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Xiaflex injection & manipulation
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03/03/2011 11:36
dianataylor 
03/03/2011 11:36
dianataylor 
Xiaflex injection & manipulation

I went to Doc Monday for the injection on my right index finger that was in stage 4 contracture. Tuesday morning the manipulation was completed with amazing results. Although my hand and especially my knuckle are still swollen, my finger is basically straight!!! The doctor was so excited to have had such dramatic results on this finger, he brought his whole staff in to see!! I took before photos and will do after photos today.

Two things I want to share:
1. He came up with a new way of manipulation that allows movement without tearing. He folded the finger into my palm then pulled it upward before trying to extend it to break the cords loose. The cord popped loose several times with NO tearing. He informed the drug company of this form of manipulation and they will now include this in their training and instructions. Pass this on to your doctor if you are going to undergo xiaflex injections.

2. Dr Chalkin specializes in shoulder, elbow & hands only, so he has nothing to gain in the following observation and warning: I asked him about finding someone in Tulsa that could do the RT on my feet (which are very bad) Although he is going to look into it, he warned that RT has caused minor to extensive nerve damage in the feet. I am still considering it because i will NEVER have surgury on my feet again. Just wanted to pass this on.

If I can figure out how to post the before and after photos, I will do so later today.

Diana

03/03/2011 20:17
Larry 
03/03/2011 20:17
Larry 
Strange warnings about nerve damage ...

Just let you know ...

A statement by a non-expert about radiation like

" ...he warned that RT has caused minor to extensive nerve damage in the feet ... " is just poor "bullshit". The literature about nerve damage due to radiation therapy starts at doses of about 50 - 55 GY with a 5% probabilty to develop this kind of damage within 5 years. Just consider : radiation therapy for DD or LD is done with doses between 20 - 30Gy,
which is far below what would cause damage .... On the other hand : Nerve damage after surgery for DD can be as high as 10% !! Everybody and even doctors should only plough their own fields ....

03/03/2011 21:26
dianataylor 
03/03/2011 21:26
dianataylor 
Re: Xiaflex injection & manipulation

Strange that you ignored all of my good news and focused in on a "could be" warning. You are right, he is not an expert on RT, just a concerned doctor that wanted to warn me to investigate before I acted. He did not use the word would cause, but could cause. Thank you for your input & the information on the levels used. I cannot make an educated decision on my feet without adiquate information and who better to give it than people that have been through it. We are all here to help each other.

I mainly wanted you all to know how unbelievable my results were for such a badly damaged finger. Xiaflex may not be the "be all - end all", but a whole lot better than the multiple surgeries my poor father went through and the one disasterous surgery on my foot that I had to endure the result of for over two months.

Any advice & info for my feet is deeply appreciated.

Diana

03/03/2011 22:02
spanishbuddha 

Administrator

03/03/2011 22:02
spanishbuddha 

Administrator

Re: Xiaflex injection & manipulation

Based on a discussion I had with Prof S in Germany on foot anatomy, I think that an MRI should be done to determine the depth of nodules, so that RT treatment can be adjusted accordingly. Further my understanding is that the single dose RT may remain the same, but a 'bolus' of appropriate absorbing characteristics is used to control the depth the radiation reaches. A gel bolus was used when my hand was radiated but it was not a customised one AFAIK, but its purpose was explained as controlling the depth of radiation.

03/03/2011 22:19
dianataylor 
03/03/2011 22:19
dianataylor 
Re: Xiaflex injection & manipulation

Thank you so much for sharing your information. I have a huge number of nodules, both deep & protruding. It is my dream to be able to walk again without pain. Information from people lke you encourages me to proceed with investigating this option.

03/04/2011 01:57
marjorieb 
03/04/2011 01:57
marjorieb 
Re: Xiaflex injection & manipulation

Diana,

Congratulations! What great news about your hand.
It's interesting that your MD warned about nerve damage from RT. My GP suggested I have Xiaflex, I told her I thought it was too early. Actually, I am afraid of someone hitting a nerve or tendon with the injection. To me, there is a much greater risk with the injection, than the RT. But, your story is comforting, as I sort out all my options.
Sorry about your foot. Hope you eventually have success there as well.
Beth

03/04/2011 02:01
LubaM. 
03/04/2011 02:01
LubaM. 
Re: Xiaflex injection & manipulation

dianataylor:
Thank you so much for sharing your information. I have a huge number of nodules, both deep & protruding. It is my dream to be able to walk again without pain. Information from people lke you encourages me to proceed with investigating this option.
Diana,
I had RT for my LD in Nov. 09...two hard nodules in the middle of the arch, the size of large marbles. Its been over 16 months since my RT, the nodules are almost non-existent (I would say they are about 85% gone). I had no side effects from the radiation. My treatments were done at Scripps Hospital in LaJolla.CA

03/04/2011 11:48
ellenpao 
03/04/2011 11:48
ellenpao 
Re: Xiaflex injection & manipulation

Diana - Congratulations! I'm so glad that it went well for you and that there was no tearing. Exciting stuff! Did you have that satisfying *snap* when the cord released?

03/04/2011 12:13
dianataylor 
03/04/2011 12:13
dianataylor 
Re: Xiaflex injection & manipulation

Thank you all. As far as the Xiaflex injection, not only did I hear that wonderful snap three times during the manipulation, but one the night before when I accidentally leaned on my hand!! I started my own manipulation.

I am investigating to see if a Tulsa doctor is learning how to use RT on feet and with your information and encouragement, I plan to jump on it when available. I need to find out about my insurance coverage. Is this still referred to as experimental treatment? I know the designation will effect my coverage.

Don't give up folks. I've had this crap for over 30 years & plan to beat it.

Diana

03/07/2011 06:03
bstenman 
03/07/2011 06:03
bstenman 
Re: Xiaflex injection & manipulation

Radiation interferes with the body's healing processes which in effect have run amok with Dupuytren's much as with cancer cells. It slows the "healing" process and is going to both slow down the likely progression of the disease and increase the interval between procedures whether they be NA, Xiaflex, or a fasciectomy. XRT is part of the solution and it is not an either or consideration.

I have had NA and XRT and going in tomorrow afternoon for a series of Xiaflex injections. Dr. Denkler did the NA in 2007 and thought at the time that my going on to Germany for the XRT was probably a good idea. I met with him a couple weeks ago and now he believes that XRT is an important treatment along with NA and Xiaflex for treating Dupuytren's.

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