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N.A. when?
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12/11/2008 07:41
GeneW

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12/11/2008 07:41
GeneW

not registered

Thanks Wolfgang--one more question to make things more clear

Thank you Wolfgang--
I appreciate what you said and it seems that I'm too late for radiotherapy with my lesions--the cord and nodule that have been there for more than a year on both hands, the cord under another finger that has been there for more than a year on both hands and the large cord and large nodule that has caused ring finger contraction on both hands. I agree I should have treated these at the earliest stage but did not know about radiotherapy.

However, I'm still unsure about the nodule on index finger PIP. As I wrote, it had been thin and almost unnoticeable--certainly stable for years, but in the last months has grown somewhat now it is certainly noticeable and I can't really tell if the very slight tissue prominence under it is the beginning of a cord--at this point it doesn't seem so, but I know it could be. So I guess what I'm asking is--would this kind of situation be worthwhile for radiation? The reason why I'm wanting to be very clear is that it seems from what I've read on the forum--including Wolfgang's posting is that nodules on the PIP and cords under them are not amenable to NA and certainly I don't think doctors will risk doing collagenase on a nodule sitting on the PIP joint. This leaves only kenalog for slowing the situation and surgery to deal with any contracture that will probably come--which probably means early recurrence and then recurrence, etc.

Also, it seems from Dr. Seegenschmiedt's paper that cord and nodule without contraction is still considered early--but probably it has to be that they should have just grown so that there are fibroblasts, which I understand are the "bad" cells, to zap. Otherwise, it may not work if the combo has been stable for some time.

I'd appreciate any comments that would make this as clear as possible for me.

Thank you.

12/11/2008 08:04
Wolfgang

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12/11/2008 08:04
Wolfgang

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Re: N.A. when?

Gene,

one year isn't very long with Dupuytren's. We are usually talking about 5-10 years, or even longer, to really develop this disease. One year I would still consider an early stage. If the nodule started growing again, it makes a good target. Even growing cords are a reasonable, though not as good target. Growing cords consist to very small percentage of myofibroblasts, too. Slowing them them down might slow down the overall progression which is still success. The odds are just not as good as for initial nodules.

The large cord already causing contraction is probably not a good target. NA might be the better option if the contracture is already big enough.

Collagenase is also used to treat PIP contracture. But I think it needs to have a cord to dig into. I don't think it works on nodules.

I myself have a slight PIP contracture on my right pinkie caused by a fairly large nodule. Obviously nothing pulled on it, so it kept growing its size and developed only a small cord. I am having that radiated right now and have the impression that it stabilized (it was growing quickly before).

Wolfgang

12/12/2008 01:34
pgiovingo 
12/12/2008 01:34
pgiovingo 
Re: N.A. when?

The Dupuytren's in my hands has developed in the last 2 years. I have cords and nodules in both hands, with the left hand being more pronounced, but no contracture. The nodules have just shown up in my right hand the last couple of months. Dr. Herman did not seem to think my left hand had progressed too far for the radiation to help. He mentioned something about catching it within the first few years.

12/13/2008 07:36
GeneW

not registered

12/13/2008 07:36
GeneW

not registered

Re: N.A. when?

Thanks for responses.
To clarify--I wrote "more than one year"--the cords and the cord and nodule complexes have been there for 3 years--no contraction yet on those. But probably increases in size-thickness during this time. From what I now understand these may be amenable to radiation--but it is not certain because they are beyond the plain nodule state; and the nodule on the PIP joint may be amenable to radiation but also not certain because although it is recently growing, the original nodule has been there for probably 5 years.

I hope very much that Wolfgang's radiation is successful. It sounds unusual that a nodule by itself would cause contraction.
I'm glad to hear that radiation oncologist be confident with a 2 year (no contraction) situation.

I had read on this forum before that one of the US NA docs was thinking to inject the nodule with collagenase. But probably not anything directly on the PIP joint.

12/15/2008 07:37
Randy_H 
12/15/2008 07:37
Randy_H 

Re: N.A. when?

Kline is in fact quite the proponent of post NA Radiotherapy. He has a local radiologist who he refers his local post NA patient to. I would consider it but for all the hoops someone in LA would need to jump through to get someone here to do it.

The cortisone injections he did for me 18 months ago have kept the nodules soft, out of pain and with no recurrence. Still, even cortisone injections are hard to come by in LA where Open Surgery stills rules the day.

It would be helpful if we had a list of MD's who will do either Radiotherapy or cortisone injections.

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RandyH--Thanks   nodules   Wolfgang   dupuytren-online   radiotherapists   semi-preventative   radiation   contraction   unnoticeable--certainly   contracted--so   Radiotherapy   radiation--but   forum--including   size-thickness   recurrence   myofibroblasts   growing   contracture   Seegenschmiedt   contracted--this