No Name,
It sounds like you have a different opinion from the one expressed by Randy on NA's long term effects I would love to hear what your thoughts are.
Donald

Steve, you might apply for the collagenase trial but I don't know how easy it is to get onto and you need to be clode to the hospital because of the frequent post-injection checks. Another alternative to slow down progression might be radiaition therapy. At least it does not trigger recurrence/extensions. It worked for me when I developed very fast growing nodules immediately after a surgery. The issue with radiotherapy is that it is hardly available in the US and you might have to take a long vacation in Germany.

You find an overview on therapies on www.dupuytren-online.info.

Wolfgang

Hi BobN,

it might help discussions if we distinguish between "recurrance" (= re-appearing at the treated joint or area) and "extension" (new nodules/cords elsewhere). This terminology is not my own invention but I think it's useful because it helps to better understand a difference between surgery and NA.

Recurrance occasionally happens after surgery but if the surgery is done well and the diseased tissue is fully removed it is rare and, at least, takes a while, i.e. years or forever until it appears again in the same area. (side comment: if you talk to good hand surgeons they sometimes complain about having to reoperate on alread operated hands because the originaly surgeon did not do a good job in removing the deseased tissue. That's another aspect of recurrance after surgery). I myself had surgery on my left hand six years ago and the fairly large operated area (ring finger from PIP joint down via MCP joint through most of the palm) is still without new disease. I would consider this is a good success (knowing that we can only delay the disease, not cure it).

NA does not remove the cord, therefore "recurrance" here might be a misleading term because the cord is not removed anyway. Recurrance for NA might thus be defined as a new or increased contraction of the treated joint. For some of us it seems to take years until contraction demands another NA, for others only months, the majority probably taking several year (let's wait for Charles Eaton's data).

The picture is quite different for extension: as we all know trauma/surgery can foster growth of new nodules/cords in other, not operated areas. Because it is difficult to judge what would have happened without the surgery, this effect is not researched and documented very well but I can assure from personal experience that it exists (and several others have described in this forum). Maybe the new nodules had been in a "sleeping" mode prior to surgery and surgery just triggered their growth or maybe surgery really initiated the new nodules. I myself had a single cord growing over maybe 10 years or so, I had it operated and within just a month I could feel six new nodules growing in previously not affected areas. This does not happen to all patients, I guess it is rather the exception, but it is worth considering. As NA does much, much less damage to the hand I would not expect it to trigger extension to other areas and so far no one reported that.

Finally, as sort of advocatus diaboli, I want to mention an argument that is occasionally raised against NA: because NA allows the cords to grow, the cord might eventually become so big that it is either very difficult to operate on or that even the finger has to be amputated. I personally believe that this is exaggerated and I don't know of any documented such case. But it is still worth considering and possibly the basis of Keith Denkler's suggestion to use radiotherapy after NA to stop/slow down further growth.

Finally, is NA better than surgery? I am tempted to use a frequent answer of an Italian friend of mine: "Yes and No". It is just two different approaches with different effects.

Wolfgang

Wolfgang,
Thanks for the great write-up on recurrence/extension. It certainly clarified things for me. What we need now is some NA long term data on "new or increased contraction of the treated joint."

For those of you new to this forum, I'd like to post a little info about 'Sean'. 'Sean' has posted under other ids including the most frequent one of 'Gary'. While posting as Gary he repeatedly belittled NA and viciously attacked and insulted anybody that dared disagree with him. If you take the time to read the threads that go back to 2001+ you'll find proof of this for yourself.

I've followed this forum since 2002 and am sick of seeing this individual attempt to portray himself as reasonable and unbiased.