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Enough NA
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09/14/06 02:57
Carl

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09/14/06 02:57
Carl

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Enough NA

When is it time to say enough NA is enough? I had NA treatment last October and at first I was really pleased with the results. However about 5 months ago I began to see the problem returning and now it's almost back to where it was before treatment. I knew before the NA treatment that my pinky may become bent again and the size of the nodules may return to the original size. So all this is not completely unexpected. However, I've seen on this forum where people are going back for NA 5-6 times. I saw a recent post in which the individual is returning for thier 4th NA treatment in 2 years. That's NA every 6 months! I do plan on going back for another NA treatment soon, but I'm just wondering if thier is a point in which one should say, "For some reason NA is just not working in my situation and maybe I should consider the alternative(surgery)?

Does your DC get better with each NA treatment. Anotherwords, after my second treatment and although the condition may return, it won't return as bad as it did after the 1st treatment -and- after a 3rd treatment it won't return as bad as it did after the 2nd treatment -and- so on and so on?

09/14/06 02:05
Carl

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09/14/06 02:05
Carl

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just want to add this to my post below

I just wanted to add that I also understand that surgery is not a garauntee that the DC symptoms(bent finger(s)or nodules) will not return. However, from my research it appears that if the symptoms do return it is usually years later instead of months. I do not know this to be a fact, but from my reading it appears to be that way.

09/14/06 02:53
CM

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09/14/06 02:53
CM

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3 Yrs and Counting

Carl,

You touched upon the ugly issue that the NA proponents wish to ignore. NA can work, but recurrance is high and you asked a good question: how many times and how often should one get NA? Every six months seems like a lot and also probably expensive.

My surgery was over 3 years ago for two fingers at more than 90 degrees. The surgery went well and recovery time was good. The total out of pocket cost was about $500. Surgery was $150.00 and the rest PT. The going price for one NA is about $750 (from postings on this site I have seen) plus travel.

But, the good news is that so far no recurrance, my hand is flat and from what I can tell, I have paid far less than someone who has NA once, let alone 3, 4, 5 or 6 times. It sounds like NA may not be your best choice. Good luck.

09/14/06 02:31
Wolfgang

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09/14/06 02:31
Wolfgang

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worth it?

CM, I guess the $ amounts that you posted are true for your specific situation. For someone without insurance surgery would certainly be far more expensive. The opposite e.g. is in Germany where most insurances would cover NA as well as surgery.

Having NA every six months would eliminate its cost advantage and risks would add up. I think everyone agrees that this is not a good perspective. But someone who has such an agressive Dupuytren might experience also heavy extensions to other areas if he/she undergoes surgery. A difficult situation.

Generally we do need long term data on recurrence for NA and on extensions for surgery. Both are missing.

Wolfgang

09/14/06 02:09
Frances

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09/14/06 02:09
Frances

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cm = Sean / Gary

Hi CM,

Good to have you here. As an advocate for NA I can assure you the rate of reoccurrance is no secret. Understand that the issues around NA also include the right to choice based on the severity of ones *own* DC, medical history, and personal preferences. Futhermore decision making should always be done while under the care of a surgeon - even if you do not agree with what they have to say.

As for the cost. Absolutely. NA is not cheap, but that is because it is new, not completely covered by all insurance companies, and the doctors who are performing it live in the most expensive areas of the US. Personally I hope/believe NA will eventually be available in every city across the world and that it will covered equal to surgery - as it should be. Patients should not be forced to have surgery when surgery is not necessary.

Take care for now,

Frances

09/14/06 02:27
anonymous

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09/14/06 02:27
anonymous

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cm = Sean / Gary

CM sounds like another pseudonym for the Gary/Sean anti Na advocacy team.

Jeez, this guy never gives up. Pretty pathetic in light of all the benefits and advantages NA offers over surgery.

09/14/06 02:33
CM

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09/14/06 02:33
CM

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anonymous?

anonymous,

Your post is silly, childish and wrong. You appear to be another poster on this site that includes toM who is consumed by Sean.

Well, I'm not Sean and/or Gary. They can speak for themselves. I'm sure I speak for others when I ask you to not post such silly and hateful messages. Have you nothing better to do?

09/14/06 02:35
CM

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09/14/06 02:35
CM

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NA

Frances,

You are quite that the issue is to choose your treatments carefully. I did not mean to suggest that NA is wrong, only that it has issues of its own and in the end is no better and no worse than surgery. Personally, I'm hoping for total non-invasive treatment. But, that is probably years away.

CM

09/14/06 02:15
Randy H.

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09/14/06 02:15
Randy H.

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Pro Choice

I have long ago stopped looking at OS & NA as an Eithor/Or proposition. I think proper NA advocacy should simply be to call for NA to be added to the "Ladder of Treatment". Presently, most medical intervention does either *nothing*, or moves all the way to Limited Fasciectomy (LF). I feel NA's proper place is simply somewhere in-between these two.

If after one or two NAs recurrence proves to be an issue, LF is the logical next step. But if NA does the trick, you're done (or willing to occasionally have it repeated).
Eaton's best guess is that for >50%, NA is all they'll ever need.

We all know that a higher rate of recurrence is NA's weakness. LF is the cure in that case. And if that doesn't get it, you move up the ladder *again* to LF + skin graft. I don't think anyone *starts* at Skin Graft. Why? No secret. You try the less invasive first. What we are advocating that there is also a step *down* below LF. It's NA. It's not Eithor/Or. Why even bother to think in those terms?

Now some, after looking at the data, may choose to go straight to LF. Nothing wrong with that. Nothing. All most NA advocates want is for someone to show people the data so they *can* make a choice. As Francis said, and I reiterate: "Patients should not be forced to have surgery when surgery is not necessary."

But they clearly *are* being forced to right now (or do nothing). That's why Francis and I, along with a very *long* list of others, are here.

I don't think anything I've just said is in dispute or even controversial.

09/14/06 02:34
Mark D

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09/14/06 02:34
Mark D

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Respectful Disagreements

CM & Randy:

The last exchange of posts by you guys is just what we need more of....

Civilized discussion.

It's a pleasure to read posts by people who may disagree with each other, but do so in a respectful way.

Mark

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