How long does the supply of items in a Dupuytren treatment plan last?

How long does the supply of items in a plan last and does the plan need to be ordered more than once.  I have a finger that is getting contracted and have had surgery on other fingers that had some success but are still somewhat involved and I’ve been told another surgery would probably not help.  I can function well but cannot do piano / guitar playing or clap my hands etc. I have had some Peyronie symptoms which seem to have mostly subsided.  Is there really curative benefit for me with one order of the plan?  Thanks.  DB

 

Greetings DB,

Each person approaches his Dupuytren treatment plan a little differently, not only in regard to size of treatment plan and overall direction of therapy, but especially in terms of dosage.  Some people take all their Dupuytren therapies in a very conservative way, others take all their Dupuytren therapies in a very aggressive way, while some take 1-2 of their therapies conservatively and a few very aggressively, and unfortunately some do not follow their plans very faithfully and so forget to do what they should do.

Because of this, each bottle and each therapy plan will last for a variable length of time.  In other words, not all people who get a Large Plan use it in the same way or at the same rate.  So, how long individual bottles of any therapy plan will last is a personal and variable issue for which I can only give you approximations based on what I see others doing.

Based on my experience with others who use the large DCI treatment plan the average person re-supplies the DMSO, Unique E oil and Super CP serum closer to every 3 months, while the Factor 400/400 and Maxi-Gamma E, Scar-X, PABA and MSM about every 4-6 weeks, and the systemic enzymes every 4 weeks.  Of course, the most expensive part of the Large Plan – the Genesen pointer pens – never have to be replaced.   My guesstimation is that the average person will spend about $80-110 monthly to replenish the large plan.

Generally, what is said about the Large Plan is also true of the Medium and Small Plans.  Since there is not that much difference between these last two plans except two therapies (Super CP Serum and Quercetin-Bromelain) they cost about the same each month to replenish – about $60-80 monthly.

Most people approach their treatment plans aggressively, taking the limit of their therapy each day dependent on the amount they can tolerate of a particular product.  In other words,  they pretty much take as much as they can comfortably tolerate without creating gastric symptoms.  Others limit themselves to the suggested daily dose as found on a particular bottle label, and thus they will be slower to go through a product, but also get slower and more limited treatment results.  In short, how long it takes you to go through a bottle all depends on what you decide to do.   As a suggestion for your own deliberation about formulating a plan: it is my experience and my observation of other’s success that those who are “heavy hitters” tend to do much better than those who are modest and conservative in their approach.

You will find that there is an abundance of practical information and suggestions to maximize benefit and performance for each product that is sent to you.  I have a “stuffer” for every product that requires explanation and direction.  Many people comment that they are impressed with the follow-through in making sure that each person is given more than enough information in regard to when, when not, how, and how not to use each therapy that is sent to you.

I caution visitors to read between the lines to understand what you mean when you comment about your limited  “success” with Dupuytren’s surgery.  You mention “success” but in the same sentence you say your fingers are still “somewhat involved.”   What you do not mention is how long ago you had this hand surgery.  My guess, based on many years of working with people who have had Dupuytren surgery, is that you had it done just a few years ago, and that you will soon see your hands and fingers once again contracting and becoming limited in use.   People tend to say things like, “Oh, I am really happy I had my hand surgery and it really worked out well, except that one finger is worse than before and there are still many things I cannot do, and I notice that my good finger is now beginning to get flexed.”    People tend to throw around the idea that their surgery was a “success” and then list what is still bad or what has gotten worse.  I think this happens because we do not want to face the fact that all the pain and risk of hand surgery did not do what we wanted it to do, and actually is worsening.

When you say “I can function well but cannot do piano / guitar playing or clap my hands etc.”   I think this gives a confusing message to the readers of this DCI blog.  While I know what you mean, I am concerned that others might not.   When you say you can function well it says one thing, but when you say you cannot play a musical or clap your hands I will assume there are many practical and important daily functions you cannot do as well.  I suspect you have trouble getting dressed, opening doors, washing your face, driving a car,  or going to the bathroom.  These significant limitations are important for the reader to understand about the common outcome of Dupuytren surgery so that they can accurately understand what really happens after hand surgery.  If someone takes you at your word, that you are functioning well after hand surgery, but the reality is that still you cannot many important things after taking the risk of surgery, it will help someone who is considering surgery to evaluate the outcome.   Be aware.

I cannot answer your question about curative benefit the way you have posed it.   You are asking me to predict the future for you.   I do not know if you will faithfully or accurately follow a treatment plan, so I have no way of knowing about your particular outcome of care.  When someone follows a large and aggressive plan as outlined on the DCI website, and asks for help along the way as needed, the outcome is for positive and favorable tissue change in 10-12 cases out of one.  Those are very good odds.  But I cannot say what your particular outcome will be.  You also ask if one order will get results for you.  That I also do not know, but I doubt it.   You must invest time and effort in recovery.  If you are not willing to do that, then you will have to live with the situation you now have.  TRH 

Is it common for lumps to be found on the bottom of the feet?

I have those lump in my hands and also under my feet. Is it common for lumps to be found on the bottom of the feet?

I’m 59 and still active with my hands and my fingers.  My fingers have not yet started to pull in yet as it did with my father and grandfather as they got older.

My neighbor had the operation and had complications and almost lost a finger because of the Dupuytren surgery.  That is why I’m looking for other alternatives.  Thank you.

 

Greetings,

When these lumps appear on the palm of the hand and later develop cords that bend the fingers down, it is called Dupuytren’s contracture.  When a similar process of lumps developing on the bottom of the feet, it is called Ledderhose disease.   About 5-10% of people who have Dupuytren’s contracture will also have Ledderhose disease. 

Complications from hand surgery for Dupuytren’s contracture are far more common than what you will see mentioned when the doctors write articles on the Internet.  DCI is not against Dupuytrens surgery, but advises that a person tries alternatives to see if the palm lumps can first be reduced or eliminated so that their is no need for surgery.   There is a lot of information to help you find alternative treatment ideas on the DCI website; you can find help at Start Dupuytren treatment.

Worse after Dupuytren surgery. Will I ever get any better?

Doctor,

I had my Dupuytren operation on the left hand on small finger and one next to it in June 2011.  I wasn’t going to get it done but my doctor said it was a simple operation.  I had the local anesthetic which was great but little did I know about 4 hours after the Dupuytren surgery that your arm starts to violently jump around and hitting you in face and flopping everywhere for about 10 hours until the anesthetic wore off.  Getting the stitches out a couple of days later was horrendous.  I  mean I can take pain, but this was so painful I could hardly stand it. It is now nearly March 2012, 10 m0nths later, and after all my painful exercises and keeping my splint on every night, my poor fingers are worse than before my hand surgery and the scar is extremely painful. 

Will this ever get any better?  Please advise me.

Liz

 

Greetings Liz,

Sorry to hear your sad story.  People would be surprised to know how common your results are after having Dupuytren’s surgery.   I commonly hear people like you saying that before the operation the surgeon makes the procedure sound like it is a small and simple thing, and always that his/her results are “great,” “wonderful,” and “hardly every any problem at all.”  Then after the surgery when the hand is more painful, or there is suddenly weakness or coldness or numbness that does not go away for years, the same surgeon hides behind the complexity of the procedure and denies making bold promises of a hand as good as new.

I wish I had some magic wand to wave over you and help you out, but there is none.   I cannot tell you if your problem will ever get better.  The best you can do now is to try to salvage what you are able.

The good news is that I have worked with many people like you in the past and in a good percent of cases we can help to reduce pain and maybe begin to get your hand operating better.  There are too many variables with tissue that could have been permanently injured during your surgery, for me to tell you that for sure you can be helped.  Everyone is different and not all surgeons are as good as we would like them to be.

I think you should at least try working with your hand problem by putting yourself on a DCI treatment plan for at least 2-3 months to see if your tissue can make some positive changes.  Some people get small relief, a lot get moderate relief and improvement,  and some get great relief.  You will never know until you try.

I also suggest you contact a very experienced physical therapist who is not affiliated or connected to the hospital in which you had your hand surgery.   You should be able to get an honest opinion and some helpful exercises and stretches to help your tissue to recover – if it is possible.  Time and a lot of work will tell.     

If you have any questions please let me know.   TRH

 

 

My hands got worse after Dupuytren’s surgery, what can I do?

Strategy to avoid risks of Dupuytren hand surgery   

All surgery has risks. Even the most simple and direct surgery can result in an unexpected bad reaction.  These can occur due to human error and judgment issues, or simply for reasons that are unavoidable and totally unexpected.

Complications after open hand surgery for Dupuytren contracture  (palmar fasciectomy) is variously reported to occur in 17% to 41% of cases, clearly higher than for many other types of surgery.  While the side effect and complication rate for needle aponeurotomy (palmar fasciotomy) is much lower at 2 to 4%, this must be weighed against its much faster Dupuytren recurrence rate and the need for additional palmar fasciotomy surgery sooner and more often.

It is important to understand that chances for adverse reactions after either of these two types of hand operations are at least doubled when performed as a second or third Dupuytren surgery.  Simply stated:  1. The more often palmar fasciectomy or palmar fasciotomy are performed the riskier each succeeding surgery becomes, and 2. repeat hand surgery is performed because of the high rate of recurrence of Dupuytren contracture after surgery.  With each surgery normal anatomy changes and less useable tissue remains.  Sooner or later so little tissue is left for the next surgeon to use, until no more hand surgery can be done.

Avoid or delay palmar fasciectomy surgery with Alternative Medicine

Those considering a second or third Dupuytren surgery after a needle aponeurotomy (palmar fasciotomy) or open hand surgery (palmar fasciectomy), should be interested to consider natural Dupuytren treatment as a possible way to postpone or avoid another hand surgery.

To learn about Alternative Medicine self-management, please see Different Way of Looking at Dupuytren Contracture Treatment

Medical researchers, Loos, Messina, and Bulstrod report successful outcomes of Dupuytren treatment using massage, exercise and traction, all without surgery.  Even so, not much interest is given to their work because research funding is always focused on high profile surgery and drug therapies. Natural therapies of Alternative Medicine are not a high profit way to treat Dupuytren contracture, although the Dupuytren Contracture Institute has been providing insight and assistance since 2002 to help people deal with their hand problems.

Not all people respond well to drugs and surgery, and not everyone responds to Alternative Medicine.  And just as no one in the practice of medicine can say with certainty that any drug or surgery will be successful, no guarantee can be offered that non-drug and non-surgical natural methods will assist your recovery. Even so, the advantage of using a simple and low cost Alternative Medicine approach is that when it does successfully assist the body to recover from a health problem, the need for drugs and surgery is lowered, delayed or eliminated.   Another major advantage is the well known low risk of natural therapy compared to drugs and surgery.

For those who have never had Dupuytren surgery, the conservative option is to undergo a short therapeutic trial of care with natural remedies first – rather than last – to possibly avoid hand surgery.  For those who have had one or two Dupuytren operations, the conservative option is still open but with reduced expectation.  In these cases the body has less normal tissue to work with; results cannot be as good as when surgery was never performed.

In the experience of the Dupuytren Contracture Institute working with those who have had one hand operation, it is possible to eliminate the need for a second surgery and cause doctors to change their recommendation for the need of a second surgery.  With a brief trial of Alternative Medicine treatment it is possible to make positive tissue change and either avoid or delay the need for surgery.

Rapid recurrence of Dupuytren contracture means more hand surgery later

Many who write on Dupuytren’s forums express the cavalier notion that they are willing to submit to needle aponeurotomy every few years even though recurrence is more rapid with this type of less invasive hand surgery.  They explain that they prefer NA because recovery is so rapid or they can use their hands in a few days with no rehabilitation. They fail to calculate that this does not necessarily happen each time needle aponeurotomy is done. They do not consider the risk of an adverse reaction increases with each surgery, preventing this approach to be used indefinitely.

For those who already have had one Dupuytren’s hand surgery and want to avoid another, this article presents possible avoidance options as well as the potential complications and risks of palmar fasciectomy, also known as Dupuytren’s contracture open hand surgery.

Bad reaction after Dupuytren’s surgery, what is next?

The idea that it is possible to correct a bad surgery with another surgery must be examined very closely.  While there must be cases where this works out well for the patient, extreme caution must be used to assure a bad situation is not made worse by additional irreversible tissue changes of compounded surgery.

First, get a second surgical opinion but not for the reason many people think. Patients typically approach a second medical opinion only to see if it agrees with the first.  This is often just another way of allowing two doctors to make a decision for a patient. The best use of a second doctor’s opinion is to receive additional medical information and a different view point to round out the thinking of the patient.  Both medical opinions should supply information to help the patient decide the next step to take.  It is the patient who must ultimately decide the best course of action to take to return to health.  When the patient does not feel capable of making that kind of decision, it is the fault of the doctor who has not provided adequate information to the patient.  Find another doctor who will talk to you and explain things in such a way that you can make this decision!

In no way is it suggested that a layperson can know more about the practice of medicine than the doctor.  Even so, the layperson must ask questions and receive answers from at least two doctors so she is able to make an informed and intelligent decision about her care – not the doctor.  A lazy patient does not get the best care.

It is the responsibility of the patient to assure that a second surgery is the best step to take – as it might be. Too often patients rely solely on the judgment of the first doctor they encounter to make important decisions for them.  This is not wise.

If you do not like the thought of additional Dupuytren surgery, for whatever reason, you can consider attempting Alternative Medicine treatment for a month or two or more to learn if your body is capable of reversing the abnormal hand contracture.  If it helps your situation and surgery is no longer indicated, look what you have gained.  If it does not help, you can have surgery knowing you have not been hasty, you have used conservative measures appropriately, and whatever reaction occurs from a second surgery was indeed unavoidable because less aggressive measures did not help you.

Suggestions to determine if your body is capable of changing the soft tissue contractures in the palm and fingers:

1. Learn about your Dupuytren problem from a different standpoint.  You were told you needed hand surgery by the MD who gave you the diagnosis of Dupuytren contracture.  Almost all internet information about Dupuytrens promotes surgery.  Go to the home page of the Dupuytren Contracture Institute for holistic information about day-to-day treatment. The information found on this website is unique because we present the idea that not all Dupuytrens needs surgery.

2.  Determine the most aggressive Dupuytren therapy plan you are comfortable following.  For best results do all that you can to help yourself.  Consider using what is called the “Large (Best) Plan” for personal treatment.  The “Medium (Better) Plan” is the most popular of the DCI plans.  The “Small (Good) Plan” is also well designed.  These three plans are found at the top of the page at Dupuytren treatment plans.   Any plan can be modified by subtracting or adding to suit your personal Dupuytren contracture treatment philosophy.  These plans are only examples of how to approach this problem, and have helped hundreds of people over the years.

3. Stop feeling discouraged. Read the Dupuytren Hand Bump Forum.  Get educated, motivated, and reminded that everyday around the world there are people who are actually beating their Dupuytren problem following the Alternative Medicine methods of the Dupuytren Contracture Institute.

Complications of open hand Dupuytren surgery (palmar fasciectomy)

No one, not even a surgeon, can predict the side effects and complications of a particular surgery – and that is the problem.  While many patients, even a majority, receive a palmar fasciectomy without an adverse reaction and no post-surgical complication at all, there are those who are worse after surgery.  The number or percent of adverse surgical cases is not important if you are one of the unlucky patients whose outcome is poor. The only bad outcome that matters is your own.

Keith Denkler, MD, in 2010 wrote, “Surgical Complications Associated with Fasciectomy for Dupuytren’s Disease: A 20-Year Review of the English Literature.”   His final comments,
“In conclusion, results of this study underscore the importance of
treating Dupuytren’s as an incurable genetic disease understanding that
surgical excision, fasciectomy, has a high rate of major and minor
complications. Surgeons must understand that while fasciectomy for
Dupuytren’s does offer a chance at long-term ‘straight’ fingers, there is
a high cost in terms of numbers of complications that are borne by the
patient.”

Because the hand is a highly complex and densely packed machine with practically no space separating very delicate nerves, blood vessels, muscles, ligaments, tendons, and fascia, the patient must carefully select the best surgeon for the best hand operation outcome.

The Dupuytren Contracture Institute is not against hand surgery.  DCI only suggests it is a prudent step to first try Alternative Medicine to learn if their Dupuytren soft tissue problem is partially or completely reversible, thus making surgery unnecessary.  If the need for Dupuytren hand surgery remains after natural methods has been unsuccessful, find the best surgeon possible.

Why you should think twice about Dupuytren’s surgery

Specific reasons to be wary of hand surgery for Dupuytren contracture

Few people are overly eager to have surgery for Dupuytren’s contracture simply because they are not comfortable with the cutting and bleeding associated with any surgery.  However, there are specific and unique complications and side effects that occur as a result of surgery for Dupuytren contracture that should stir even more caution.

Because Dupuytren’s surgery, even when done well, can lead to unsatisfactory results and stimulate the recurrence of new cords and nodules in the palm, the Dupuytren Contracture Institute since 2002 has proposed the use of conservative non-surgical and non-drug methods to help the body reverse and even eliminate the Dupuytren nodules and cords.  For more information please see Different Way of Looking at Dupuytren Contracture Treatment

Limitations of Dupuytren surgery

Each Dupuytren surgery candidate must remember there are limitations to what can be accomplished in this kind of hand surgery:

1.  Every Dupuytren patient thinks, “I will get this surgery for my Dupuytren problem and then I will be OK.  I will be normal again.”  That is not the case.  Surgery will not restore the hand to its original condition.  Even though surgery might remove all or some of the diseased tissue, Dupuytren contracture is notorious for recurring in a few yesrs.

2.  After Dupuytren’s hand surgery complications (greater pain, greater loss of hand/finger mobility and dexterity, hand coldness, numbness, sensitivity to pressure and touch) occurs in 20-50% of cases when nerves and blood vessels are cut, and scar tissue develops.

3. After any of the different palmar fasciectomy types of surgery there is less normal tissue in the hand, even when healthy skin is grafted in to close the open wound and replace diseased tissue.  Since the graft comes from another part of the body, it will react differently when in the palm. If a tissue graft is not used, it is necessary to reconnect open wounds, resulting in a hand that has less tissue in it. This results in reduced finger and hand movement, reduced hand strength and alteration of the tissue bed that nerves and blood vessels lay in, resulting in a hand that is “better before the hand operation, but still not right.”  This outcome is common, and all people I speak to are surprised because these things were never explained before the Dupuytrens operation.

4. Given enough time – usually just a few years and sometimes a little as one – Dupuytren contracture will likely recur again at the same site as a prior surgery, or in tissue adjacent to prior surgery. This idea of post-operative recurrence of Dupuytren contracture makes many wonder why bother having the surgery if the problem will recur and additional surgery will be needed.

For these reasons DCI contends it is better to be conservative first, and then try aggressive Dupuytren surgery later if it is still needed.

Reality of Dupuytren’s surgery

When a patient with Dupuytren contracture speaks to a hand surgeon the doctor will often say something like, “This will be a really simple surgery.  I have done hundreds over the last 10 years. The results are very good.”   Any potential surgical patient would like to hear that while trying to decide to have surgery for Dupuytrens.  That is why the doctor would say it that way; to make it easier for the patient to decide to have surgery.

Of course the doctor says the hand surgery is simple and easy from his or her standpoint; it probably is compared to other surgeries.  What the patient might envision after hearing it is a “simple surgery” would be to minimize the process to make it easier to accept the idea of having it done.  The patient would tend to think, “The doctor said it is a simple surgery, so maybe it is like when I had my tonsils removed or when I had that boil on my back lanced.  Those were pretty simple, so maybe this will be just like that.”  And of course, nothing could be further from the truth.

It is always wise to have surgery done by someone considerable with the same kind of problem – the longer the time and the greater the number of surgeries, the better.

But, from my experience, when a surgeon comments that the results of a particular hand surgery are “very good” or a similar expression, it would be wise for the potential patient to ask a few questions to clarify what the doctor actually means.  When a doctor thinks the surgical results of a palmar fasciectomy are “very good,” the doctor has something else in mind that is much different than what the patient is thinking.

The doctor is thinking soberly about the current level of the patient’s problem in terms of greatly limited hand use and degrees of joint deformity.  The doctor might consider the operation to be highly successful because before surgery the little finger was locked at 80 degrees and after surgery for Dupuytren’s contracture the little finger is at 20 degrees flexion.  To accomplish this increase the doctor might not be disturbed that his surgery also resulted in pain and numbness that the patient never had before, or weakness that causes him to be unable to open doors with that hand.   The doctor might not also be bothered that his patient will again have recurrence of Dupuytren contracture in that same finger a few years after the first hand surgery.  In spite of this the doctor will contend the surgery results were “very good.”

The patient is thinking emotionally about what the doctor said in relation to the “very good” results of his proposed surgery for Dupuytren contracture.  For the layperson “very good” means almost like brand new.  Full range of finger movement; being able to put his hands in his pockets again, brush his teeth and comb his hair like a normal person, and all the things he did before he developed Dupuytren contracture. And, of course, this patient is not even remotely thinking about developing new problems like pain and numbness after surgery. Lastly, the patient will be most surprised when the Dupuytren contracture returns in a few years, usually worse than the first time. How could any of that happen if the doctor said the results are “very good”?

Not against surgery for Dupuytren contracture

With no drug treatment for the contracted hand tissue, traditional medicine offers Dupuytren surgery as their only cure. DCI is not against surgery for Dupuytren’s contracture.  DCI’s position has always been to recommend surgical intervention in those cases that have not responded to an aggressively applied round of conservative Alternative Medicine therapy.  If someone has attempted to reverse or reduce their hand contracture with limited results then they should seek out an evaluation of two doctors who specialize in Dupuytren’s hand surgery.

Yet, people often approach the management of their Dupuytren contracture in the reverse order:  They first receive one or more surgery for their Dupuytren’s problem and upon seeing the limited response or worsened condition they are in, will only then think in a conservative direction.

People from around the world report to DCI that they rushed into their hand surgery thinking it would be an easy and sure solution to their palm nodules and contractures.  This is often not the case; in some cases their hand is worse after Dupuytren’s surgery.

It is DCI‘s opinion that it is safe and reasonable to attempt to improve the body’s ability to heal and repair the problem of Dupuytrens contracture by aggressively using several conservative Alternative Medicine treatments that are based on sound science and common sense. We strongly suggest that anyone with Dupuytren contracture works with what is known and what is available – even if it is not perfect – before undergoing potentially risky surgery for Dupuytren’s disease.   If DCI’s conservative concepts do not help your hand lump, you can always have Dupuytren surgery later.