Wednesday, March 7, 2012

Dupuytren's Disease a NON surgical option- XIAFLEX

Some of you may have noticed my playing of new courses have slowed over the past few months. In 1978, I severely lacerated my left hand causing some contraction of the ring and middle finger. For 30 years every time a new doctor saw my hand they would tell me I had Dupuytren's Disease and I would respond that it has been that way for years and never changed since the time of my accident. Four years ago, my hands and right foot did start to change and indeed I now had developed Dupuytren's.

What is Dupuytren's? A contracture of the fascia in the palm of the hand which eventually prevents you from straightening out your fingers. It affects mostly men over the age of 50 and women over 60. Doctors don't know what causes it, but it tends to run in families. It is more common in individuals whose ancestors are from northern Europe. I fit the profile perfectly when it hit me, 58 years old and from the northern British Isles. There is no cure for Dupuytren's Disease and even after treatment it may reoccur. Until recently the only option was some type of surgery that may include splinting for 3-6 months along with rehabilitative hand therapy for a couple of months. A couple of things that may accelerate the contraction is Diabetes and the use of Glucosomine/Chondroitin.

In July of 2009, the contraction had gotten to the point that it was starting to affect some of my daily functions but I could still hold a golf club and play to my 2 handicap. I decided it was time to see a hand specialist before it started to screw up my golf game. The doctor I saw luckily was involved in a clinical trial for a new drug, Xiaflex, and told me I was a good candidate for its use. The new procedure involved injecting this drug into the palm (cord) and then a day later under anesthesia manipulating the hand. Unfortunately, the FDA had not approved it yet and there was no indication when they would.

Inpatient waiting for the FDA, I got a second opinion from a doctor at a famous Clinic five months later. The specialist there after examining my hand for all of 15 seconds, in between taking four non-medical related cell phone calls, told me that I needed surgery and possible skin grafts that would cost about $18,000 and at least 3 months of rehab. He said my case was too advanced for injection therapy and charged me $780 for the 10 minutes I sat listening to him talking on his cell. The old saying, "If a man only has a hammer everything looks like a nail" certainly applied to this guy. The contraction of my ring finger was about 30 degrees at that time.

Fortunately, the approval from the FDA of Xiaflex came in early 2010 but my state BC/BS health insurance kept on saying it was an experimental procedure and wouldn't cover it. After 46 other states and Medicare made it part of their coverage, Michigan finally approved it in January of 2012. Over the past 6 months the contraction had accelerated to about 90 degrees where it had become difficult to even put on my Bionic golf glove, but I could still play golf but my handicap was now up to a 5. Because I didn't want to spend time in snowy Michigan I got a referral to a specialist, closer to my winter home, at the University of Florida Orthopedic and Sports Medicine Clinic to perform the procedure.

On Feb. 16th the major contracted cord in the palm of my hand was injected and the next day manipulated (snapped). I have had about a 75 degree improvement in the range of motion and on the 14th day was swinging a golf club. Today on Day 19, I was comfortably hitting full shots. Embedded below is a pictorial timeline of my progress. For a more extensive explanation of the procedure just Google XIAFLEX.
https://picasaweb.google.com/InPursuitof1000/Hand?authuser=0&feat=directlink

The drug cost for one injection was $4,000 and the Doctors fee less than $1,000. I had the major cord injected and two minor ones are also involved which I may need treated in the future if I want more range of motion. Currently the FDA only allows injecting one cord at a time. I am back to where my fingers were 4 years ago and satisfied with the current result. I have been wearing a splint at night and will continue it's use for about 6 months or if I notice any relapse. Only time will tell how this new procedure works and if there is any relapse.

This is not an uncommon problem among older men and hopefully I have made you aware of an alternative treatment that is less expensive and gets you back on the golf course much quicker than the traditional surgical procedure. I hope to start experiencing new golf courses very soon.

Thursday, March 1, 2012

Golf Ethics Question

What if you were playing in the club championship tournament finals and
the match was even at the end of 17 holes. You had the honour and hit
your ball a modest two hundred fifty yards to the middle of the
fairway, leaving a simple six iron to the pin. Your opponent then hits
his ball, lofting it deep into the woods to the right of the fairway.


Being the golfing gentleman that you are, you help your opponent look
for his ball. Just before the permitted five minute search period ends,
your opponent says: "Go ahead and hit your second shot and if I don't
find it in time, I'll concede the match."

You hit your ball, landing it on the green, stopping about ten feet
from the pin. About the time your ball comes to rest, you hear your
opponent exclaim from deep in the woods: "I found it!". The second
sound you hear is a click, the sound of a club striking a ball and the
ball comes sailing out of the woods and lands on the green, stopping no
more than six inches from the hole.

Now here is the ethical dilemma:
Do you pull the cheating bastard’s ball out of your pocket and confront
him with it or do you keep your mouth shut?