Calorie Restriction to help Dupuytren's and Ledderhose?

A literature review to analyse the link between calorie restriction and pathways associated with Dupuytren's disease

Over recent weeks I have heard several patients talking about calorie restriction and how eating a low calorie diet really seems to help with the pain that they were experiencing with Dupuytren's and Ledderhose and that when they stopped the diet it seemed to get worse. 

The IGF-2 link:

There is some logic behind this, after all I have already discussed how these conditions can be linked to IGF2 and IGF1 is linked to calorie restriction. However further research did not seem to come up with any evidence to suggest a good link between IGF1 and collagen. The only way I could see that the IGF2 information could help is as follows: 

• I know that IGFBP6 binds to both IGF1 and IGF2, albeit more strongly to IGF2, and that calorie restriction causes a decrease in IGF1.

• So of you have less IGF1 then the IGFBP6 is more likely to bind to IGF2, assuming that the concentrations are at a level where the increased availability of IGFBP2 still results in an increased binding affinity for IGF2. 

• So if low IGF1 causes an increase in IGFBP6 binding to IGF2 and therefore decrease the downstream effects of IGF2 one of which is collagen production you may see a difference http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684083/figure/F3/

I think that the above is a little bit of a stretch but you never know. That was all I could find using IGF1 and collagen.

Figure 1: Overview of the impact of TGF-B1 on Collagen production and how calorie restriction impacting IGF-1 levels may result in a lowering of Collagen production.

Calorie Restriction and Collagen:

So instead of that I took a different approach and decided to look for a straight linked between calorie restriction and collagen. Here I managed to find a link, in that the following paper states that calorie restriction results in a decrease in collagen production, perhaps this would also hold true a) in humans b) under conditions where Dupuytren's is present. (Ref 1). I did not have full access to the paper so could not really see what they had done but it also states that this decreased collagen production also has a negative impact on would healing which of course relies, to some extent, on the same pathways as Dupuytren's. This may be a good thing for Dupuytren's or Ledderhose patients.  

The MMPs: 

Another key set of proteins in the extracellular matrix (ECM) is the MMP protein. These are involved in breaking things down and it has been shown that knock-down (removal in cells) of  MMP2 (Ref 2) inhibited cell mediated contraction. Interestingly there have been studies in rats that have shown that a calorierestricted diet results in a decrease in MMP2, so you could argue that a calorie restriction diet will lower MMP2 and that a lowered MMP2 will aid Dupuytren's and or Ledderhose. Furthermore they showed that it appears that calorie restriction also lowers the TGFB1 pathway which I discuss in the IGF2 link at the top. 

Figure 2: The role of MMP2 in Dupuytren's and the potential impact of calorie restriction on Dupuytren's and Collagen production. 

Collagen, the extra-cellular matrix and calorie restriction:

My final search I just thought I would have a look for ECM itself and calorie restriction and see what I could find and I found a couple of very interesting papers which I believe are both free to download. 

The first paper (Reference 4) is looking at the impact of calorie restriction in tumours. Interestingly they found that there was a decrease, as expected in IGF-1 which I have discussed above but they also observed that in calorie restricted mice there was a decrease in MMP2, which as discussed above is linked to the development of Dupuytren's. There was also a decrease in the levels of TGFB-1 which again I have also discussed above. 

Another protein that they mentioned that took my interested was collagen 4. Although Collagen 3 is the main component of the Dupuytren's lumps it is interesting that there are downstream effects on the levels of a collagen type. The second paper I am not going to go into as it basically has similar but less information as in the above paper though it does have a good picture on page 6 (Reference 5). 

The other side of the argument: 

You cannot construct a complete article without looking at both sides of the story. My research into this side was not as extensive because it is hard to find information disproving something that it just an idea but did bring up some interesting points.

The following paper (Ref 6) shows that despite the information I have seen above that TGF-B2 (yes 2 not 1, still looking into this but from what I have seen so far 1 and 2 act through the same pathways) does not affect the collagen levels in Dupuytren's cultures. In fact I am not sure what else to say on this side, if anyone has any information they would like to add then let me know.

Conclusions: 

Would having a calorie restricted diet hurt someone? It might but at the same time you can come off of it and may not have lost anything but you may have gained the used of your foot or stopped your hand from progressing. There is no information out there that says that it will work like that, in fact there is no direct evidence at all linking calorie restriction and Dupuytren's (for or against). The above data is a collection of the information that I could find that linked calorie restriction to pathways that have been linked to Dupuytren's. A lot of this data suggests that there could be some impact but there was nothing there that made me think that it definitely will work. 

As a non-medical professional I cannot endorse having a low calorie diet in general or a as a treatment for these conditions, although the information above suggests that it may have some impact. Note that many of the above studies were in cells or cancer and not in humans and none were related directly to Dupuytren's or related conditions. You should always consult a doctor before starting a very low calorie diet. If a doctor was interested in using this then I would be happy to work with them to look into this.

If any patients have experience of this and would like to share their story it would be great to add the information to the blog.

Other areas of interest: 

There is another signalling pathway called the Wnt signalling pathway. I know from back in my degree that this is using is development and it is still active in adults. I mention this pathway because it has been shown that a high number of Dupuytren's patients have SNPs (differences to everyone else) in genes that are associated with that patients (Ref 7). Although this is as far as the evidence go the Wnt signalling pathway has been linked to diabetes, cell growth and certainly warrants more investigation. 

Reference 1:

Reiser K1, McGee C, Rucker R, McDonald R - 

Access 29-09-2014

J Gerontol A Biol Sci Med Sci. 1995 Jan;50A(1):B40-7.Effects of aging and caloric restriction on extracellular matrix biosynthesis in a model of injury repair in rats.

http://www.ncbi.nlm.nih.gov/pubmed/7814778

Reference 2: 

Biochim Biophys Acta. 2012 Jun;1822(6):897-905. doi: 10.1016/j.bbadis.2012.02.001. Epub 2012 Feb 9. MMP-14 and MMP-2 are key metalloproteases in Dupuytren's disease fibroblast-mediated contraction.

Wilkinson JM1, Davidson RK, Swingler TE, Jones ER, Corps AN, Johnston P, Riley GP, Chojnowski AJ, Clark IM.

http://www.ncbi.nlm.nih.gov/pubmed/22342364

Reference 3: 

Calorie Restriction Reduces MMP-2 Activity and Retards Age-associated Aortic Restructuring in Rats , Mingyi Wang et al

http://circ.ahajournals.org/cgi/content/meeting_abstract/114/18_MeetingAbstracts/II_335-b

Reference 4:

Caloric restriction reduces growth of mammary tumors and metastases - Mariana S. De Lorenzo et al

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165123/

Reference 5: 

Molecular Mechanisms of Calorie Restriction’s Protection against Age-related Sclerosis, Elena Chiarpotto et al - http://onlinelibrary.wiley.com/doi/10.1080/15216540601106365/pdf

Reference 6: 

Enhanced Dupuytren's disease fibroblast populated collagen lattice contraction is independent of endogenous active TGF-β₂ Raymond Tse¹⁴, Jeffrey Howard¹²⁴, Yan Wu¹⁴ and Bing Siang Gan^1234*

http://www.biomedcentral.com/1471-2474/5/41

Reference 7: 

Wnt Signaling and Dupuytren's Disease, Guido H. Dolmans,  et al

http://www.nejm.org/doi/full/10.1056/NEJMoa1101029

Progression of Ledderhose disease

Below is some information that a visitor to the blog felt was missing. They said they had some information on it and they were happy to write it up. All information is posted with their permission, in fact they wrote it for the purpose of me posting it. 

It is true that I do not have much information on the progression of the disease, this is partly because, as you can see below, there is not a huge amount of information out there and secondly because I started the blog looking at treatments as that was the stage as I was. So for all of those that are new to the condition you may find the information below interesting to read. I felt that the paragraphs below were not enough to warrant a complete post so I conducted a small survey to complement the information. 

There is very little statistical information on the potential progression of Ledderhose Disease (LD)/Plantar Fibroma (PF).  There are individual disease trajectories provided by individuals on various patient forums. These patient histories can not be properly weighed as indicative of the normal course of the disease because there is no broad sampling of patients, no regular follow up, no quantitative measurements.  Therefore, the reader does not know if these patients are outliers or the norm.  In addition, there may be completely fabricated patient histories that have been authored by unscrupulous people preying on the fear and desperation of patients to sell their products.

The most rigorous published scientific studies that I have found on the LD have been performed by German researchers who were investigating the effectiveness of radiation therapy on Dupuytren's Disease (DD) and Ledderhose Disease(LD).  What is of most value in these studies is their use of a control (untreated) population.  For example, Seegenschmiedt[1] reported that for a control patient population of 47 people with 67 affected feet with minimal symptoms, 6 year average time of observation, minimum observation time of 1 year, 10 feet (15%) had a spontaneous remission, 34 feet (51%) remained stable, and 23 feet (34%) progressed and required treatment.  

These data are quite remarkable as they indicates that for a large percentage of LD patients  (66%), the expected disease trajectory is stability or regression for a non trivial period.  

I wanted to complement this information with anything extra that I could find, this included information from a patient that contacted me around that time. They suffered from Ledderhose and despite having nodules bigger than mine they did not experience pain. I do think that up to a certain point the size of the nodule is not the problem, it is the location and depth under the skin and whether it hits a nerve. Once it protrudes significantly out of the sole of the foot this can then cause issues based on the size of the lump (that is all just my opinion and thoughts but is based on the size of the fibroma not necessarily being related to the pain caused, which as it turns out is the case in the survey).

In order to gather more information on this I conducted a small survey which revealed some interesting results. 

Participants were asked to rank from 1 to 10 (10 being most painful) their condition from year 0 (diagnosis) up until now or year 30 (only 1 participant had had the condition for 30 years). Below I have 2 tables showing some of the results. 

Change	Num Occurrences	Comment
-10	0
-9	0
-8	1	*Year after RT treatment, no later pain increase
-7	0
-6	1	*Year after RT treatment, no later pain increase
-5	3	*all 3 after surgery and again increased
-4	0
-3	1
-2	3
-1	14
0	107
1	55	*High number of 0/1/ 2 suggest that progression is normally slow
2	19
3	7
4	7
5	3
6	3	*But over 1/2 of respondents experience a sharp increase
7	1
8	0
9	1
10	1

Table 1: Column 1 shows the change from the previous year, column 2 shows the number of years in which this change occurred and the third column shows a comment. Colouring is used to group results together.

Avg Max pain
2.28	Max yr on yr diff 2
7.22	> 3 year on year diff

Table 2: The average max pain for patients split by those that report a max change year on year of 2 and those that reporting having a change of greater than 2.

Table 1 shows that in most cases year on year there is little change in the condition however 50% of patients experience at least one year where there is an increase of 3 or more. When used in conjunction with table 2 this shows that those patients that experience a large jump are more likely to have significant pain. I have not calculated a number to show this but this is not simply due to an increase in the number of years a patient has the condition but it is that those with high levels have pain have had a large jump and not a gradual increase. In fact with only 1 exception the highest pain level reached by someone someone without a large jump was 3 (the exception being level 8).

Several patients report large decreases in pain, the 2 largest pain decreases were both as a result of radiotherapy. There were 3 patients that report a minus 5 in pain, all of these were because of surgery but in all 3 cases the pain then rose again. In no patients did the condition naturally regress year on year by a significant amount when there was no treatment involved. 

The above information and the rest of the results are summarised below. 

•  The size of the nodule is not proportional to the amount of pain
• Age of onset does not impact on progression
• Male or Female does not impact on progression
• Generally when gets bad seems to progress quickly
• It appears that without a large increase in pain you are not like to be experiencing too much pain
• Significant decreases have been observed post treatment with radiotherapy and surgery, after surgery pain rose again.

Of course to get these results I arbitrarily chose a jump of 3 as being large. I did chose this before analysing any data to try and avoid bias. Also this survey did not have many answers as it was just an initial survey which may help in the future development of a more comprehensive survey on the subject or a database to collect patient information. The results in the summary are all results which were clear from looking at the data and no numbers or graphs have been provided but I can make upon request. 

Below are some examples of patients pain levels over time. 

(1) Radiotherapy for primary or recurrent morbus ledderhose: 12 year long-term outcome of a prospective phase 2 trial. M. Heinrich Seegenschmiedt, Etienne Hanslian, Mark Wielpütz

A bit about me and things

An update on me is probably overdue. Things have been hectic recently which is great. 

As you will have seen over the past month or so I have been hearing about a few new and alternative therapies in Laser treatment and shockwaves. I am always keen to hear about new treatments and although the above 2 are yet to have much evidence for them they are still worth considering. After all every treatment has to start somewhere or it does now, imagine if surgery had never been done for Ledderhose and they conducted a clinical trial on that now.... anyone think it would actually be approved? 

The above 2 interviews both results in long and helpful discussions with the people involved, it is nice to hear how passionate some people are about these things. Sure the shockwaves guy was a salesman but it sounded like he really believed in the product he was selling. It would be nice to be able to try to use the equipment, I have achilles problems after running and knee pain after badminton and it would be great if there was something that could alleviate them (weight loss would but that is a long term goal). What I have just said shows that at least I am still playing badminton and running, this time 2 years ago I was 3 months post RT and starting to improve. Soon I will be adding a post on the progression of Ledderhose based on the mini-survey I am doing and although I do not have many responses it is only going to be an overview, probably just showing that everyone is different. 

Soon I will also be doing my 300th post, this will be a post to celebrate everything that has gone before, passing 150,000 page views and maybe wondering where the future will take me.

The facebook group continues to go from strength to strength and it is exciting to see so many people coming together to share and talk about experiences. The survey results are continuing to come in and we can already see some interesting trends. 

I have entered the blog into the UK blog awards, whether it will go anywhere I don't know but if it results in 1 person gaining some knowledge on the condition then it was worth entering. I am not sure if my blog is award worthy in terms of layout etc but I am hoping that the sheer amount of unique content and the number of people it has helped give it a chance of doing something. 

I have also had some sad family news recently, it is fair to say that I don't feel that Ledderhose and Dupuytren's get their share of the limelight but then they aren't life threatening even if they can make your life really suck. Being told you have Ledderhose or Dupuytren's is much more of an "Oh" thing rather than many other conditions where you are left speechless and in that sense I can fully understand the amount of research and money that goes into preventing and curing other conditions. Hopefully they can hurry up and cure those and then crack on with these conditions! 

There is so much going on in life that finding time for the blog and related matters is not always easy. What with working a full-time job, spending time with my amazing daughter and wife, helping my wife in setting up her new business (please feel free to like her Facebook page and if you are in SE England then order some cakes, they are really yummy just look at my waistline), doing some badminton coaching and much more time is very precious. Thank you to everyone that helps in anyway, whether it be with a nice comments, helping someone or answering their question on the Facebook group so I don't have to or whatever, thank you. 

Shockwaves for Dupuytren's, Ledderhose and related conditions

Recently I came into contact with a gentleman at Cell Sonic, they manufacture the equipment used to treat with Shock-Waves. This is an interesting treatment which has very little documented evidence. My gut says that this is a treatment that is worth a try. From what I have read it appears that there is very little to lose in terms of side effects or aggravating the condition but it could potentially help. Really what is need is a bigger and better study than the one I discussed before. 

Anyway the guy that I spoke to is extremely passionate about this technology and it was clear to me that he really thought that it could be a great way to treat many different problems. 

Below is a copy of some information that I received from CellSonic and have published with their full permission. If there are any doctors that are interested in using this treatment then please get in touch. I have been told it is a diverse piece of equipment and that it would pay for itself without even taking into account the conditions I am interested in. Then again the person selling it is of course going to say that. 

Doing a bit of research and a quick search of PubMed certainly shows that there is a lot of information out there and it has been used to treat scar tissue and many other conditions. 

http://www.cellsonic-medical.com/cellsonic.htm

Dupuytren's contracture can be almost totally cured using CellSonic’s electro-hydraulic shockwaves. This is a non-invasive, drug free treatment that takes about five minutes. Sudden bursts of sound are directed into the palm and fingers to loosen the tightening cells pulling the fingers. The vital characteristic of a shockwave is that from zero decibels to high must happen in a few nanoseconds. To achieve that, CellSonic flashes 25,000 volts across a one millimeter gap inside water and the sound wave projected through gel into the hand which is also acting as water. The fast moving sound wave hits the tightened cord and stretches it. Moreover, it activates stem cells to migrate to the site because through the nerves the brain has detected a problem and is  instructing white blood cells to make a repair. The patient will feel the shockwaves and it will be uncomfortable, some would say painful, but do tolerate it because the nerves are sending a necessary message to the brain. An anesthetic would block that message and the immune system will not be activated. The fastest rise time of decibels is achieved with the CellSonic machine so fewer shocks and fewer treatments are needed. The recommendation is for 1,000 shocks at energy level 5 using a shock head focused at 5 mm. Aim the shocks on the area of the palm and the fingers where the tightening is apparent, keeping the shock head sliding gently around on the gel. If another treatment will help, do it two weeks after the first. Improvements are still taking place a year after the last treatment. This is because the shockwaves are causing new cells to grow thanks to the stem cells. Dupuytren's contracture involves similar cell damage to that experienced with plantar fasciitis, Ledderhose Disease and Peyronie’s disease. They can all be treated with the same protocol described above except Peyronies needs fewer shocks at lower energy level.

There are no side effects and that has been proved over the last 40 years because the same technology has been used with much more powerful machines to break kidney stones and millions of patients have been treated without side effects. Other applications with shockwaves include healing wounds because they kill infection, repairing broken bone, treating sports injuries and releasing pain. In Germany, CellSonic shockwaves are being used to reduce cellulite and this will soon be marketed in other countries.

The shockwaves will do two things. Firstly they will damage, soften, loosen and release the tightening tendons and cells which are causing pain and problems. This is an alternative to the scalpel which certainly has side effects.

Secondly, the immune system is triggered because the brain senses that the body has been attacked. It is the immune system that causes new cells to grow and that is achieved by causing stem cells to be released by the pelvic bone where they are stored. It has been shown that zapping the pelvic bone is helpful.

The distributor who can arrange for doctors to try the machine is:

Mark Wilson, Managing Director

Cellsonic Ltd

M            07794822295

E              mark@cellsonic-medical.com

W            www.cellsonic-medical.com

T              @cellsonicESWT

F              https://www.facebook.com/pages/Cellsonic-Ltd/382099131900991

Laser treatment Plantar fibroma patient from USA

Today I have an interview with a plantar fibroma patient from the USA, she has undergone laser therapy and shares her results so far....

1) Do you have Dupuytren’s and /or Plantar fibromatosis?

Just Plantar Fibromatosis

2) How old were you when you first noticed the fibroma?

67

3) Where are you from and do you consider yourself to have any of the common risk factors?

I was born in Butler, PA., USA of Scotch, Irish, German decent.

I have none of the known risk factors.

4) What treatment options were you initially offered?

I was referred to a foot surgeon who told me that there was very little successful treatment for this condition. He told me that neither he nor his patients were satisfied with the outcome of surgery or cortisone injections. 

He was working in conjunction with the University of Arizona researching the use of laser in the treatment of neuroma and was having some success. He thought that fibromas might also respond to laser treatment and asked if I would be interested in giving it a try. Faced with the other treatment options that seemed to not work, I chose to undergo the laser treatment he suggested.

5) How was the laser treatment?

The treatment was for a fibroma on my right arch which looked remarkably like the photo you posted of yours.  I received 14 laser treatments between July 27, 2013 and February 14, 2014.  Each treatment lasted approximately 14 minutes and only about 2 minutes involved moderate pain.  The first 10 treatments were one week apart.  The final 4 were approx.. 1 month apart.  In mid-October (part way through the laser treatment) we decided to include Verapamil Gel Therapy as part of my treatment plan.

At this point I was part way through the laser treatments and it seemed like it was working.  When Dr. Bocian suggested and explained the addition of verapamil gel, I trusted his opinion that this was a reasonable course of action for me.  

I had developed 3 very small nodules on my left foot, but they were not bothering me in any way so they have not been treated with the laser.

I used the gel 2 times per day on both feet and Dr. Bocian would apply it to my right arch fibroma immediately preceding the laser.  So the Verapamil was used 7 times with the laser on my right foot.  I continued to use the Verapamil gel on both feet 2 times per day for 9 months from October through June.  This concluded my treatment.

Today the nodules on my left foot remain small and asymptomatic, and the laser treated fibroma on my right foot cannot be seen and can barely be felt.  The pain is gone.  Occasionally I experience a very mild discomfort (where the restructured tissue of the fibroma is) with weather changes (we have no idea why this would be) or if I wear shoes with a high or padded arch.  The discomfort disappears when I change shoes or the storm front passes. I currently walking 7,000 – 8,000 steps a day and I attend 3 aerobic fitness classes a week.  All in all, I am very happy with the outcome of my treatment from Dr. Bocian.

As a side note – The laser treatments have not been approved to treat fibroma, so my health insurance covered none of the expenses.  The cost of the Verapamil Gel was $790.00.   I filed a request with my health insurance carrier to cover the Verapamil Gel and was denied.  I filed an appeal, since they did cover the use of Verapamil for other ailments.  There was much sarcastic laughter around our house the day I got the letter from them stating that they were going to reimburse me 22 cents for the sterile water used in the compounding of the gel !

Interview with Dr Bocian, Laser treatment for Ledderhose

Today I have an interview with a Dr who does Laser treatment. I actually only asked for this interview after a patient e-mailed me asking if I had heard of it. I have heard of it but I have not seen any evidence for it or any information in the public domain and thought it was worth trying to do something about that. 

The person I contacted was Darin whose website can be found here. Darin has been very helpful and has been very happy to answer my questions and has kindly asked a patient if they would contact me. They did contact me and I have an interview with them as well. So please keep reading to find out a but about Laser therapy for Plantar Fibromatosis. 

1) Do you often come across plantar fibroma’s? How common would you say they are in the USA?

It is relatively uncommon; I see about 5-10 cases per year. Some of them are small and may be asymptomatic.

  

2)  Do you seen any common risk factors in patients?

Although in the literature there are risk factors associated with plantar fibromas, due to the limited amount I see,  I have not been able to drawn any conclusions.

3) I understand that every case is different but what course of treatment do you recommend for early stage Ledderhose?

If lesion(s) are asymptomatic, no treatment, simply monitor for changes.

If painful, I have found cortisone injections are not very helpful; if any improvement achieved, it is temporary. An accommodative shoe insert may help.

I recommend transdermal verapamil gel 15% with Nd:YAG laser treatment. I have found verapamil alone provides extremely slow and limited improvement. However, the gel combined with the laser seems to work synergistically. Using the laser and topical gel together, seems to enhance the reduction of symptoms and reduces the time it takes to reach this goal. I have also seen a reduction of the size of the nodules following the treatment. This is most notable in the smaller lesions.

4) I see on your website that you perform laser treatment, what is this and how does it help with plantar fibroma’s? What sort of success rate does it have and can it be repeated?

The exact mechanism of how the Nd:YAG pulsed laser works for plantar fibromas is still uncertain. In fact, the mechanisms of interaction between laser and tissues in general is not well understood. It is FDA cleared here in the USA for scar tissue.

According to the limited research available, it seems to have an effect in the inflammatory process and in the formation of functional tissue. It is suggested in the literature that the ” Nd:YAG pulsed laser can efficaciously promote tissue repair process”. Much research is needed in the biomedical effects of laser.

5) What is the procedure and recovery times for laser treatment?

The procedure involves weekly in office laser treatments. Topical transdermal 15% verapamil gel is applied to the lesion and allowed to be absorbed for several minutes.

The laser treatment is performed without anesthesia. There is mild discomfort as the absorption of the light to the area will generate heat. Stopping the treatment for a few seconds alleviates the discomfort and then laser treatment is immediately restarted. Between these short interruptions of treatment, the lesions is gently massaged. It is necessary to undergo several treatments depending on the size of the lesion. Number of treatments can range from 10 to 20. There is no down time following treatment. Patients continue activity as tolerated. The entire treatment time ranges between 5-10 minutes.

6) You also recommend Verapamil with Laser treatment, what are your thoughts on verapamil as a stand alone treatment? 

Verapamil gel alone in my experience provides only minimal improvement even after several months of treatment.

7) Why do you think that a combination of the 2 treatments work? 

I believe the key to my successful treatment of plantar fibromas is the combination of the laser and the gel.

8) Do you have any other advice that you would like to give to patients with this condition?

Surgical excision in my experience should be avoided if possible. I have surgically removed many plantar fibromas. The success rate is not very good. The complications following the procedure can include hypertrophied scar tissue, adhesions and of course reoccurrence. Unfortunately, the undesirable outcomes following the procedure can make both the doctor and patient wonder if the surgery was successful.

Darin Alan Bocian, DPM, FACFAS

1845 W. Orange Grove Road, Suite 125

Tucson, Arizona, USA  85704

bociandpm@comcast.net

Ledderhose patient treated with RFA and blood platelet injections

Today I have an interview with a patient from the USA, I came into contact with her through one of the many different forums / groups and she has had some treatments that sounded interesting. She was kind enough to answer my questions and provide a few pictures of before and after pictures. 

1) Where are you from?

I reside in North Dakota and part time California.

2) Do you have Ledderhose and/or Dupuytren's? 

Ledderhose

3) Do you have a family history of this condition? 

Unknown, my Dad had 16 brothers and sisters many I did not know.

4) How did you find the medical awareness of these conditions? 

I first noticed a lump but was very busy at the time, before I knew it it felt like I was walking on a golf ball. I went to Dr. Sabot at Mission hospital in Laguna Beach ca. He told me I had a plantar fibroma and by now I had a small one coming on the other foot also. But the one on my right foot was two large masses.

5) What treatment options were you offered?

Radio frequency ablation. I also had a bunion fixed on one foot which was the difficult part. The ablation was pretty much painless after and I definitely noticed a reduced and soften in both fibromas. I needed to return to the operating room to have the screw out which I was allergic too, he recommended the area of my large fibroma be treated again with blood platelet injection to decrease and soften it even more. 

6) What condition were you in when you were looking to get treatment? (Pain wise) 

I was about 7 out of 10 sometimes worse than others.

7) What is RFA? Please could you describe the treatment process you underwent with RFA and blood platelet injections? 

The definition for radio frequency ablation is as follows. Radiofrequency ablation involves the use of heat to destroy fibroid tissue. It is a laparoscopic procedure involving small incisions.

Ultrasound is used enabling the surgeon to see the fibroids clearly.

A long needle-like device is then inserted into a fibroid. When it is in the middle of the fibroid, heat is delivered until the entire fibroid is destroyed. The process is repeated until all of the fibroids have been ablated.

Each treated fibroid will shrink in size by about 40 percent within three months of treatment.

8) How successful would you say the treatment has been? 

3 years post op and I feel I had good results. However, Now I have a new one coming on the foot that had the large fibroma but it is going off to the side. He feels I should do Tenex on it. I am not convinced and I am doing research and getting more opinions. I think it was pretty successful  however and the blood platelet injections did push it along to soften more. 

9) What other treatment options are you looking into now and what are your thoughts on them? 

I have not found anything my insurance will cover. I am therefore considering paying out of pocket for something. I am not sure what however, nothing gets my hopes up. I am getting more opinions in California as North Dakota DRs just want to cut!

I am an aesthetician and have some pretty cool equipment so I have decided to use some of it on my fibroma and see what results I can get. Currently I am using cold hammer therapy with blue light. It really helps reduce inflammation and is soothing. I'm going to do it 3 times a day for 60 days and see if I notice anything.

Before rfa blood platelet injections:

After three years, now you can see one coming off to the side.