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Great surgeon on Long Island, NY
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08/10/2007 18:12
Sandie1141 
08/10/2007 18:12
Sandie1141 
Re: Great surgeon on Long Island, NY

Bob, I'm sorry for the miscommunication. I thought you were being rude to my questions. I apologize if I came across the wrong way with my questions.

Since we've been told that someday instead of being able to have NA, my husband might have to undergo the surgery, I want to find out as much as I can about the surgery.

I'm just thirsty for every bit of information on all phases of the surgery and recovery. I'm probably weird in that I take pictures of everything (almost everything) and didn't stop to realize that I'm not the norm.

I hope you will accept my apology. Sandie

08/13/2007 07:16
Randy_H 
08/13/2007 07:16
Randy_H 

Re: Great surgeon on Long Island, NY

BobJuch

First, let me identify myself as having a bias, having had *both* NA and Open Surgery (OS). The OS was 3.5 years ago and the NA 2.5 years ago. The OS was performed by a renowned CHS, a former head of the ASSH. The NA by Dr. Eaton. Having interviewed seven CHS it is my profound experience that a strong and pronounced bias against NA exists on the part of surgeons that have never performed NA. This is understandable as they are not taught NA in med school and less that 20 surgeons currently offer it in the US

At first it was the objection that NA was unsafe and prone to nerve damage. That has been fully debunked by the report to the ASSH by Eaton/Denkler/Press in over 3000 cases.

End of misinformation.

Now the only objection remaining is a higher rate of recurrence. This objection only remans because Eaton's data is not yet five years old. Anything less is preliminary and not publishable. However the core of his argument to the meting of the ASSH was that recurrence plagues OS so badly (>50% over 10 years) that it was worth at least a few rounds of minimally invasive NA before resorting to a more dangerous and invasive Open Surgery. This was an argument heard by a number of new CHS now coming on line with NA. Your doctor may be the tops in the field, but he is apparently not one of them.

The statement you posted that "Surgery is *far* better than NA in preventing a recurrence" is based on nothing more than speculation, perhaps on the part of your surgeon. Where is the data? Personally I feel the opinions of surgeons who perform *both* OS and NA are far less prone to the bias common to those who have not yet performed both procedures.

This is not in any way a critique on Dr. Alan Freedman's ability to create the most excellent of results from Open Surgery. And without question in some cases OS is the best choice, yours included. However I must strongly disagree with the limitations you and/or your doctor have placed on NA's role in treatment. No doctor in America who does *both* NA and OS shares Dr's Freedman's opinion. Eaton's data, which is the best in the world, does not suggest that OS is "far" better at controlling recurrence. That was the whole point of this presentation to the most prestigious group of this fellows.

While prone to higher rates of recurrence, there is no reason not to try NA first before going up the ladder in invasiveness to a more dangerous and invasive procedure. Should a particular case prove unresponsive to NA, OS is always available as the next step.
NA and OS are not mutually exclusive competitors in an either/or scenario. They are in a continuum of minimal to higher levels of danger, cost and invasiveness. Why rebuild the engine when a simple tune up might do the trick?

Congratulations on a successful OS outcome, one which a *majority* of OS patients report.

08/13/2007 10:37
BobJuch 
08/13/2007 10:37
BobJuch 
Re: Great surgeon on Long Island, NY

Randy H,

Dr. Freedman is a general hand surgeon (et al). Being extremely familiar with the structure of the hand is of course a huge advantage to Dupuytren's surgery.

Any bias is my own. I believe it's best to remove the diseased tissue as it will spread the disease to adjacent tissue.

NA wouldn't have done a thing for my most recent problem as no tendons were trapped. I was having pain when carrying things and had a large, growing, lump in the web between my thumb and index finger.

It was my choice to have surgery before the lump got bigger or my skin was involved.

08/13/2007 17:32
Sandie1141 
08/13/2007 17:32
Sandie1141 
Re: Great surgeon on Long Island, NY

Randy,

Question,

If the cords start from the lumps in the hand, and you have the injections in the lumps before the cords start pulling the fingers down, would that stop the cords from starting?

Thanks, Sandie

08/13/2007 17:37
Randy_H 
08/13/2007 17:37
Randy_H 

Re: Great surgeon on Long Island, NY

That makes perfect sense about the pain. NA removes nothing, which is both it's strength *and* it's weakness. I know of a case where OS was done mostly for removing the pain of the nodules, which it did successfully.

Hoping for your full recovery with no recurrence.

08/13/2007 17:42
Randy_H 
08/13/2007 17:42
Randy_H 

Re: Great surgeon on Long Island, NY

Sandie,

That is the aim and goal. It's worth a try if you can find an MD who subscribes to the theory. It's controversial. Most CHS simply want to wait until the need for OS. However, if you opt for the NA aproach, the injections are usually part of the procedure and should perhaps be continued if necessary. That is what I plan to do shortly here in LA.

08/13/2007 18:25
Sandie1141 
08/13/2007 18:25
Sandie1141 
Re: Great surgeon on Long Island, NY

Randy,
I need to find out exactly what Dr. Kline used on my husband's hand. Whatever it was, all the lumps are gone, except for 1 and it is still shrinking. I know it wasn't the enzyme. Sandie

08/13/2007 18:40
Randy_H 
08/13/2007 18:40
Randy_H 

cortisone injections

The enzyme you speak of is Collegenase which may replace NA in many cases when approved by the FDA. What your husband had were cortisone injections. Just call Kline and ask.

08/13/2007 21:29
Sandie1141 
08/13/2007 21:29
Sandie1141 
Re: Great surgeon on Long Island, NY

Funny thing, Kline called just after I read your entry.

He said that it was Kenalog. Thankx Sandie

04/08/2014 18:25
davalan 
04/08/2014 18:25
davalan 
Re: Great surgeon on Long Island, NY

I had a real good experience with my Dupuytrens with Dr. Robert Gluck on Long Island. He's next door to Long Island Jewish. We discussed surgery, but went with Xiaflex collagenase. The results were amazing and I liked the doctor a lot, though there was a wait. He was recommended by a doctor friend of mine. He has a website: www.myhandhealth.com. Good luck.

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understandable   surgery   controversial   misinformation   miscommunication   Dermofasciectomy   Fasciectomy   clarification   Contracture   documentation   recurrence   injections   experience   diseased   performed   invasiveness   procedure   surgeon   Congratulations   Dupuytren