Dupuytren's Disease a NON surgical option- XIAFLEX

Originally posted 3/7/12
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 exactly 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 five months later from a doctor at the Jacksonville Mayo Clinic. The hand 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 Institute 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.

UPDATE 1/18/19

Seven years later my left hand is still stable and functional but three years ago my right ring finger started to contract, just like my left hand had done. In December 2018, I returned to UF Orthopaedics & Sports Medicine Institute in Gainesville for a consultation with Dr Dell. Since my last correction, the FDA now allows XIAFLEX to be injected in two cords and I was told that Medicare will cover the procedure. Dr Dell told me my hand had contracted enough to have the procedure done so I set it up for the 8th and 9th of January. Dr Dell carefully injected the ring finger four times and I was told to return in 24 hr to have my hand anesthetized and manipulated. The morning of my return, as I was stretching my finger, surprisingly it snapped and I did not need anymore done when I arrived at the clinic.

I am happy to report that nine days later I was again playing golf and feeling no discomfort. What an alternative to the 3-6 months of healing that the traditional surgical treatment would have kept me off the links.Thank you Dr Dell and Staff at UF Shands!

Play more Golf!

"The greatest challenge in life is to be our person and accept that being different is a blessing and not a curse. A person who knows who they are lives a simply life by eliminating from their orbit anything that does not align with his or her overriding purpose and values. A person must be selective with their time and energy because both elements of life are limited."-Kilroy J. Oldster

Golf is a game whose aim is to hit a very small ball into an even smaller hole, with weapons singularly ill-designed for the purpose- Winston Churchill

Alzheimer's

I peek into your pale-blue windows
See you wondering around inside
I say your name, I want to shout
"It's me your daughter, come on out!"

When I was two and at the fair
You threw me "way up to the sky"
Then caught me in your loving arms
You laughed until you cried

It must be very lonely
When cherished memories fade
Everyone you loved seems gone
You're the only one who stayed

I gaze into your pale-blue eyes
One memory I can still see
You threw me "way up to the sky"
And you said my name to me

Libby Moore

The real test in golf and in life is not in keeping out of the rough, but in getting out after you are in.- Zig Ziglar

Senior Sex Survey

The frequency of sexual activity of senior males between 60 and 80 years of age depends on where they were born. Statistics were just released from the United Nations Board of Health.

They revealed that: North American men will on average have sex two to three times per week, whereas Japanese men in exactly the same age group will have sex only once or twice per year.

This has come as very upsetting news to most of my buddies at the golf club, as none of us had any idea that we were JAPANESE!!

Do old golf balls lose performance?

I just read an interesting article on Flog about performance of new vs old golf balls. New Pro V1's were compared to three levels of wear of older ProV1 balls, which had been bought from an online retailer. More than likely some/most of the old balls had come out of the water.

They tested wedge and driver shots for spin, launch, carry and total distance. The results of the wedge shots surprisingly didn't show much difference except that the more beat up the balls are, the more spin they produced. The worst conditioned balls spun only 90 rpm's more. Launch was 0.4 degree higher for new balls. Driver tests showed a slight progression of spin and decrease in launch for the older balls. 215 more spin and 1.1 degree less launch. Carry and total distance were almost identical in all categories. Maybe extra spin compensated for the loss of launch.

Personally, I don't notice much difference in old balls vs new balls or New Pro V1x vs Top Flight Yellow Gamers. The last big Senior event I played in, I was the only player of the 180 golfers playing a Topflight. I finished 12th and I out drove everyone I was paired with by at least 20 yds!

So don't be so quick to replace that gnarly looking ball, it will perform just as good as a new one. Last year I played 16 straight rounds with the same Gamer until I hit it fat into a pond. It was looking pretty bad by the time I buried it at sea but still flying like a newer one.

"The trouble is, you think you have time."- Buddha

Golf- the classy way to avoid responsibilities.

"The only thing a golfer needs is more daylight."- Ben Hogan

"The greatest wealth is to live content with little."- Plato

"I hear and I forget. I see and I remember. I do and I understand."- Confucius

I would change the above quote to "PRACTICE and I understand." I find that most people when they get the golf bug all they want to DO is play. And most of them play very poorly and get frustrated. What I suggest they should be doing is going to the short game practice area and learning how to putt, chip, and pitch from all kinds of lies. Only about 25-30% of their practice time should be spent on the driving range working on their long game, the rest from 100 yds in. If you practice more hours then you play you will become a better player much faster.

Golf is Happiness

"Golf is happiness for

Happiness is achievement.

The father of achievement is motivation

The mother is encouragement.

The fine golf swing is truly achievement

Man may lie, cheat, and steal for gain.

But, these will never gain the golf swing

To gain the golf swing man must work.

Yet it is work without toil

It is exercise without the boredom.

It is intoxication without the hangover

It is stimulation without the pills.

It is failure yet its successes shine even more brightly

It is frustration yet it nourishes patience.

It irritates yet its soothing is far greater

It is futility yet it nurtures hope.

It is defeating yet it generates courage

It is humbling yet it ennobles the human spirit.

It is dignity yet it rejects arrogance

Its price is high yet its rewards are richer

Some say it's a boy's pastime yet it builds men

It is a buffer for the stresses of today's living.

It cleanses the mind and rejuvenates the body

It is these things and many more.

For those of us who know it and love it

Golf is truly happiness."

-- Paul Bertholy