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need advice
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10/15/04 02:50
Brian

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10/15/04 02:50
Brian

not registered

need advice

I am 45 years old and have Dupuytren's Contracture. First began appearing in summer of 1998. It has gotten much worse in the last 1 1/2 years, especially the last 7-8 months. My left pinky is at about a 90 degree angle. Although I'm not in constant pain, the frequency and degree of pain has drastically increased in the last 7-8 months. If I accidently sleep on it wrong, the pain will be intense enough to wake me up. Anyway, my point is I think it's time to do something and stop putting it off. My question is, I've done some research (not a lot), but some on surgery and needle aponevrotomy. One week I'll think surgery is probably the best route and the next week it will be needle aponevrotomy. One way or the other, I'm 100% going to make a decision here in the next few weeks. I would love to here some advice before I make that decision. Thanks.

10/15/04 02:32
Brian

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10/15/04 02:32
Brian

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additional

This is in addition to my question on the post below. I live in Central Ohio, so it's quite a trip to see Dr. Eaton in Jupiter, FL. I would fly down and back in the same day if my only choice is Dr. Eaton, but does anybody know of any other doctors who are skilled and experienced in Needle Aponevrotomy for the treatment of DC. Preferably in the NE. Also from my understanding the needle aponevrotomy only straightens the finger, but the nodules in the hand remain. Is this true?

10/15/04 02:22
larry

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10/15/04 02:22
larry

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advice

Dear Sir:
My case sounds exactly like yours, our ages are similar and our degrees of severity are similar. I had surgery (NA) on May 17th 2004 with Dr. Eaton. I was extremely pleased with the result. There has been no recurrence so far of the angulation and my fingers remain straight and I have no pain now. Even if it had to be repeated yearly, I would do it rather than have the traditional surgery.

10/15/04 02:51
Brian

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10/15/04 02:51
Brian

not registered

Imas or Larry

I have 5 nodules in the palm of my hand and 1 nodule on the bottom third of my pinky. Of the 5 in the palm of my hand, 3 are about the size of a large lima bean and the other 2 are about the size of a BB. The one on the bottom third of my pinky is about the size of an average lima bean. Sometimes the 1 on my pinky hurts, but not too bad. However, the one that's at the base of my pinky, but on the palm can at times really hurt. It's the largest nodule and the one that protrudes the most. The pain comes in two forms. It's either a dull aching pain or a burning sensation. That's why I ask, does the NA get rid of or at least reduce the size of the nodules? If it doesn't, I'm afraid even though my finger may straighten I will still have the pain. Granted if the best that can be done is just straighten the finger and I will still have some pain, I'll take it. It's just that I'm curious.

10/15/04 02:31
The other Brian

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10/15/04 02:31
The other Brian

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NA and pain relief

I had NA (Dr. Badois) to release a chord in my right hand
that contracted my "pinky" 30 degrees. I also have "dermal pits" in my left hand with no chord and no contactures.
There are palpably firm areas in both palms about 1-3 mm in
size; perhaps those qualify as nodules.
Regarding pain: Only my chord received NA. Yes, at times it
aches/burns at about 3 on a ten scale where ten is max pain.
I do not have pain all day, nor every day. I notice it more
on cold days and after sleeping. Warm water seems to relieve the dull ache and stiffness on cold days. The sensation upon arising disappears in the course of morning
ablutions (brush teeth, shower, shave, etc) and may also be
relieved by the warm water of just distraction. An NA Doctor would be the best source of info. Generally, contracture(s) are the indication for NA. I do not recall
posts about pain as an indication. Personally, I would expect some relief and would not expect worse discomfort.
I cannot address NA and nodules. Ledderhose nodules are
treated by NA followed by cortisone injections (Dr. Lermusiaaux in Paris.) Get pictures and send them with a
short inquiry to one or more Drs. on the "list" available
at Walt's Dupuytrens Links Site. Good luck.

10/15/04 02:19
The Other Brian

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10/15/04 02:19
The Other Brian

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the Clostridium web page link

http://textbookofbacteriology.net/clostridia.html

The above site discusses botulism, tetanus and more benign
aspects of clostridia. The gangrene connection refers to
the carbon dioxide gas and odor produced in wounds contaminated with soil or liquids containing the spores
that become clostridia. The toxin dissolves the tissue
(necrosis.) Biospecifics' treatment uses minute amounts
in a contolled delvery to "melt" Dupe chords and nodules.
Presumeably not from c. tetani or c. botulium.

10/16/04 02:35
Brian

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10/16/04 02:35
Brian

not registered

advice

First I'd like to thank you guys for your input to my request for advice. It is greatly appreciated. Now I'm not sure if I'm understanding this completely. Are you saying the nodules in my hand are not from DC, but are another ailment all together and only the nodules on my pinky are DC related? Again, thanks for all the info and advice.

10/16/04 02:27
Randy H.

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10/16/04 02:27
Randy H.

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I~sq~d rather Walk

Brian,

Nodules or no nodules in your palm, you need to take immediate action. NA can be performed at about 30 degrees, while open surgery is usually not done until 45 degrees. The only reason for this is that until you hit 45 degrees the hand is till fairly useful and for the majority, the recovery from surgery is no picnic. Surgery Vs NA is *not* an eithro/or situation. Why not try the radically less invasive, less painful approach first (NA) and *then* up the anti to full open surgery if NA results are not satisfactory. Once you have surgery the ability of NA to help if there is reoccurrence is sometimes diminish. NA, however, can be repeated indefinitely. As for me, having had one full surgery on my left hand, I'd rather *walk* from California to Florida than go under the knife again.

On the other hand (so to speak) I've recently met a woman who had the surgery six years ago and her pinkie is now 100% straight and her scaring is not even noticeable. No reoccurrence. Now, a big difference is that I had a PIP contraction (2nd joint) and she had correction of the first joint next to the palm. BIG difference in these two. My surgeon told me that the pinkie PIP was one of the most difficult joints in the body to operate on. Don't grow you Dups tissue there!:)

For more info see: http://www.handcenter.org/newfile20.htm

10/17/04 02:50
Brian

not registered

10/17/04 02:50
Brian

not registered

Randy or anybody

Thanks for the valuable advice. As you stated, it just makes logical sense to try the NA first and I've made up my mind to about a 97% certainty to go that route.

Because I've pretty much already made up my mind it will have no effect on the treatment I will choose, but I'd like to ask again. Except for the nodule on my pinky at the base and the one on my palm right below the base of my pinky, are all the other nodules on my palm (4 all together, 2 large, 2 small) are these 4 nodules DC related? The 4 on my palm I speak of were the first ones that formed. The one on my pinky and right below it were the last 2 to develope and were the ones that started my pinky to bend downwards.

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surgery   Contracture   indication   distraction   satisfactory   clostridia   straighten   understanding   treatment   reoccurrence   indefinitely   contaminated   aponevrotomy   contactures   straightens   Lermusiaaux   nodules   degrees   Biospecifics   textbookofbacteriology