial point. NA is certainly worth a try. If you have a fast reoccurance, then you can go for the fasciectomy.

I was also dissatisfied with his responses on the mortality issue. These studies were made by reputable researchers with reputable organizations and published in reputable peer-reviewed journals like 'Journal of Clinical Epidemilogy', 'Journal of Hand Surgery' and others. And the statistical signals are too strong to just blow off out of hand. There are certainly questions that need answering, but it bothers me that he and his clinician colleagues weren't even aware of the issue.

Regards, MML

The major objections of the uninformed professional regarding NA are as previously posted:

1) A "Blind Procedure" where the risk of nerve damage is high

2) Higher and faster rates of reoccurrence.

Eaton has shown that #1 is a non-issue for someone properly trained. Secondly, though NA will probably prove to have higher and faster rates of reoccurrence, reoccurrence for both NA *and* Traditional Invasive Surgery has more to do with the severity of the individual's disease than anything else.

I don't see the argument as "NA Vs Surgery", but whether or not the data shows that NA is worth considering as a "First Step" procedure before moving on to some form of invasive "Open" surgery if necessary. If the French statistics are to be believed, then the answer is YES. Added to this is Eaton's first year+ of clinical practice which, if the numerous testimonies posted here are to be believed, is another YES.

Therefore I don't see this as an "Eithor/Or" issue, but a "Both/And", with surgery reserved for those cases where NA may be inadequate. That being the case, none of use have anything to loose and much to gain by trying NA first. Those who have gone through *both* procedures all seem to stipulate to that.

Michael: I can almost guarantee that toM did *not* have you in mind as the board's "surgical advocate". And, I would like to think that as Eaton's success and expansion continues, such an Advocate (if he is honest) is not immune to the strong force pulling him slowly away from the Dark Side :)

Terry,

Just out of curiosity: do you go to the Santa Clara Kaiser?

Also, I should make clear that the mortality issues I have mentioned have nothing to do with NA or fasciectomy, only with Dups itself.

-MML

I am 42 years old and dup first showed up in my right hand at age 36. It grew from the centre of the palm to the middle finger and a large knuckle pad formed. The finger was quite badly bent and the palm had a large lump. On Dec. 16, 2004 I had surgery at the University of Alberta Hospital in Edmonton, Alberta. On Dec. 29 I had the bandages, splint and stitches removed. On Jan. 4 I had my follow up appointment and I had full movement of my hand, although it was a little stiff. On Jan. 17 I was back to work as a Millwright and my hand was as good as new. No pain, no lumps and no contraction. Only a straight scar down the centre of my palm which is fading more and more each day. After reading about and studying Dupuytrens for 6 years I am possitive that my case was caused by impacting with hand and power tools. I use to do a lot of pounding with the palm of my hand. (no more)

I don't no if I'll have reoccuring dup or if I'll have further complications in the future but for now I would have to say my operation was a great success. I'm keeping my fingers crossed.

Just wanted to share a good story to let readers know that not all things are bad.

Tim

Holy cow. I had no idea DC operations cost so much. $19,000 no wonder doctors are so resistant to NA.

nt