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09/17/2006 23:18
Randy H. not registered
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09/17/2006 23:18
Randy H. not registered
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1/15/2003
Hi Sean,
Looks like we have a perfect division of labor! A lot of us are here to try and help new patients learn that NA is a viable option, while you are here to help the people who blew right past us and went straight to OS :-)
You know I say that tongue in cheek because anyone in the "NA movement" has got to realize that we very much *need* fasciectomy as the next step in treatment if and when NA fails to be an effective long term fix. And for some that will be a reality. We don't know what percentage yet because we don't have the long term recurrence data. Beyond that, fasciectomy can be just fine as a first treatment if the patient wants to go that way. I've seen it work *just* as you say (unfortunately just not on me and others I know.)
So here we are, both acknowledging the complete legitimacy of *both* NA and fasciectomy. The posts of our prior arm wrestling show a different story a few years ago, don't they.
Sean, here is the reason you have been suspected of posting under other names and being far more aggressive and negative toward NA under those names:
Look at the thread called "Needle Aponevrotomy", starting at the bottom. Read the exchanges between "Gary" and toM, jim h, JERRY and others. Suddenly on 1/15/2003 "Gary" is not longer posting but "Sean" seems to pick up right where Gary left off. Anyone bothering to read this thread from the bottom up could easily come to the concussion that a morph from "Gary" to "Sean" looks fairly clear and convincing. After 1/15/2003 "Gary" *completely* disappears.
So, if someone thought you had morphed *once*, you might do it again.
Frankly it doesn't matter to me if you ever posted as "Gary" or anyone else. All that matters is the strength of what a poster has to say. And now, biased on nothing more than what those poster had to say, that exact discussion turned into the ASSH receiving it's first instruction on NA in 2006. Part of Dups history you are. Cool isn't it.
Santa
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09/17/2006 23:39
Eddie 
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09/17/2006 23:39
Eddie
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Posts
What a waste of time .....
I sometimes wonder whether some people on this forum really have DP. Seems to me they are able to type a lot without problems, obviously bothered too much by hand problems.
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09/18/2006 23:43
Sean
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09/18/2006 23:43
Sean
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NA
Randy,
Thank you for suggesting a rereading of that thread "Needle Aponevrotomy". It is one of the most informative threads on this forum and worth the read. The information presented was very good. It has been a long time since I have done that much research.
It was interesting, not only for the information, but the tone of response toward me. It was suggested that I belonged to AMA, the insurance companies, that I might be a representative for surgeons, that I was against NA, that I might be an attorney, because I had friends that were attornies, that I was other posters, and on and on. None being true. I guess using your logic, you are probably "Jerry". Or, is it "toM" who is Jerry. Where's Jerry? Or, who are all these people?
I guess mostly, who cares? Or, why would anyone care? Or, why is it worth the fixation? Or, as "Eddie" says, what a waste of time. If this is Eddie from Belgium, welcome back. Is there any more news about Dr. Moermans?
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09/18/2006 23:52
Eddie
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09/18/2006 23:52
Eddie
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NA : I finally did it !
Yes, Sean, it's Eddie from Belgium.
I have been on the forum only occasionally, since I made up my mind 3 or 4 years ago, and, most of the discussions in here where about treatment in the US anyway ( including some 'nice' (sic) discussions )
Moermans ? I made a few attempts to contact him, about 4 years ago. No result. Stopped trying because I was't really interested in walking that path.
Like I said somewhere in the past (2002?), my next DP treatment would probably be NA (after having rather extensive surgery on my other hand in june 2001).
So last week I went to see Dr Lermusiaux, and voilà ...
He treated two fingers :
- 4th finger : just had a cord, almost no contracture yet ; took less than 2 minutes
- pinky was worse, PIP contracture of about 85 degrees (silly me, why did I wait so long ? Could it be I was scared? Don't answer that !!! )
So, after 40 minutes (about 25 mins on the table) I left the dr's office.
4th finger straight, and able to bend backwards.
Pinky PIP is still bent for about 15 degrees, but, this is not due to DP contracture but to the fact that the tissue around the knuckle had thickenend an lot, and the fact that it didn't move for several years.
I am able to bend it straight using force. I will have to excercise it (10 mins twice a day according to the doctor) for a couple of weeks.
Mind you, after I had the surgery in 2001, the pinky PIP knuckle showed a similar behaviour (though a bit less, because the initial contracture was only 45 degrees. It took me 60 (sixty) sessions with a hand therapist.
I'm not going to tell in here what I had to pay, nobody would believe that anyway.
Bottom line, if I ever see a cord in my handpalm, and/or the slightest contracture of one on my fingers, I'm on my way ... to Paris or another doctor who practices NA.
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09/18/2006 23:59
Sean
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09/18/2006 23:59
Sean
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Eddie
Great to hear about your success! I was thinking that there were doctors in Belgium doing NA by now. Is it a controversial procedure in Belgium? Or, perhaps no one has done the training.
I have always wondered what Dr. Moermans comments would be about NA? His procedure is very similar, using very small incisions. It seems that he would support NA. He did mention what was considered the first use of NA, "Closed fasciotomy was advocated by Sir Astley Cooper (1822) by the subcutaneous division of a band with a pointed bistoury introduced through a small wound in the skin; a splint was then applied to maintain the finger in a straight position."
"As the frequency of recurrence became apparent, simple fasciotomy was progressicely given up except by some surgeons if the band is well defined and bow-stringing."
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09/18/2006 23:49
Eddie
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09/18/2006 23:49
Eddie
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Doctors in Belgium
Yes, there are. I know of two frenchtrained doctors, a third one I'm not sure about (I 'heard' he trained in Paris or Lille, but never gave his 'teacher(s)' any feedback, so he never appeared on the list).
Controversial procedure over here ? Among the surgeons, naturally. Always the same response : "blind treatment, hence larger risks". Is it below their dignity ?
Anyway, NA cannot be considered surgery. In France it is performed by rhumatologists (if one looks at a DP-hand, it 'looks' like rheuma-related anyway).
Family doctors in general (mine included) never heard about the procedure. A possible reason might be that there are strict laws over here on making publicity in some professions, especially medicine (and lawyers :D).
So, why did I go to dr Lermusiaux ? In life we all make choices, some rational, others more on feeling. And, nobody can say that dr Lermusiaux doesn't have the necessary experience :).
So I went to Paris, which looked surprising to some people over here because one of the 3 above mentioned doctors is living 5 km from my home (that's about 3 miles for you guys :D)
Cost wasn't a parameter I considered, although my total expenses (trainrides, dr's fee, lunch) are lower than what I would have paid a doctor in Belgium (very strange, how the fees are so much different for different doctors).
Dr Lermusiaux made the treatment look so easy ..... is it his experience ?
Coming back on cost, when I see what the doctors in the US charge, I ..... oh, forget it, no use talking about that :).
When I left the dr's office, I told him "see you in 1 to 4 years".
Again, I'm glad I did it, just sorry I waited so long.
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09/18/2006 23:56
Marjorienot registered
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09/18/2006 23:56
Marjorienot registered
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Lermusiaux
Eddie,
Good on you for making the decision. Does it matter if the problem comes back? Not to us who have NA with DR L it doesn't, we just go for him to perform his magic again. Let's face it, we have to go to the dentist regularly and we don't moan about that so why not for NA.
Dr L is so good because he absolutely knows what he is doing. It really annoys me when people say he is just a rheumatologist and not a surgeon.
Best,
Marjorie
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09/18/2006 23:38
Graemenot registered
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09/18/2006 23:38
Graemenot registered
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Lermusiaux
Marjorie
the dentist analogy is a beauty. Dr Lermusiaux pointed out to me that in France a Rheumatologist has broader/different qualifications than in say the USA and UK.
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09/18/2006 23:18
Randy H. not registered
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09/18/2006 23:18
Randy H. not registered
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Breaking Even
Sean,
I agree. That thread is great for anyone new here who wants to get up to speed on the issues. It is confrontational, but that's not unusual here.
Eddie,
I think the US NA cost issue is simply reflective of the overall American medical industry. My guess is that the fees are set in accordance with replacing the dollars per hour a surgeon would have charged for doing a fasciectomy. It *is* considerably more by European standards, but at least it's not a financial deterrent when an American CHS considers offering NA. He breaks even.
Congrats on your outcome.
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09/18/2006 23:33
BobN
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09/18/2006 23:33
BobN
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Moermans
Hi all,
For a while I carried Moermans' paper "Place of Segmental Aponeurectomy in the Treatment of Dupuytren's Disease" - pictures and all - around with me on doctor's visits. It made so much sense to use a very small incision to straignten a hand. Gee, ya think?
I even took it to my foot surgeon to see if he would consider it. All of the hand surgeons wouldn't discuss it. My foot doctor asked me to send him the paper but never responded.
Essentially, it came down to what they know how to do (and also, why take on a new procedure - their malpractice insurance is high enough...)
On the news front, I heard through my primary care doctor, that my hand doctor is considering performing NA here in New England. I understand he just returned from the ASSH meeting. I'm hoping he saw Eaton's work and attended the clinic and I hope other CHS's are thinking along the same lines. BUT - please take this as anecdotal hear-say until I can confirm or he comes out of the NA closet himself.
Has anyone seen or heard of where Eaton's work is published or will be published? I could use the data as I continue to battle my insurance co. for my first NA procedure.
Bob
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