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Dupuytren's NA Surgery Planned with Dr. Benhaim
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09/10/06 02:35
carmen

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09/10/06 02:35
carmen

not registered

Dupuytren's NA Surgery Planned with Dr. Benhaim

Since my first post I have not hade the N.A. procedure performed; but I am scheduled for Sept. 20. It will be on my right hand. I never asked what the cost was, since I am hopeful my insurance will cover it. Either way, I am going to do it.

I did meet with Dr. Benhaim at his office at UCLA and he is very nice and very thorough in explaining both the standard surgical procedure and the N.A. procedure. It took about a month to get an appointment with him for a consultation. Then I had to wait another month to get the NA surgical appointment. (This is done at an outpatient surgery center at UCLA.) He does not perform the NA during this first visit. I thought I read that in Florida the doctor will perform the NA surgery at the time of the initial consultation. But I am not sure about that. In any case, Dr. Benhaim will not do that. You have to schedule a separate appointment for the surgery.

I found out I am not a really great candidate for the N.A. procedure, as I have DC in the finger up to the knuckle as well as in the palm. Apparently there are many nerves in the finger which could get easily be damanged in such a "blind" procedure. By "blind" procedure he means that because in the NA the finger or hand is not opened up, the doctor cannot actually see where the blade (actually a very sharp hypodermic needle) is cutting. He makes between 10-12 slit/cuts along the tendon to release it. The tendon is usually--but not always--free of these nerves. So, he explained there is a risk of some nerve damage, which may result in numbness. But, he has not had this happen yet. So, I hope I am not the first!! But we decided to go ahead with it anyway, with the hopes that the knuckle part of the DC will release on its own after the tendon is released. I can always return and have more work done on the finger in the regular manner as a mini-surgery.

I also made my decision to go ahead with the NA in part because I have a condition known as RSD (reflex sympathetic dystrophy) which may make the regular surgery more apt to cause residual constant pain--which I do not want. Although I had a mild case after surgery to set a broken left wrist last year, it cleared up with treatment and we are taking preventative measures before this N.A. surgery. I think I may pose more challenges than most.

I will know more after the 20th.

He has me scheduled to begin physical therapy (occupational therapy, really) the next day. So, NA has a way much faster healing time. No cast, either.

09/10/06 02:49
Randy H.

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09/10/06 02:49
Randy H.

not registered

Nerve Damage

carmen,

A recent study showed that the rate of nerve damage with traditional surgery is significantly higher than with NA. My surgeon doing the traditional invasive surgery at UCLA could see *just* fine. I have permanent nerve damage.

Eaton might have caused nerve damage when he did my NA (blind as he was :) except that I told him I could feel a shap electric shock. He stopped immediately and took a different angle. You personally are the safely net to protect against your own nerve damage. I'm sure you will.

09/10/06 02:59
CM

not registered

09/10/06 02:59
CM

not registered

Surgery

Carmen,

The study Randy referred to is flawed and cannot be trusted.

As to the safety of surgery vs. NA: well its just common sense. If you can see what you are doing, you are less likely to cause problems. Unfortunately, some day soon there will be a "couple" of nerves cut with NA and then the "supposed" safe NA procedure will be the same as surgery. What this means is that you have to find a surgeon that is qualified to do the surgery. Also, if you go with NA its the same thing: go for the best.

On a side note the NA proponents should tone it down and hope that NA is slowly adopted by more doctors. If everyone jumped into it, you can bet that there will be errors and cut nerves. It will happen.

My surgery went very well and the only way you would know is a scar on my palm that is quickly fading. The surgery took about 5 hours and I was home. Working a couple of days later. No recurrance and so far so good.

Surgery works. Trust your surgeon (but check him or her out first) and good luck.

09/11/06 02:43
Carmen

not registered

09/11/06 02:43
Carmen

not registered

NA Surgery Planned

Randy:

Thanks for the thoughts. I think Dr. Benhaim is qualified to do this. I was impressed that he probably would have preferred to do the traditional surgery, but the RSD condition makes that surgery a little more complicated. Also, the fact that it is "blind" surgery is why he is avoiding the actual finger itself, as that is where the nerves really are all over the place.

I agree that we don't want every "surgeon" doing this. It is very complicated work. Even the regular surgery is very complicated. My highly qualified (local) hand surgeon would not want to do either one on me. So, you can see my predicament. Wish me luck.

Carmen

09/11/06 02:00
Randy H.

not registered

09/11/06 02:00
Randy H.

not registered

The statistics Are On Your Side

Actually Carmen, according to Dr. Eaton NA is "simplistic and crude" when compared to typical Open Surgery. In Europe it is performed mainly by Rheumatologists with *no* other surgical training. So far in the US it has mostly been in the hands of CHS, which might explain why the rate of nerve damage is at Zero so far with over 3,000 procedures. Also, while we all need to consider legitimate criticism of the study I posted here, someone simply saying it was "flawed" without a real critique is a meaningless statement. In regard to Zero Major Complications in the NA group, exactly what flaw?

That's not to say that nerve damage isn't a virtual *certanty* in US NA. However, at 3,000+ NA procedures so far in the US, it would take an immediate 60 such instances just to catch up statistically with the >2% rate of nerve damage typical of OS. The key is good training on the part of new CHS, either French or working with those with experience. Both Denkler and Press have helped out in this regard.

Again Carmen, any NA vet will tell you that a lot of the responsibility for avoiding nerve damage lies with *you*. Don't be nervous, but be on your toes to tell Dr. Benhaim *immediately* if you feel a small electrical shock. You'll know it if you feel one. It means he's getting too close to a nerve.

09/11/06 02:34
Mark D

not registered

09/11/06 02:34
Mark D

not registered

Dr. Benhaim

Carmen:

Randy mskes great points, as usual.

All that I want to add is my opinion that Dr. Benahim is an outstanding surgeon.

Although I didn't know Dr. Benhaim did N.A. when I made my N.A. appointment with Dr. Denkler, I've been using Dr. Benhaim as my "local" CHS.

Keith Denkler himnself told me that Dr. Benhaim is an outstanding CHS.

Benhaim is also a good guy - that's important too.

Good luck.

Mark

09/12/06 02:31
Randy H.

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09/12/06 02:31
Randy H.

not registered

Thanks Dr. R

Thanks Mark.

At last contact, the Top Dog CHSs working out of UCLA were only partially sympathetic to NA at best. As a group of top pros they meet regularly to keep up with the latest. Dr. Benhaim has stepped up out of this pack to be the first to incorporate NA into his proactive. He has done so alone, in the shadow of his senior and nationally recognized elders.

What more can I say? Professional guts and integrity. This also explains his more conservative approach that I see reflected here on the Forum. Not a bad thing at all.
Working with Denkler from SF, the two of them are the future upon which West Coast NA will be built.

True to his word, and at my request, the top man at UCLA did in fact attended Eaton's (et all) presentation. That's all I can ask, and I want to thank him for doing so.

09/13/06 02:51
Mark D

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09/13/06 02:51
Mark D

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CA Docs - Benhaim & Denkler

Randy:

As usual, I appreciate your post.

And yes, we Californians are blessed to have the Benhaim-Denkler Axis running from South to North.

Based on what I've heard from Dr. Denkler & Dr. Pess, I'm hoping that more CHSs will see the light.

Mark

09/13/06 02:10
Randy H.

not registered

09/13/06 02:10
Randy H.

not registered

Update & Retraction

We have finally received report of nerve damaged caused by NA in the US. I posted earlier that this would be an absolute *certainty*, and so it is. The rate still is < 1%.

Denkler's talk at the ASSH included a review of numerous published studies on the rate of nerve damage from OS and showed it to be at about 3%. (see: http://plasticsurgerysf.com/customhtml1/)

But, a higher rate of recurrence of NA is undeniable. How much? We'll need 2-5 years for definitive data. I'm running a personal test with a sample size of One. ;-)

So, there are (+-) for *both* OS and NA. Fortunately, anyone reading this Forum has the links and data available to make an informed personal decision. Hopefully a percentage of the 350 CHS in attendance for Eaton/Denkler/Press will be added to the list of NA providers, and the minuscule number of patients who are informed they have a valid and real choice will begin to increase.

09/13/06 02:16
CM

not registered

09/13/06 02:16
CM

not registered

NA Nerve Damage

Randy,

I actually posted this "insight" first. Keep it straight.

CM

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