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N.A. when?
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12/03/2008 18:54
dude 
12/03/2008 18:54
dude 
N.A. when?

so,all you who had the needle thing...
do you recommend waiting till a finger is bent?
or doing sooner,as a semi-preventative?

local anes.,I assume?

12/03/2008 20:53
Randy_H 
12/03/2008 20:53
Randy_H 

Re: N.A. when?

Dude,

You can't do NA until you have some contraction. There is no preventative measure, only corrective.

See: http://www.handcenter.org/newfile18.htm

In fact, I'd read everything on Eaton's site and get educated.

12/04/2008 04:46
wach 

Administrator

12/04/2008 04:46
wach 

Administrator

Re: N.A. when?

Radiotherapy is the only early stage treatment and it is most effective in this stage. Radiotherapy works on the initial small nodules. NA and surgery address the contracted cord and only make sense when your finger is already contracted.

Wolfgang
PS: You might also read through the info on this site, e.g. starting with http://www.dupuytren-online.info/dupuytrens_contracture.html and then the stages and therapies page http://www.dupuytren-online.info/dupuytr..._therapies.html.

12/04/2008 05:43
GeneW

not registered

12/04/2008 05:43
GeneW

not registered

Re: N.A. when?

Wouldn't steroid (Kenalog, etc) also qualify like radiation. I see from another thread that there is some suspicious about it, but still many on the forum noted good effects, and it is recommended by the most experienced NA doctors (re: story of how Dr. L. "discovered" NA, etc.).

12/04/2008 06:43
Randy_H 
12/04/2008 06:43
Randy_H 

Re: N.A. when?

Radiotherapy is the only therapy that has the possibility of stopping Dups in it's tracks. There is noting close to it's effectiveness when done in the early stages. It is more accepted in Germany. Most US MDs are afraid of it.

Steroid injections can work well to stop pain and *slow* the growth of diseased tissue. I will not hesitate to have more steroid work done when and if my right hand disease gets on the move again. NA is the next move after that.

Moat traditional US hand docs do *nothing* but open surgery and shy away from both steroid and Radiotherapy. However, both treatments are reported to work as advertised. The conservatism of US CHS seems to know no bounds.

12/10/2008 07:48
GeneW

not registered

12/10/2008 07:48
GeneW

not registered

What is "early stage" and qualifies for radiation plus question for Randy H.

To RandyH--Thanks for your response. Is your hand not in an "early" stage which is why you haven't done radiation?
What qualifies as early stage and therefore makes radiation possibly effective? I have one finger that is contracted--so I realize this is not early stage of the disease, but have another finger that has cord and nodule (several years of this) but no contracture, a cord that has not contracted yet under another finger, and a nodule directly on the PIP joint of index finger which has yet to sprout a cord (I think) and certainly is not contracted--this nodule recently became noticeable, but was from a thin pad, almost impossible to feel, that I ignored for 5 years not thinking it was DD. So nothing is early in time--but would you or others think these are early stage in terms of being candidates for radiation? Or would steroid just be all that should be used? Any comments on this would be appreciated. Thanks.

12/10/2008 08:03
wach 

Administrator

12/10/2008 08:03
wach 

Administrator

Re: What is "early stage" and qualifies for radiation

Gene, "early stage" is the initial small, growing nodule without cords. That's the ideal target for radiotherapy. Radiotherapy is much less efficient on growing cords. BTW that's also why radiating after NA doesn't make much sense to me. Also, if you have had a stable nodule for years, radiotherapy won't be able to change much. Catch them as early as you can.

Wolfgang

12/10/2008 11:20
TrevB 
12/10/2008 11:20
TrevB 

Re: N.A. when?

Quote:



Radiotherapy is much less efficient on growing cords. BTW that's also why radiating after NA doesn't make much sense to me.

Wolfgang



I think the information on the website would suggest that it is still efficient at that stage. Didn't someone on here from the US say that their HS (Denkler I think?) thought that radiotherapy after NA was a good idea?

"Research at the University of Erlangen, Germany, showed the following: ten years after the therapy, for 84 percent of the patients having Dupuytren in stage N (just nodules and cords) and 67 percent of stage N/I (hand bent by 1-5°), the disease either had not progressed or had actually improved

I only say this because I'm going myself in a few weeks. I'm not particularly happy to take any risk and if the cord in my palm (ring finger but no contracture yet) is not going to be helped then I'd rather not take the risk.

Cambidgeshire, UK.

Edited 12/10/08 13:22

12/11/2008 05:51
Megan 
12/11/2008 05:51
Megan 
Re: N.A. when?

Quote:



BTW that's also why radiating after NA doesn't make much sense to me.

Hi Wolfgang,

I had a brief conversation with Dr. Kline about this when I was in Boise. If I understood him correctly, he said it is possible that the radiation after NA might slow down the recurrence of the contraction.

12/11/2008 07:32
Wolfgang

not registered

12/11/2008 07:32
Wolfgang

not registered

Re: N.A. when?

Megan, certainly several hand surgeons, including some offering NA, suggest that radiotherapy might postpone recurrence. But leading radiotherapists, like Prof. Seegenschmiedt, have doubt about post-NA or post-surgery radiotherapy for several reasons:

a) the target is not clearly defined. What exactly do you want to radiate?
b) preventive radiotherapy is in conflict with the general rule of minimizing the exposure
c) radiotherapy is most efficient of growing nodules, not on hard cords.
d) there is no proof of the efficiency in postponing recurrence, at least not far.

I would therefore not recommend radiotherapy after NA. To me a night splint seems to be the better option. But that's my personal opinion.

Wolfgang

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