Wednesday, 24 July 2013

Interview with Dr Hochman, an RT specialist in Florida

Today I have an interview with Dr Hochman. He treats patients with radiotherapy in Florida, I am in contact with a patient of his and he agreed to do an interview. This interview is basically a transcript of a phone conversation we had as this is how he wished to communicate. I did learn from him that persistent patients can be a good thing as that is what got Dr Hochman started with treating Dupuytren’s and plantar fibroma’s. So if you are looking for a local guy or girl to do radiotherapy it is sometimes worth asking questions and giving them the information.

Dr Hochman is based in New Port Richey, Florida

1) How long having you been treating Dupuytren's and Ledderhose disease (plantar fibromatosis) and where are you based?

I started treating Dupuytren’s disease in the hands just over 3 years ago in 2010. It was actually a patient’s husband that came to me, his wife being a harp player she needed her fingers. The patient and her husband asked me about radiotherapy for Dupuytren’s and at the time I did not think there was enough information. They pointed me in the direction of the work of Professor Seegenschmiedt in Germany who had recently published a new article. I read the article and contacted Professor Seegenschmiedt to discuss his work and decided that I would like to offer radiotherapy for Dupuytren’s patients. The patient mentioned above had a hand treated and then came back later to get the second hand treated. It was from this that I started treating both Dupuytren’s and Ledderhose. 

2) Roughly how many Dupuytren's patients have you treated and how many Ledderhose patients have you treated? 

In total I have treated around 20 patients. About 3 of these patients have been feet patients and I have treated about 5 feet in total. Several patients have been treated for a combination of hands and feet.

3) How common do you think Dupuytren's and Ledderhose are in the USA? They are supposedly more common in males then females and have been linked to a family history (of these conditions), smoking, alcohol consumption and diabetes are these risk factors you see in your patients?

I would say that certainly the foot condition is not that common and appears less frequently than Dupuytren’s. Looking at past patients about 20-30% have been female, so in my experience males to seem have an increased incidence.

A familial history of the condition is fairly common however many patients do not notice this until they are told that there is a possible genetic link for these conditions. Once they are aware of this they start to remember how their Dads hands were curled up.

I have not noticed the other risk factors in the group of patients that I have treated.  

4) You treat with radiotherapy, what protocol do you use (dose, no of doses and gap between the 2 weeks of treatment etc.) and what is the success rate on these diseases with radiotherapy? 

I treat with 3gy of radiation of 5 consecutive days followed by a 6-8 week gap, ideally 8 weeks, followed by another 5 consecutive days of 3gy.

Dupuytren’s patients are very happy with the outcome, many experience improved flexibility in their fingers after radiotherapy.

Ledderhose patients are again very happy; they normally experience a significant improvement through a decrease in pain.

5) Why is radiotherapy a better course of action than other treatments such as surgery?

Radiotherapy is a better course of action because it is a non-invasive option. Invasive options such as surgery typically do not have as good an outcome as non-invasive treatments.

6) What are your thoughts on other treatments that are becoming available such as Xiapex and cryosurgery?

I do not know any patients that have had Xiapex and I have not heard of the use of Cryosurgery to treat Ledderhose. I have come across patients who have used verapamil, it seems to work but often not as well as the patient would like.

7) Finally do you have any advice or other information that you would like to share with Dupuytren's / Ledderhose patients?

I would recommend that patients seek as many options and as much advice as they can and try to learn all of the options and make an informed choice. Too many patients will see a surgeon and have surgery or a see a radiotherapist and so have radiotherapy, patients should see a range of specialists and make an informed decision.