Hi Frances,
I have completed my appeal papers and will post them off tomorrow. Lots of references to the problems caused by surgery and the body's normal wound healing response. I was turned down becuase there is a surgeon where I live who uses a procedure called 'simple fasciotomy' and the PCT said this is similar to NA. I appealed on the grounds that similar is not the same. SF is done by using a knife to make small cuts and then severing the fascia with a stitch cutter. Still surgery, no thanks.
Thanks for your ideas,
marjorie

Marjorie,

The minimal surgery the doc is talking about is sometimes called a *fasciotomy*. No attempt is made to remove the Dups tissue, only release the contraction. This was in fashion in the early treatment of Dups, but later it was felt that that by removing all the diseased tissue (fasciectomy) a lower rate of recurrence would he achieved. In *that* sense NA is *similar* to fasciotomy, but that's where the similarities end. NA achieves the same result with nothing more than a needle entrance as opposed to a knife. It's not surgery. Being far less invasive, the risks of surgery are greatly reduced. The recovery time is quicker. As an in office procedure it should be much cheaper.

Yes, a fasciotomy is "similar" to NA, but it can also be said that a shotgun is similar to a be-be gun.

marjorie

This too might be what they want you to do: <<From Dr. Denkler's site>>

Segmental Fasciectomy

A scalpel excision of a short segment or piece of a contracted Dupuytren's cord. This technique was developed by Moermans http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1960487&query_hl=19

He has reported favorable long term results and this is the most non-invasive surgery http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8982932&query_hl=19 This technique may be the first surgery necessary and is the next step after needle releases become ineffective. It is very useful on the thumb, as it is difficult to release thick thumb cords which lie over the digital nerves. In many cases, a small incision, under local anesthesia, will break up the contracting cord.A bigger surgery than needle releases, recovery will take weeks or even a month or two. Formal physicial therapy is not usually requred as it is after a limited fasciectomy. <END>

This is where I'd go if and when NA is ineffective.

Thanks Randy. I have looked at the web page you listed.
Can I just explain that the National Institute for Clinical Excellence (NICE) here in the UK have to investigate procedures, drugs etc and decide whether to pass them as suitable. In 2004 they agreed that the NA procedure was acceptable. The problem is that no-one in the UK appears to be using the procedure so I went to Paris for my NA. However, since NICE passed the NA procedure, but there is no-one in the UK doing it, this means that it should be possible for me to claim the cost of my NA from the National Health Service (NHS). So, I made a claim for refund from the NHS via my local Primary Care Trust (PCT). They are refusing to pay me as they are saying that I could have had a Simple Fasciotomy (SF) in my local hospital. My appeal is on the grounds that NA and SF are not as was stated 'similar' I have very fragile skin and am not letting anyone with a knife anywhere near me. I know of someone who had the SF done recently and the results are nothing like NA, much pain, difficulty using the hand and the need for lots of physio.
To be honest, I don't care if they do not refund the cost but, there are people living in the UK who could not afford to go to Paris for treatment and if I can set a precedent on this it will help others.
Now Randy, I realise that you may already be aware of much of the above but, the info may be useful to others who visit the forum.
Keep well,
Marjorie

Marjorie,

Anyone will fight for just themselves. Humanity is about the common good, regardless of the impact on the Self.

You go Girl!!

(And while your at it, could you arrange for some great NA guys in LA?) Humor, Humor (mostly) :-)

We are definitely on our way Francis.