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Intervention treatments for non-contracture DC
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02/17/2009 22:51
flojo 
02/17/2009 22:51
flojo 
Intervention treatments for non-contracture DC


NA, collagenase, radiation therapy or ?

A User suggested that I resubmit this post to the main DC forum. I'm new to this great opportunity to connect with others and get their first hand experiences so don't know all that's available. I do appreciate Dupuytren Society for making this forum and all of the information of the site possible.

Since I posted this last night, I have been in email contact with Keith Denkler at Larkspur,CA regarding NA. I was initially impressed that he asked me to email pictures of my hand and said the he "will respond with comments and suggestions." That's a BIG plus! Most doctors would absolutely require an office visit first. FYI, I asked about Medicare coverage. He said that he does bill Medicare and that NA is covered.

So, I'm considering NA but I would be interested in opinions about other early intervention therapies. It just doesn't make sense to me to wait until my hand is deformed before doing something about it. As far as I know, the early intervention options are NA, radiation and collagenase.

I am a 71 year old woman, diagnosed with DC in November '07. I have many nodules all over my right palm. My little finger is most involved and it feels tight at times all the way to the wrist, but there is little contraction, maybe 10 degrees, hence my interest in early intervention. I don't want to wait for contraction severe enough for collagenase and definitely don't want to do surgery. My thumb is involved, too, which I understand is rare as well as DC is more rare with women. It seems to me to be progressing rapidly, but maybe not from what I have read on other posts.
Larkspur/San Francisco would not be difficult for me as I have family living in the Bay Area.
I live near enough to go to Scripps Clinic in San Diego/La Jolla. I know the great reputation of Scripps in general but not about the DC treatment. Does anyone have personal experience with Scripps Clinic and their radiation therapy for DC?
I'm very concerned and want to get treatment early rather than later if it is likely to be effective. I'd appreciate your input about NA, radiation therapy and other early interventions as well as what I need to watch for as it progresses.
Would wearing a splint at night help? It seems to make sense to me to do that as it feel tighter in the mornings, but I have never seen anything about it written anywhere.

02/18/2009 04:11
RMC 
02/18/2009 04:11
RMC 
Re: Intervention treatments for non-contracture DC

Hi,
I've had a couple surgeries on my right hand little finger about 20 years ago after it started to develop on my left hand little finger about 5 years ago I went to a couple surgeons trying to find something I could do to avoid surgery I was told to just wait till it was contracted. Last september it was at about 90 degrees contracture I decided to get something done. First I spoke to my gp he sent me to a hand surgeon between the time of my appointment I found this website and several others on NA. I also contacted Dr. Denkler by email and sent him some photos all within about a 12 hour period of time made an appointment to have NA done. I am very impressed with the communication with him and his office staff it's almost unheard of these days. I flew to Oakland on a Friday morning drove to Larkspur had lunch in Tiberon and went to his office for the NA procedure at 4:00 p.m. left at 5:15 flew home at 9:00. After speaking with Dr Denkler I would trust his opinion on all options you may have. He is definitely an expert in his field in my opinion. The only regret I have is not taking my wife to spend a few days in the bay area. Good Luck

02/18/2009 06:36
wach 

Administrator

02/18/2009 06:36
wach 

Administrator

preventive night splint

I wearing a night splint on my pinkie as preventive measure. So far it seems to work but I guess when I stop wearing it contracture might start. For splint designs you might have a look at http://www.dupuytren-online.info/NA_side_effects.html . Im also had radiotherapy on that nodule. It stopped its fast progression but in the mean time I got two new nodules further down the palm.

Wolfgang

Quote:



... Would wearing a splint at night help? It seems to make sense to me to do that as it feel tighter in the mornings, but I have never seen anything about it written anywhere.


02/18/2009 15:42
flojo 
02/18/2009 15:42
flojo 
Re: Intervention treatments for non-contracture DC

Thank you both for your input.
I am glad to hear the validation of Dr. Denkler. He responded immediately after I emailed photos of my hand. He said that I have time because there is not much contraction so far. I have lots of nodules, so the contraction is coming, I'm sure.
I plan to get a splint and use it at night. It just makes so much sense to me to use it as prevention.

02/18/2009 19:40
Mike S

not registered

02/18/2009 19:40
Mike S

not registered

Re: Intervention treatments for non-contracture DC

I had NA done by Dr. Denkler 2+ years ago - 90 degree small finger contracture. Simply put, it was one of the best decisions I ever made.

I'm not sure how much can be done with NA at 10 degrees but I'm not the doctor. I know that NA is effective at 30 degrees or more

Dr. Denkler and staff were terrific all the way around.

02/18/2009 23:40
flojo 
02/18/2009 23:40
flojo 
Re: Intervention treatments for non-contracture DC

Hi RMC,
Referring back to your trip to Dr. Denkler's office - Obviously, you drove yourself back to the airport after the NA procedure. I assume that your hand was bandaged. Was it heavily bandaged and did it create any difficulty driving?
How long did it stay bandaged?
How long did it take to completely heal?
Was there any need for a follow-up visit?
Thanks!

02/19/2009 00:06
Gweneth 
02/19/2009 00:06
Gweneth 
Re: Intervention treatments for non-contracture DC

I just finished my first round of radiation treatments with Dr. Tripuraneni at Scripps Clinic in La Jolla, CA on 2/6/09. I first saw him in the middle of January for the Dupuytren and Ledderhose in my left hand and left foot. He determined that both my right hand and right foot are also affected.

I have already noticed a difference in my left hand, in that I don't have quite as much pulling when typing. Dr. Tripuraneni also indicated that the nodes in both my hand and foot had started to flatten some after the first 5 days of treatment. Now 12 days after treament, the two largest nodes appear to be slightly smaller.

I have already scheduled my next appointment for radiation treatments of my right hand and right foot.

Dr. Tripuraneni seems to be very knowlegable about Dupuytren and Ledderhose, and the staff that I dealt with was all very friendly and helpful.

Gweneth

02/19/2009 11:04
TrevB 
02/19/2009 11:04
TrevB 

Re: Intervention treatments for non-contracture DC

Quote:



I just finished my first round of radiation treatments

I have already noticed a difference in my left hand, in that I don't have quite as much pulling when typing.



I too have had one treatment on my right hand. When I stretch my hand it is indeed looser than it was before and the diseased area (I had full palm treatment) does appear to be much quieter than it was before. My only issue is the dryness and slight redness on the area in the crease at the base of the thumb. Other than that, pleased so far

Cambidgeshire, UK.

02/19/2009 16:13
rmc

not registered

02/19/2009 16:13
rmc

not registered

Re: Intervention treatments for non-contracture DC

Hi,
Yes I did drive myself the worst part was traffic going to Oakland at 6:00 pm on a Friday night. I did have a splint put on because of (not sure of the right term) the tendon reflex he wanted to keep it straight for 48 hours I did go to hand therapy for 4 weeks 2 times a week for this. I wear a night splint most of the time and do exercises to keep the tendon straight. There was no pain after NA except for the movement of the knuckle after over 5 years of being frozen. The actual healing from NA was only about a week from the needle punctures which was nothing just like poking yourself with a pin.

02/19/2009 22:30
flojo 
02/19/2009 22:30
flojo 
Re: Intervention treatments for non-contracture DC

RMC, thank you again for the info.
Where did you get the hand splint that you wear at night? Sounds like Dr. Denkler provided it. Is that something that you have or may need to get adjusted? I can't picture how the hand splint is made.

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