Greetings All PD and DC Warriors:
Welcome to the April 2013 PD Institute newsletter.
As I write this newsletter the Midwest is receiving another blast of snow and wind. Old man winter does not pay attention to the calendar or the flocks of robins that have been on my lawn for the past week. The early bird might get the worm, but when the robin is early he gets snow.
The topic for this newsletter is “Using a PD/DC fibrous tissue baseline is like losing weight.”
A baseline is a reference point used for measurement or comparison. It is used to judge the progress or change of some value; the purpose of such a baseline is that with it a person has a reference point to know how much change is being made and this helps to know what to do to increase or decrease that change. In the case of treatment of Dupuytren contracture and Peyronie’s disease, the baseline is simply a very detailed description and measurement of the Peyronie’s scar or the Dupuytren’s cord and nodule and finger restrictions.
Creating such a baseline that describes the structure of the offending fibrous tissue is a challenge for most everyone at the start of their Dupuytren’s contracture or Peyronie’s disease treatment. Even though having a detailed description of the structure of the foreign fibrous tissue is the most important tool for successful treatment, I have never met anyone who did not underestimate its importance and initially do a rather bad job of it.
Since this website is all about self-treatment of Dupuytren’s contracture and Peyronie’s disease, let me give you a common example in healthcare that will show you the importance of using a baseline, and how to use it to improve your health. Let’s say you want to lose weight. There are three very common baselines that people often use to judge if they are losing or not using weight:
• Judging if your underwear feels looser
• Looking in the mirror to compare what you look like
• Using a scale to weigh yourself
Remember, even though we are mentioning weight loss, this discussion applies to DC and PD treatment. Please notice how all of these points directly relate to Peyronie’s and Dupuytren’s treatment.
I just read a California study that shows almost 92% of people who put themselves on a weight loss program never get on a scale; they either use the “underwear method” or the “mirror method.” By this I mean that they do not make an accurate measurement of their weight, they just assume they will recognize weight loss as soon as it occurs. They say to themselves, “I know all the experts say you should use a scale when trying to lose weight, but I will compare what it feels like to get into my underwear or what I look like in the mirror to know if I am losing weight. After all, I am not stupid. I know how my underwear should feel like, and I have seen myself in the mirror every day of my life, so I will know when I lose weight. I can do it easier my own way. I will know when I am losing weight.” But they do not.
Of these 93% of people who rely upon their memory and their personal perception, almost 100% fail to lose weight. The explanation is that the great majority deceives and confuses themselves by not having a clear baseline of information. Personal observation and comparison based on memory are terribly ineffective and inaccurate; the study shows relying upon your eye or memory is not a good way to approach weight loss. Because they have no accurate baseline about their weight they change a successful weight loss plan, or maybe quit completely when the weight loss is actually doing well but going slowly. Or they continue with a plan that is not working because they think they see weight loss when they are not. Eventually discouragement sets in and they quit.
Of the 7% of people who use a scale to determine their baseline and make frequent weight comparisons, 58% actually lose weight (reducing 2% or more of their starting weight and keeping it off for six months or longer). The California study also discovered that the longer a person continues to get on a scale to monitor weight the longer the weight stayed off. An accurate baseline weight that is compared to later accurate measurements of weight helps them to know what is working (or not working) to lose weight. They are aware of the first sign of weight loss and they do not change the diet once the weight starts to fall away; they are also aware of lack of weight loss and can change the diet and activity level until weight loss does occur. They use the scale as a tool to know how to modify their diet.
Also, the people who weigh themselves more often lose more weight. Those who do daily weigh-ins lose more weight than those who do weekly weigh-ins. The people who are more involved, who watch their progress (or lack of progress) are in a better position to know what is working (or not working) and can control the outcome of their weight loss program better.
The California study showed that this method works because those people who frequently got on a scale learn immediately what is or is not working. The information from the scale gives them the signal to change their weight loss approach until they can actually see the scale go down soon after making the right changes in food intake and exercise levels. Scale users do not guess about weight loss. They know if what they are doing is working or not. IF THE SCALE DOES NOT GO DOWN THEY CHANGE WHAT THEY ARE DOING UNTIL IT DOES GO DOWN. These people frequently change their diet or their activity level in some meaningful way, based on their baseline, until they get the results they want. Their diet does not go on, and on, and on for weeks or months without getting results. Also, when they start to see the scale go down, they know it and they are given immediate information and feedback to continue with those diet and activity changes that created the weight loss. PD and DC treatment works in the same way, if you monitor your fibrous tissue in the way I am suggesting that you use.
I cannot think of a better example or a clearer way than the weight loss example to explain how everyone needs to approach your Peyronie’s treatment and Dupuytren’s treatment plans. The way you use a scale to lose weight is the same way of using the information about the fibrous tissue to get rid of that hunk of fibrous tissue that is ruining your life.
For almost 11 years I have been preaching to everyone who starts a PD or DC treatment plan the same way to approach treatment with this outline of care:
• For Peyronie’s disease they must know the size, shape, density and surface features of each PD scar they can locate. (More about PD scar location toward the end of this newsletter.)
• For Dupuytren’s contracture they must know the size, shape, density and surface features of the hand nodules and cords, plus they must also know the direction and degree of movement of the palm nodule in relation to the tissue below it, the distance of the involved fingertips to the wrist crease, and how far from a table top they can flatten their hand. (More about judging the DC nodules in the next section of this newsletter.)
• Every 7-10 days monitor the physical condition of the fibrous tissue to determine if your plan – no matter what it is – is improving or changing the condition of the fibrous tissue.
• If the fibrous tissue has shown change and improvement 7-10 days after making your most recent treatment increase, then make no more changes to your plan; continue until your problem is either resolved or until you stop making tissue changes
• If the fibrous tissue has not shown change and improvement 7-10 days after making your most recent treatment increase, then again increase your plan slightly as described in the DCI and PDI websites; re-evaluate in another 7-10 days
Everyone who comes to DCI and PDI is told this message repeatedly, but only a small percent pay attention and do it correctly. Many people cut corners so they only do the easy parts of the treatment protocol; many work hard for a week and then get discouraged when a miracle does not fall on their head; many seem to forget to follow the plan for days on end; these people do not get good results. Those who are faithful and aggressive, and use this treatment outline as I have suggested, almost always see good changes with their fibrous tissue problem.
Most people rush into treating their Peyronie’s disease or Dupuytren’s contracture. They are so eager to get well, that they focus only on the treatment end of the process. They call and email asking questions about “what is the right dosage?” When I tell them that dosage is determined by a process of slow and gradual increase based on fibrous tissue response, they struggle to understand. They want a clear and definite dosage number, but I have to tell them I do not have a magic dosage number – they must work that number out on their own, and I explain how it is done.
I explain the correct treatment dosage is determined by frequent evaluation of the tissue to see how the tissue responds to whatever treatment that is being used. I believe that m any are not ready to take full responsibility for doing the work of managing their treatment in this way They think that all they will have to do is start popping pills into their mouths.
When I explain to people how they must evaluate their fibrous tissue they act like they do not want to hear about this part of the treatment method. They always, I mean always, tell me, “Oh, I know how my hand is, and I know what my cords and nodules look like. After all, it is my hand! I will know when my fingers will change.” And, “I will know if that curvature will improve. I am really motivated so I have been paying attention to this for a long time. I will know, honest.” Then two months later, I hear back from these same people, “I have been on the plan for some time now, and I think it is working but I am not sure. Most days it seems better, but then some days I just do not know for sure. I am really so confused I might even quit. Can you help to get on the right track?” I just sit back and moan.
In the last month I have had too many conversations with people who do not want to listen to what I am suggesting to them about closely monitoring the soft tissue changes going on in the shaft or hand. Several warriors had a consultation with me in the past week and complained that their PDI or DCI plan was not working after many months and a thousand dollars being spent. When I asked them for information about the size, shape, density, surface features and their hand measurements, none of them – none of them – could tell me anything definite, factual or accurate about the current condition or the condition of their hand/shaft when they started. In other words, they all were guessing with what they were doing. They were popping pills and hoping for something good to happen. They had hoped during our phone consultation they would be given their magic dosage number.
Everyone doing this work needs to understand that dosage is determined by scar response.
These are some of the answers and explanations I get from people when I ask them about the physical condition and description of their scars, nodules and cords. From this information I am supposed to understand what was going on in their recovery. Worse yet, this is the information about their problem they had in their heads that was guiding their treatment:
• “My scar is hard. How hard exactly? Oh, you know, hard.”
• “The lump is large and hard. How hard exactly? I think the best way to explain it is that it is really hard.”
“I think my penis is curved less than before, and the erection is better than before I started treatment but not as good as I want it to be. How much was it curved when I started? Oh, about a medium bend.”
• “My right hand is drawn up into a claw, and my left hand is not too bad but I do not want it to get like the right. Exactly how bad is the claw hand? Pretty bad.”
• “The curve is pretty severe, and I am positive it has not changed after two months of treatment. How do I know? Because it has not changed. Did I measure it? No. How do I know if the curve has not changed even though I have never measured it? I just know.”
All of these descriptions and explanations are totally meaningless and useless in guiding care. I cannot help these people because they do not know what is going on in the life of their problem. Worse yet, these people do not know what is going on either, and for this reason they cannot help themselves. They are in no position to guide their care because they have no accurate baseline of information to judge the effectiveness of their plan. They are throwing darts in the dark, and because of this they are not hitting the target.
No wonder these folks are confused and getting no results. What does “really hard” mean and how do you compare that to the fibrous density you will have in 7-10 days? How do you compare a “medium bend” to some other bend in the future? What exactly does a “pretty bad claw hand” look like and how will you know it is better or worse to the claw hand you will have in 7-10 days? If you never actually measure a “pretty bad curve” or evaluate the scar that is causing it, how will you know if it is better or worse in 7-10 days?
Not only is this kind of care wasteful of their effort and money, it is wasting precious time for early recovery as their problem gets to be older. These folks are playing around guessing about what might help them. It is simply foolish to spend all that money and effort, and not do the job correctly when there is so much at stake.
This is such an important topic. Everyone who starts to treat their finger contraction or bent shaft only focuses on the obvious – the first thing that comes to mind when they think of their problem – and that is the outward appearance of their contracted finger or penile curvature. But this is not the right way to measure what is wrong when you have Dupuytren’s contracture or Peyronie’s disease.
The outward appearance of the distorted hand or shaft is only the end result of the internal fibrous tissue. While the distortion gets your attention, it is not the real problem you must eliminate. The real problem is the foreign fibrous tissue inside. For this reason it is critical that you evaluate the internal fibrous tissue in as many ways as possible and record that information for further comparison as your treatment progresses. Later, to help you decide every 7-10 days whether you should increase your plan or not, you will then compare the current size, shape, density and other important physical structural qualities of your internal fibrous tissue factors to what they were previously. In this way you will accurately know with confidence if your plan is working or not, and whether it should be changed or kept on its current successful course. No guessing. You are confident and comfortable being in control of your care because you are accurately measuring what is actually wrong with you, and using that information to guide your care to a successful conclusion.
Everyone who is reading this newsletter and is motivated to get great results should decide right now to become an expert in developing and monitoring the true status of the contracted fibrous tissue in your hand or shaft. This will give you knowledge and control over what is going on, and you can use that powerful information to guide your treatment to the most effective degree of correction of which you are capable.
Now, I will present some new information about Dupuytren’s contracture evaluation I have never presented before. This is some very important information, so please read carefully and use it to help your Dupuytren self-evaluation. Later, I will present some information about Peyronie’s disease evaluation and how to find the PD scar.
DUPUYTREN’S CONTRACTURE EVALUATION
Besides the usual evaluation of the size, shape, density and surface features of the cords and nodules, there are additional Dupuytrens baselines that help to evaluate the hand contracture problem and guide treatment.
There is the important hand caliper tool that DCI created to accurately measure the exact degree of contracture of each finger and the ability to flatten the palm on a flat surface. Click here for additional information about using the Dupuytren hand caliper.
Now, for the first time, there is an additional method to evaluate the Dupuytren palm nodule that is easy and convenient, and requires no special tools. This is the first time I have given written directions about this new method DCI has developed to evaluate and monitor the Dupuytren contracture palm lump or nodule. This little technique assesses the degree of restricted movement of the palm nodule in relation to the tissue below it. Basically, you are using this particular method to see how much the nodule “sticks to the deep tissues of the palm.” The larger the palm lump, and the more developed the fingers of fibrous tissue blend into the tissue below it, the more the movement is restricted. As your DC lump improves you will notice it is easier to move and that I moves farther in all directions.
You will use this method to assess the degree of nodule movement, along with the measurements of size, shape, density and surface features of the cords and nodules, plus the caliper measurements of finger movement, to determine the beginning status of you Dupuytren’s contracture. You will use all this data to determine progress (or lack of progress) as you develop your treatment plan.
Here is how you do this nodule or lump movement evaluation method:
- Hold the hand to be evaluated palm-side up, relaxed and comfortable, with the palm flexed slightly. The hand should not be tense. Do not flatten the hand or attempt to tighten any hand muscles in the hand you testing.
- Use the index or middle finger of the opposite hand to do the testing. If your left hand has a Dupuytren’s nodule or lump you will use the 3rd or 4th finger of the right hand.
- Place the fingertip of the right 3rd or 4th finger on the palm lump of the left hand, like you were going to ring a door bell. Use the tip of the right finger to make firm contact with the lump on the left palm.
- Press downward slightly with the right fingertip on the palm lump using about one pound of force. Try to maintain the same amount of pressure throughout the testing process.
- While holding pressure on the palm lump with the fingertip, you are going to determine how “movable” the nodule or lump is in relation to the flesh of the palm.
- First, while pressing down on the lump, try to slide the lump down toward the left wrist. Note how far and how easily the lump will slide or travel downward toward the wrist. Make note of any restriction or areas of “catching,” “tightness” or resistance you might notice.
- Next, try to slide the lump in the opposite direction, up toward the left fingertips. Note how far and how easily the lump will slide or travel upward. Make note of any restriction or areas of “catching,” “tightness” or resistance you might notice.
- Next, try to slide the lump sideways toward the thumb-side of the hand. Note how far and how easily the lump will slide to the thumb-side of the palm. Make note of any restriction or areas of “catching,” “tightness” or resistance you might notice.
- Next, try to slide the lump in the opposite direction sideways toward the little finger-side of the hand. Note how far and how easily the lump will slide to the little finger-side of the palm. Make note of any restriction or areas of “catching,” “tightness” or resistance you might notice.
- Next, try to slide the lump in a circle. Note how far and how easily the lump will slide around in a circle on the palm. Make note of any restriction or areas of “catching,” “tightness” or resistance you might notice.
- Write down your findings. It is often helpful to draw a simple circle indicating the nodule and add arrows with notes indicating which direction was easier or more difficult to move the nodule. Date your notes and keep this with other records about the structure of your Dupuytren’s contracture fibrous structure.
- In 7-10 days do the same nodule movement tests again. Compare all your findings to determine if you are making progress, meaning if the nodule moves easier or farther than before. If this test shows you are making positive changes in your hand problem, do not change your treatment plan. If this test shows you are not making positive changes in your hand problem, change your treatment plan using information from the DCI website.
PEYRONIE’S DISEASE EVALUATION
Testing for Peyronie’s disease progress is different than testing for Dupuytren’s contracture. There is not as many ways for you to test and evaluate your PD progress, because PD progress is determined simply on the size, shape, density and surface features of each PD scar you can locate.
However, even though PD evaluation is simpler than DC evaluation, many men have a difficult time finding their Peyronie’s scar. In fact, sometimes MDs even have a difficult time locating it.
Knowing where your scar is located – although not always easy or obvious – is essential to PD treatment. Finding and describing the PD scar is not a matter of curiosity; you MUST know about the scar in as great detail as possible in order to know if you are making actual progress or not. If you do not know whether you scar is or is not responding to care, you are guessing. Guessing leads to poor or no progress against the enemy that is the Peyronie’s scar. You must not guess, you must know.
Before I go into this subject in some detail, I must remind you that the PD scar is best located while the shaft is soft or flaccid – meaning not erect. This will be true 99% of the time, so don’t bother to look unless you are flaccid.
While some men have PD masses of fibrous tissue like nodules that are best described as “beans’ or “peas,” these are seldom difficult to locate and not the subject of this discussion. You see, not all PD scar shapes are this dense and well-defined; many tend to be flat, soft and often larger than what is expected and these tend to pose the greatest problem to locate. So for this reason if you are having a problem locating your penile scar, it is probably a good idea to shift your thinking and anticipation in this direction: You probably should be not be looking for a “pea,” which is small but has height; instead you might be better served looking for a “postage stamp” – maybe even a large postage stamp – which is flat and has margins that are sometimes difficult to locate. Changing the mental image of what you are looking for sometimes makes all the difference in the world in locating this tissue.
PD “scars” or plaques are quiet variable. Some men have an obvious scar and others cannot find one if their life depended on it. Often, when a scar is not found, but there is still pain and bending or any kind of recent penile distortion, a diagnosis of PD can still be made. This is so, because the scar that is causing the pain or bending is either:
- So small – it cannot be found
- So very soft – it blends into the other tissue and cannot be detected
- So deep – it cannot be reached or felt easily
- So large and flat – that the edges are not easily determined, almost like trying to find the edge of a roll of plastic wrap. When it is a large scar – as many of them are – it is something that is so close to you that you do not see it because you are looking far away and cannot see what is under your nose
- So greatly different than what you think it is going to feel like that you miss it only because it does not meet your image of what it will be like
- The doctor’s lack of ability, experience or concern when he does the scar examination – that he simply misses what is actually there if he was better at this kind of thing – yes, I know, it is difficult to imagine but it is true.
Usually, when a scar is NEVER found it is because of a combination of two or more of these factors – deep and small, or soft, large and flat, or deep, soft and doctor error, and so on. From my experience with those who have an extremely difficult time locating their scar, it seems that #4 (so large and flat) or #5 (so different than what you expect) are the reasons for failure to locate the scar. Keep this in mind when you search your landscape trying to locate the scar.
Big hint: Your primary scar will be located at the lowest or deepest point of the bend, curve or distortion you have. It will be found at or near the deepest or most curved area of your bend or dent formation or bottle neck or hour-glass deformity. It will be on the CONCAVE side of the bend or in the deepest part of whatever type of distortion you might have. The CONCAVE side of the bend is the side that is folded or bent over, or you might say it is the lower or bottom side of the rainbow. The opposite of the concave side is the CONVEX side. The CONVEX side of the bend is the side that is arched over or curved up, or you might say it is the upper or top side of the rainbow.
Ultimately, if you have PD you must begin the search with the attitude the scar is there, and it is only waiting to be found. Do not start with a negative attitude; you want to have a sense of high anticipation that it will be found within the next few seconds – this will help keep your senses alert. You should use as many different tactics as you can to find your scar(s) because having a good knowledge of your scar situation will help your treatment effort. The CONCAVE side is where the primary scar is located. If you have any scar located away from the concave side, it is not your current primary scar. For the most part you will want to evaluate all scars you can locate for changes in the size, shape, density and surface features, but when you work to stretch a scar using the PDI gentle manual penis stretching method it is more efficient and effective to only work with the primary scar found at the concavity of the distortion. So when you are looking around to locate you scar you really should be looking only in that small area that is at the concavity of the bend when you are erect. Once you have that one located it will easier to find others if they are also present.
Hint: It seems to be more common for a man to have multiple scars, than just one. Men have told me they have found 6-8 internal scars. I had 3-4 scars when I treated my own PD problem. So when you find the 1st one, continue looking for more and you will probably find them.
Hint: Although I mentioned looking for a postage stamp sized scar earlier, PD scars are not regular or evenly shaped; they often do not have straight sides or 90 degree corners. They are usually very irregular and odd shaped. Think of the shape of the state of Florida or Idaho or Maine – not like Colorado or Wyoming,
Hint: Try to think in terms of your scar being much larger than you have previously imagined. Allow yourself to mentally expand the size of the scar you are looking for. Meaning, if you were looking for a “pea” before, start looking for a “peanut” size structure or even larger like a postage stamp. This changes your methods and your outlook about what you can detect.
It seems that lately I have many men reporting that their scars are as large as the length of the shaft, and some are narrow while others are wider. Image your scar is that large. If you are looking for a pea-sized scar it will prevent you from easily finding something much larger like a postage stamp.
Do not be discouraged if the scar you have is large since it does not seem that the size has much to do with difficulty or time required to eliminate it. Larger scars can take just as long as smaller scars to treat.
Try this: forget about finding a “scar.” Just try to find something – anything – within the mass of erectile tissue that feels unlike the other tissue. Find something that is unlike the rest of the shaft. When you find it, mark its location with a marker pen or something that will stay on the tissue for a day or two. Go back each day to that area and re-think what you are feeling. You are trying to see if it becomes easier to make sense of it. It could be that you have an unreasonable expectation of what a “scar” should feel like, and you are missing what is really rather obvious only because your expectation is wrong. Really, how could you know what a PD scar feels like if you have never had to do this before? Trouble locating the scar is a common problem.
PDI has much success with the methods we present to you. Just because your doctor could not locate your scar does not mean it is not there. And it definitely does not mean that you cannot find it just because he can’t. As so many men with PD finally come to understand, you must take control of your situation and begin to get well on your own. A large part of being in control of your treatment is to have a vivid image of the scar’s physical qualities in your mind.
I have worked with well over a thousand men with Peyronie’s disease, some mild and some severe cases, some just a few months and several that were more than 10 years old. I had a pretty bad PD problem until I cured my condition using the procedures found in the book I wrote and the same Alternative Medicine ideas as on the website. You will not feel like a victim once you start working to improve your health and immune response against the presence of this foreign tissue.
This turned out to be a longer newsletter than I anticipated. I hope you found it interesting and helpful to understand how to get better self-treatment results for your Dupuytren’s contracture and Peyronie’s disease.
If anyone has questions about this newsletter please email them to me and I will do my best to clearly explain.
See you next month in May when it should be a bit warmer and more pleasant outside.
Stay focused on your treatment plan. Please feel free to send your emails to ask any question about your treatment progress.
Theodore R. Herazy, DC. LAc