Patient Experience with Dr Hochman in Florida, RT for Ledderhose

Today I am taking information both from the following post (with Permission from Author) and also from conversations I have had with this patient in order to form a post to go with the interview I have done with Dr Hochman. I personally have had contact with many specialists, particularly those doing radiotherapy and for the most part they do the same treatment or at least get the same results and therefore I think that the other important factor when going into getting treatments is the doctor. I am not going to name any names but I can think of a clear example where the way that the doctor treated me made the difference, 2 doctors basically sent me abrupt e-mails and were almost treating me like a customer, the other answered in detail and offered to phone me, I know who I chose and so here is some of that information on Dr Hochman. 

Dr. Lawrence Hochman met this patient at the Florida Cancer Affiliates and it sounds like the patient was treated well and felt like she could take her time and ask questions at will. It is always good when the doctor is not trying to rush you and is willing to explain the treatment you might be having to you and what are the benefits and drawbacks.  He included the risk with radiotherapy, such as increased risk of cancer and also the less serious issue of dry skin on the treated area.

Dr Hochman was able to fit this patient in straight away, I know in the UK the lead time is about 2 weeks with Dr Shaffer (personal correspondence). I guess no lead time at all  is a good thing as if the patient wants to think about it then they can but if they want immediate treatment it is available to them. I did however think, through personal correspondence with RT doctors, that the shielding for Electron beam took longer to set up  than that but I guess not. 

The patient found Dr Hochman to be able to answer her questions on the subject and then they set about marking out the diseased area. They found the lumps and then put a safe margin around the area to ensure that they do not miss any diseased tissue, of course this does not stop it from appearing elsewhere but the chances of it coming back in the area treated are greatly reduced. As you would expect the radiation team were all very professional and mentioned that Dupuytren's was more commonly treated than Ledderhose. The Dr actually pointed out that the patients brother had Dupuytren's, looks like there might be a genetic link to the condition in this case. 

It is normally at this point that you are passed over to the radiation team, these are the people that set up the equipment, tell you what is going on and ensure that you get the right dose. The above patient informs me that the staff working at this hospital were very good at keeping her updated throughout the process so that she always felt she knew what was going on, at the same time they were efficient at their jobs but she did not feel like she was being rushed through. The team, using the marking put in place by the doctor, created a lead plate to shield the rest of the foot and calibrated the equipment to give the correct dose. Actual treatment time was under 10 minutes per day.  

Overall the patient was very pleased with the doctor and his team, for more details click on the original link above where other details such as cost and other treatments she has tried are outlined. 

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.