What should I change in my Dupuytren treatment plan?

Hi Dr. Herazy,

I am about to place my third order with you. I wanted to let you know about my 5 weeks of treatment so far. I started with your medium Dupuytren’s contracture treatment plan. For 2 weeks I have been taking 5 Neprinol capsules with 2 fundamental sulfur 3 times per day. I find it difficult to find times in the day where I haven’t eaten or plan to eat within 2 hours. I try to take one dose when I wake up in the middle of the night to visit the bathroom. Additionally I am taking your vitamin E and PABA (2 caps ea) once per day. I also try to take Scar X twice per day. Lastly I use topical vitamin E, copper serum with DMSO. This topical Dupuytrens treatment has really softend the surface of my palm. Callouses nearly gone.

I must say, it may be early in treatment but I have not noticed any difference in the dupuytren cords or nodules as far as reduction in size or hardness. I must tell you the unexpected good news about my foot. Plantar Fibroma (aka soft lumps) on the sole of my right foot. they are notably smaller. I have had them for 10 years at least. This to me is proof that your treatment is doing something. These foot lumps are not as hard as the hand dupuytrens lumps.

Additionally I have had 2 dupuytrens surgeries. First one in 2009 needle aponeurotomy. It was quick, some sharp pain during surgery. Results lasted about 3.5 years and grew back. My second surgery was just in Sept 2012. I tried Xiaflex. Dr. injected into the main cord only. It softened the cord enough where he could release it. I could hear and feel it snap like a rubber band. This is when I started your treatment. I am hoping your methods will at least prevent the cord from growing back. I still have cords running up my ring finger and in the web between my ring and pinky.

My questions to you are: what should I change? More Neprinol? or something else? I know you say its trial and error. I was just wondering if you had any comments or recommendations. I am sure these hard firm bands will take more time. But question the treatment plans effectiveness.

Also. When I wake I take my morning Neprinol dose with coffee. I know you say water but I can’t find three times per day where I can commit to 3 doses for 2 hour periods without some kind non-water intake. does caffeine negate the enzymes?

What about wine in the evening? Is that a no-no too?

Thanks for you help.

Jim VH


Greetings Jim,

Congratulations on the early progress you are making with the several problems you are dealing with. Five weeks is not a lot of treatment time and your therapy levels apparently have made some good tissue changes for you to be able to notice them so soon.  

What you have going on that puts you in a slightly different (and more difficult) category than a lot of people is that you have had multiple surgeries and you have more than just a Dupuytren’s contracture problem to correct. People who have had Dupuytrens hand surgery tend to take longer to recover while using Alternative Medicine, bu then again people who have had Dupuytrens surgery need this work a lot more since they have seen that recurrence of the lumps on the palm and cords is a real problem.  You cannot continue to have hand surgery when the problem will always come back, because a surgery or two more you will run out of tissue for the surgeon to work with.  At that point you will be worse off than before the surgery.  

I have worked with many people in the past who had plantar fibromas just as you do and I find that this tissue drains a lot of the Dupuytren treatment products away since it competes for them at the same time you are attempting to reduce the nodules and cords on your hand.  The more of these soft tissue problems that are present, the more therapy products that the body will need to address them all.  There is no way, other than the topical or external therapies that you use, to direct or select where the internal therapies will be used by the tissue; the rule apparently is an equal distribution since they travel in bloodstream.  I am confident that if you only had Dupuytren’s contracture and not the plantar fibromas to deal with, your current plan would be giving you greater improvement with the hand contracture problem. 

I suggest that you reduce the vitamin E to two capsules daily, total.  Also, I suggest that you consider taking perhaps three Neprinol more than your current dosage, and that you add these additional three to the end of the day when they will stay in your stomach and bloodstream longest while you go the longest time without eating.  You might also consider adding in acetyl-L-carnitine to your plan, starting at 3-4 capsules daily. 

Taking your Neprinol with coffee is not a great problem since caffeine does not influence the enzymatic activity or availability in any way.  Limited wine intake is also OK.    TRH   

Is my hand problem a cyst or Dupuytren contracture?

dear dr. herazy, 

my name is mark c, and  i have a question concerning my hands.  on my left hand, immediately under my ring finger, it look’s like i have a cyst! very hard to open my hand fully. in the middle of the hand i see something like a tendon sticking out and it appears to be  connected to the cyst. i also have a little one starting on my left hand. i can’t fully extend my left hand flat out because of the cyst.  i have heard there are alternative procedures for my ailment, like cortisone shots, etc. i do not know if i have a cyst or dupuytrens.

thank you for your time,

 mark c.


Greetings Mark C,

Thank you for writing to ask about the problem with your hand.

Based on the way you describe your hand problem, and the fact that you did not say so, I will assume that you have not seen a doctor at this time for the problem you are having with your hand.  This is a mistake.  You should see a doctor in your area about your hand so you will know exactly what the problem is that is causing your complaints.

Further, since you are having a problem of a mass located near the base of your ring finger and trouble flattening your hand and cannot open your hand fully, along with the appearance of what looks like a tendon connected to the palm lump, your description does make it sound like you have Dupuytren’s contracture.   

If it turns out that you do have Dupuytren’s contracture it would be helpful to determine if you can increase the ability of your body to remove the dense fibrous tissue that is developing in both of your hands by using Alternative Medicine methods as are outlined on the DCI website.  Many people find improvement after aggressively following a plan of treatment for a few months of self-administered care.   If after this time you do not see improvement in your problem then you can always consult with a surgeon to discuss hand surgery, although Dupuytren surgery is always eventually followed by recurrence of the same problem – usually within a few years.

Once you know the exact cause of the problem you will know how to proceed.    TRH

My Dupuytren’s surgery lately is going badly; do you have any suggestions for me?

Hello Doctor,

I had Dupuytren’s surgery on my right hand on August 3, 2012. Most of the surgery involved the area below my little finger with the incision extending upwards to the adjoining ring finger. A nodule on my palm was also removed from the base of my thumb. I began therapy on August 31, after complaining about the pain. After 3-4 sessions, the therapist felt I was progressing well enough that it wasn’t necessary for them to check my progress.

My concern is that lately I am experiencing some numbness in my fingertips, wrist pain, and a shooting pain up my right arm. Also, I am unable to make a fist when I wake up. It generally takes 2-3 hours before I can make a normal fist without too much pain. I continue to do the prescribed exercises and wear an Isotoner glove each night.

It appears to me that my healing process is going in the opposite direction it should be going after surgery, as the pain and lack of range of movement and poor flexibility were not that apparent 3 weeks after surgery. I’m regretting the surgery already, as I can no longer workout with weights or anything that requires squeezing.  Do you have any suggestions for me?

Thank you for any help or ideas you can provide.



While you did not name the type of Dupuytren hand surgery you had, based on your very brief description and commentary I will assume (but feel rather confident) that you had some type of palmar fasciectomy, with several different types possible depending on the amount of tissue removed during hand surgery. 

To understand this hand surgery it would be good to first explain the term, palmar fasciectomy. The word palmar refers to the palm of the hand, that broad area of the hand that is in contact with anything being held and to which the fingers are connected.   The word fasciectomy refers to surgery that is performed to remove fascia from the body.  Fascia is a thin but tough layer of soft fibrous tissue that covers, surrounds and lines all tissues, organs, structures and cavities of the body.  Fascia is as thin as, and in a way is used in the body like, the plastic Saran wrap that is used to cover and protect food.  You can see fascia as the pearly white thin tissue membrane found in cheaper grades of roasts and steaks.  There is normally a considerable amount of fascia tissue in the palm of the hand to provide extra strength, durability, support and protection during the heavy work done by the hands. 

The “-ectomy” ending of the word fasciectomy indicates the surgery is done through an opening in the skin, and that something is removed during the surgery – fascia in the case of a fasciectomy. 

The exact course and degree of tissue removal performed during a palmar fasciectomy is based on the patient’s age, occupation, family history of the Dupuytren’s contracture, duration, location and severity of finger  contracture or degree of reduced range of motion, level of disability, general health, as well as history of previous hand injury and prior hand surgery. 

With that explanation out of the way, let us discuss your situation. 

It is probably important to DCI readers that your email was received on October 15, 2012, approximately two and a half months after your hand operation.  This means that for approximately the first three weeks or month after your Dupuytren’s surgery your progress was good, but you are saying during the next six weeks you are having new hand and arm symptoms and that you now feel you are regressing.

You did not mention if this was your first Dupuytren’s surgery; this is important in regard to how you decide to manage your hand problem.  Since you did not mention prior hand surgery I will assume there was none. 

Your description of a very brief period of improvement – in your case about a month   followed by gradual appearance of numbness in the fingertips, wrist or hand pain, shooting pain in your  arm, stiffness and weakness in the involved arm is not uncommon for someone undergoing the rapid recurrence of Dupuytren’s contracture. There are many adverse things that can and do sometimes happen after even small or simple hand surgery that are totally unintended and unexpected.  Please see Dupuytren’s surgery risks for palmar fasciectomy for further discussion. 

I have no way of knowing if that is what is happening with you, but your flare up of symptoms fits in with the way that DC will always recur after surgery. On the other hand you could be going through some temporary complaints that are easily explained and common and consistent for the kind of Dupuytren’s surgery you had.  At this point I think you need to get some answers from someone who has direct knowledge and experience with the kind of surgery you had.

I suggest you go back to your surgeon and tell him exactly what you explained in your email to me.  If you receive a response that does not make sense to you, or you get brushed off with a hasty and unsatisfying reply, I suggest that you go for another opinion from a surgeon that is not associated with the surgeon who did your operation.     

Your story is a lot like many people who send me emails or call to discuss their results and side effects after Dupuytren hand surgery; I hear of bad results frequently and some much worse than what you are reporting.  From my perspective in doing this work since 2002 I observe that poor surgical results and aggravation or worsening of the original hand problem happen much more often than patients are being told prior to surgery; it seems that surgeons downplay the poor results and permanent pain, increased scarring, numbness and weakening that can happen.  They also seem to downplay the speed of Dupuytren recurrence; for some people it is never mentioned although it always recurs.   This is an unfortunate situation I hear about frequently.     

Lastly, I suggest that you consider doing your best to avoid additional hand surgery if at all possible.  The DCI site is all about the successful use of Alternative Medicine to support an encourage the natural healing of the Dupuytren’s nodules and cords.  Please spend some time looking over this information to see if it makes sense to you.  Let me know if I can assist you in any way.   TRH


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.



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.