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question for Wolfgang
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12/03/2008 08:10
GeneW

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12/03/2008 08:10
GeneW

not registered

question for Wolfgang

In October (I think) Wolfgang posted about his current radiotherapy and splint wearing for a PIP nodule, cord, and early contracture. Although it has only been one month, I'm wondering how this went--did radiotherapy have any effect? Also did you try any steroid injection after the nodule appeared? If not I'd be interested to know what you thought of this and also why radiotherapy was delayed until the contracture? I'm making decisions for myself and would like to know since you have so much experience and knowledge. Thanks.

12/03/2008 09:46
wach 

Administrator

12/03/2008 09:46
wach 

Administrator

Re: question for Wolfgang

Hi Gene,

here are my answers:

- radiotherapy is still going on. I had 1/2 of the total dose so far and believe that the nodule's growth slowed down. Hard to tell but before it was growing very quickly and now it grows slowly, if at all. I recently had other surgery elsewhere and my Dupuytren boosts after surgery, so overall I am happy that the nodule is fairly stable.

- I had no cortizone injection because personally I am a little suspicious about cortizone. It might damage neighbouring tissue and skin, and this nodule is very close to my PIP.

- originally I had hoped that the nodule would grow slowly and that I could have NA when I need it. I tried to avoid radiotherapy because the next finger already had been radiated and there is a danger of double exposing the intermediate area. When the contracture started an experienced NA doctor inspected my finger and told me that NA wouldn't work because of big nodule, only small cord, and close vicinity of PIP.

- the doctor suggested radiotherapy and wearing a night splint, That's what I am doing now. It's not an immediate cure but will hopefully keep my finger in its current state for a number of years. I am keeping fingers crossed ...

Wolfgang

-

12/04/2008 05:39
GeneW

not registered

12/04/2008 05:39
GeneW

not registered

Re: question for Wolfgang

Thanks very much for this and all you've written--it's very helpful. I hope all you are doing works and that you keep us posted.

12/11/2008 07:51
GeneW

not registered

12/11/2008 07:51
GeneW

not registered

And one question for "Newman"

A few weeks ago "Newman" mentioned that the lump in his hand disappered after radiation but the the nodule in his finger (location not known) did not and that he was considering steroid injection. Would it be possible to have some follow-up on this--also where is the location of the finger nodule? All this is very helpful to know. I also hope this recent round of radiation means the end of what has been an amazing, inspiring but what must be a challening many years of dealing with this.
Thanks

12/11/2008 09:49
newman 
12/11/2008 09:49
newman 

Re: question for Newman

Hi Gene Australia Calling.
The lumps I referred to were located in the web between the thumb and index finger of my right hand.
The nodule on my left index is located between the metacarpal and pip joint. This had the 30 Gy radiation.
I am not aware that I mentioned in the forum about steriod injection, however I did discuss this option with Prof. Seegenschmiedt ,as my GP thought there would be no benifit. His opinion was it was worth a try, it may reduce the nodule size . That was in October 08. I am going to see a Surgeon for him to administer the injections. It would be a Kenalog Injection. (Cortisone.) Have you read the article written by Luck .(Dupuytren Disease-literature ) I think this a must for anyone with dupuytrens to try and grasp how complex this disease is. Regards from down under.

Edited 12/11/08 11:52

12/13/2008 07:42
GeneW

not registered

12/13/2008 07:42
GeneW

not registered

response

Yes, based on recommendations from you in earlier postings, I have previously read the excellent Luck article. His small knives seem to be a forerunner of NA. I couldn't help but wonder why what he recommends--just taking out the nodule and cutting the cord (now morphed into NA) is still not done--probably because of recurrence statistics. But could these stats be much less than the surgery done now? NA recurrence, I've read, is about50 percent after 3 years--maybe taking out the nodule also would increase that to at least the recurrence rate of today's open surgery--but I guess it wouldn't be a simple office procedure.

12/13/2008 08:03
Wolfgang

not registered

12/13/2008 08:03
Wolfgang

not registered

more literature on surgery

Gene, you might find the thesis of Moermans interesting http://www.ccmbel.org/These.html . He is a surgeon and suggests an intermediate approach. To reduce recurrence he is cutting out segments of the cord, not just breaking it as NA does. To minimize side effects of surgery he leaves the rest in the hand. I haven't lately seen statistics on this technique. In his thesis he mentions a recurrence rate of about 40 % after 3 years which is probably about what other surgical techniques achieve and possibly better than NA. But even the definition of recurrence is difficult (see http://www.dupuytren-online.info/dupuytr...techniques.html).

His thesis is interesting to read anyway.

Wolfgang

12/14/2008 06:10
GeneW

not registered

12/14/2008 06:10
GeneW

not registered

Re: question for Wolfgang

I wasn't able to connect to the Moermann's website, but had read of this before. Does anyone do his type of surgery since his recurrence is so low and probably side effects of surgery are low also?

Also on the other citation there's a photo of the glove. Would they make one that covers the PIP of the index finger, or is this their only model?

Thanks

12/14/2008 06:50
wach 

Administrator

12/14/2008 06:50
wach 

Administrator

Moermans

Strange, I tried it and the link works on my computer. Q&A:

Q: Does anyone do this type of surgery since his recurrence is so low and probably side effects of surgery are low also?
A: Moermans himself: http://www.jpmoermans.be/Welcome.html

Q: Would they make one that covers the PIP of the index finger, or is this their only model?
A: No, FixxGlove is a standard product. If you want a night splint covering the PIP of your index finger you might try the (custom made) type on http://www.dupuytren-online.info/NA_side_effects.html. Very comfortable to wear, extremely easy to use (simply push/pull) and cheap, at least in Germany (30 Euro). I guess any hand clinic in the US could make it for you. Just show them the picture. The material what we call thermo plastic, maybe that also a common term in the US?

Wolfgang

Quote:



I wasn't able to connect to the Moermann's website, but had read of this before. Does anyone do his type of surgery since his recurrence is so low and probably side effects of surgery are low also?

Also on the other citation there's a photo of the glove. Would they make one that covers the PIP of the index finger, or is this their only model?

Thanks


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