January 1, 2013 Newsletter
Greetings to all PDI and DCI Warriors,
Welcome to this January 2013 PD Institute newsletter. I must be getting older. While I still think winter is the best season of all, the thought of dealing with all that snow doesn’t excite me like it did just a few years ago.
Two important topics in this newsletter:
1. BIG changes in the way vitamin E will be used in all future treatment plans.
2. Important ultrasound instruction information and questions answered in several emails that were sent to DCI and PDI in the last month.
First section: VITAMIN E
As many of you have become aware in the last month or so, both PDI and DCI have been having worse problems than usual receiving our inventory of vitamin E from our supplier; we have not been receiving our Factor Vitamin E 400/400 or Maxi-Gamma vitamin E on time to be able to ship it to you folks when you order it. Many of you – except a lucky few here and there – have had to wait to receive your orders of either Factor Vitamin E 400/400 or Maxi-Gamma vitamin E, or have received split orders in which your vitamin E products were delayed by days or weeks.
I appreciate the patience and consideration most of you have shown, and understand the irritation some have shown when these vitamin E problems arose again with filling many recent orders. Over the years we have had frequent and ongoing problems receiving our vitamin E shipments on time from the manufacturer, but continued using their great products anyway because of the high quality and unique formulations they offered.
Well, all of that is now behind us.
The vitamin E manufacturer we used for over 10 years has decided to immediately stop manufacturing Factor 400/400 (and I have learned will stop manufacturing Maxi-Gamma in the very near future). As a result there is no manufacturer available who makes a vitamin E product that emphasizes gamma tocopherol, or combines tocopherol and tocotrienol vitamin E family groups, such as we have used in the past. All of that has changed how we will use vitamin E to treat PD and DC, for reasons beyond my control.
Since this diversified vitamin E treatment option is no longer available we will switch our vitamin E exclusively to Unique-E products from the A. C. Grace Company. This will serve to simplify and streamline all Dupuytren’s treatment and Peyronie’s treatment plans for everyone. Additionally, I have never had any problem with delivery of Unique-E products to PDI and DCI so your orders should not be delayed in the future.
Actually, this change will directly affect only a part of the DCI and PDI Warriors; most of you folks are already using Unique-E capsules in the 180 size from the A. C. Grace Company. There will be no change in the vitamin E usage for the majority of you. It seems that most people slowly switched themselves over to Unique-E because of the lower price and greater convenience of the larger size bottle they provide.
For those of you who recently used Factor Vitamin E 400/400 or Maxi-Gamma vitamin E, you will only have to use Unique-E from this point forward. You will find that this change will not only simplify your treatment, but it will lower your total treatment costs considerably.
From this point forward, look for Unique-E capsules (180) in the PDI store front, or Unique-E capsules (180) in the DCI store front.
Second section: ULTRASOUND TREATMENT information from email Q/A
In the last month many of you have added ultrasound therapy to your Dupuytren’s and Peyronie’s treatment plans. You are now using the new ultrasound treatment protocol I created over the last few months with a small group of people who had already incorporated it on their own, and had asked me to help them use their machines for better results.
When I write any new procedure instructions there are always small changes (and usually a few additions), as more and more people ask questions that expose weaknesses and omissions in the original notes. This process of improving the US treatment notes has already begun, and this will be given to you below when you read the email responses I have sent to people in the last few weeks.
So, if you purchased an ultrasound machine in the past month, please read the answers and additional information to these recent email questions so you can make small changes and expand your understanding how to use your US machines for better results. Right from the start I got good questions from people who wanted to know important things that I had not thought to include. Several of these emails you will see discuss problems that I am sure many of you will face. And now you will have answers. Be sure to read these emails to learn more about what you should be doing with your US treatment protocol.
To convey this additional information we will use the familiar and popular format of presenting a simple exchange and blending of emails between one of your PD brothers or DC sisters and me. What will be different this time around is that instead of several emails between one person and myself, this month you will see seven different emails from seven different people, all wanting more information about US treatment of their hand or shaft problems.
Because of the spam filters that we all use for our emails I had to edit the content for some of these emails. A few men when writing very naturally and appropriately used the word P_ _ _ S to discuss that part of their anatomy. If I used that word as often as it is written all of your SPAM filters would reject this newsletter to your junk folder. To avoid this problem, I have substituted the word SHAFT for the word P_ _ _ S so that no one will have a problem receiving this issue of the newsletter.
Even you folks who are already successfully treating a Dupuytren’s contracture problem should read all these emails because all ultrasound treatment for PD is applicable to DC with little variation, other than the obvious difference in location.
Read this group of combined emails like the back-and-forth conversation of two people talking while one occasionally interrupts the other to make an important point or answer a question. To understand the flow of the conversation, keep in mind that the text in black is from a reader and the text in red is my reply or interjected thought.
Greetings MXXXXXXXXX,
See below for comments, please…
Regards,
Theodore Herazy, DC, LAc
From: MKXXXXXXXXX
Sent: Wednesday, December 12, 2012 6:20 PM
To: Theodore Herazy, DC LAc
Subject: Re: PDI and DCI instructions for US
Dr Herazy,
I have been using the US every other day for ten minutes a session (4 times to date). I have noticed that the plaque gets a little sore the next day and seems a bit swollen. The first time I skipped an extra day to see if the swelling would go down and it did. You can avoid the soreness by using the low setting to avoid applying too much sound energy to a small area per treatment. The soreness is likely not due to rapid tissue change but due to overstimulation of the tissue to the sound energy As far as directions go I have it on full power Please use the “LOW” setting instead of “HIGH.” and pulsing and I keep the unit still on the spot. Good. I have read in research that others have tried to hit the spot from the opposite side since the US waves according to them when using the 3Mhz unit go deeper than the skin. 3MHz sound waves penetrate less deeply than 1 MHz sound waves. But when comparing one 3MHz machine to another 3MHz machine you will find that there are differences in their ability to penetrate and treat tissue. This ability depends on the particular machine, the thickness of the area being treated, as well as the intensity of the US being used. As with most things in life, I suggest you experiment a bit and see what works best for you. TRH I am not sure if this makes sense so I have not tried it as of yet. I am hopeful.
I also set up an appointment with Dr Laurence Levine to see what his thoughts are. He seems to be an MD that may offer more solutions than most MDs.
If you have any thoughts I am all ears.
Thanks,
MKXXXXXXXXXXX
Another email Q/A about ultrasound treatment:
Greetings,
Please see below for comments…
Regards,
Theodore Herazy, DC, LAc
From: k4XXXXXXXXXX
Sent: Thursday, December 13, 2012 12:55 AM
To: Theodore Herazy, DC LAc
Subject: Re: PDI and DCI instructions for US
Hi,
I've used the 3MHz ultrasound machine 3 times now, each treatment was 10 minutes. All instructions were very clear and it is easy to operate. Thank you. I have been setting it on high and it has felt fine. I haven't noticed any changes yet. In fact, I haven't had changes to the scars in several months. What is the current size, shape, density and surface feature of the primary Peyronie’s disease scar you are focusing on right now? Please be specific. If you do not know the exact structure of the scars you are working with you will not be able to recognize changes when they occur. I find this to be the most consistent reason people fail to recognize scar changes – they do not have a starting point to recognize change when it is sitting right in front of them. They think, “Oh, I do not have to go through all that trouble to measure and compare my scar to create a standard for comparison – I will remember what my scar feels like.” And then later, they cannot and fail in their management of their care. While you might get tired of hearing me repeat this idea over and over again, it is that important. I think I've pretty much maxed out on the supplements (up to 30 Neprinol per day and your maximum dosages for the other supplements). Not very likely. You have not come even close to fully exploring all the possible therapy options and combinations you could be using to help yourself. You only think you have done it all because you do not know what is available to you. There is a lot more involved in using Neprinol than swallowing 30 capsules a day. If you do not know what I mean by that, it is only because you have not used all the possible options and variations possible to take Neprinol and other therapy products. If you would please describe your current plan I can make suggestions to modify it and perhaps get things moving again for you. I even began taking nattokinase and serrapeptase made by the makers of Neprinol along with nearly every other supplement you recommend. I stopped doing the stretching and using the accu-touch pointers after a few months with no results. There are many modifications to both of these procedures I know you have not tried. We have not communicated enough to get your plan in high gear. I suggest you set up an appointment time for a telephone discussion so we can work together to get things moving again for you. Please do this soon. I'm not sure where to go from here, so if you have any suggestions they would be greatly appreciated. You will be surprised what changes can be made within the context of your current plan.
One more thing regarding the ultrasound machine. I accidentally ran a 10 minute cycle with the cover on (no gel). How can I tell if the quartz crystal was damaged? While holding the machine face-up so the sound head is pointing toward the ceiling, put a single drop of water on the center of the sound head. Turn the machine on high. You should see movement of the water (bouncing around and vibrating), and you should see vaporization of the water). If you do not observe movement of the water you have damaged the crystal; if so, contact me for further instructions about replacement. TRH It appears to be working as I can feel the sound waves when using it.
Thanks,
MXXXXXX
Another email Q/A about ultrasound treatment:
Greetings RXXXXXXX,
Sorry for the delayed response; heavy emails lately.
See below for comments…
Regards,
Theodore Herazy, DC, LAc
From: RKXXXXXX
Sent: Thursday, December 13, 2012 1:42 PM
To: 'Theodore Herazy, DC LAc'
Subject: RE: PDI and DCI instructions for US
Hello,
I did receive the ultrasound device and have used it several times. Your instructions were clear and I’ve been using the device accordingly. Thank you. I do notice a tingling sensation during and shortly after completing the 10 minute cycle which I assume is good? Tingling could indicate a positive or favorable tissue response, or it could simply indicate that the tissue has been stimulated by being massaged by the sound waves. Immediate tingling sensations are probably just from tissue stimulation. Delayed tingling or a dull ache that is noticed at odd times of the day or night is usually associated with desirable tissue changes. As for the overall treatment I’m 7 weeks into the PDI plan and so far cannot detect any improvement. What kind of changes have you made to your plan? I ask because I know we have not discussed any plan changes, so I would like to know what you have done to change your plan in order for correction to take place. If you continue to use the same plan for 7 long weeks without seeing a change in the size, shape, density or surface features of your scar suggests that you have not read the treatment notes that were included in your first order. Following the same treatment plan for almost two months indicates you are making a fundamental mistake in your treatment. Please read my essay, Peyronie’s Disease Treatment and Insanity. I’ve purchased and read both on line books and understand patience is required so I still remain optimistic. I’ve found trying to identify the size, location and density of the scar to be difficult If you are not 100% sure about the physical structure of your scar your care is suffering; you must get this information straight in your mind before you can reasonably expect to get results. If you do not have this information clearly in mind then you are guessing at your treatment and can only guess at your outcome. This is not the way to be successful. Please contact me to get the help you need. and it seems the scar’s texture (firmness) can change during the day. Yes, that is exactly right and I know this is good news to hear that you can detect those small changes. I take these changes to mean that your scar is responding to various systemic and environmental factors, suggesting that it is ripe to change in the direction you push it with your treatment. The PDI therapy lineup is designed to push it in the direction of removal. I know identifying the scar is an important factor in the treatment so not being able to accurately do so is a major concern. If you need help in this way I suggest you schedule a phone discussion to help you in this very important area. TRH I remain focused and dedicated to the plan and remain hopeful for a successful outcome.
RKXXXXXXXX
Another email Q/A about ultrasound treatment:
Greetings RXXXXXXXXXXXX,
Sorry for the delayed response; so many emails lately.
Please see below for comments…
Regards,
Theodore Herazy, DC, LAc
From: RGXXXXXXXX
Sent: Thursday, December 13, 2012 2:21 PM
To: Theodore Herazy, DC LAc
Subject: Re: PDI and DCI instructions for US
Good Morning, thanks for the e-mail. I do have a couple of questions in regards to the ultra sound machine treating PD. Are there any past results negative or positive using the ultra sound machine for Peyronie’s disease? Yes, that was discussed in the last newsletter. Several people reported recently that they are seeing improvement with US therapy – and they were using the wrong machine! Also, does it matter if the shaft is soft, semi rigid or fully rigid while receiving the ultra sound treatment. US therapy should be done while flaccid since you will have best contact with a flat surface rather than a rounded contour of the shaft. TRH
Thank you, RXXXXXXXXX
Another email Q/A about ultrasound treatment:
Greetings,
See below, please…
Regards,
Theodore Herazy, DC, LAc
From: PXXXXXXXXXXX
Sent: Monday, December 18, 2012 11:04 PM
To: Theodore Herazy, DC LAc
Subject: Re: PDI and DCI instructions for US
Dr. Herazy:
Thanks for asking about the US machine and any problems I might be having while using it to treat my Dupuytrens.
First or all I want to tell you I am so grateful to have found your site since I have been experiencing so many new problems with my left ring finger since my hand surgery, like thicker cord development and more loss of finger movement. I have been on your program No, PXXXXXXXX, you have not been on “my program” you have been on “your program” for your Dupuytrens. I have not made any decisions for your treatment and I have not told you how to increase your plans. I have given you suggestions and you have decided what to do and when to do them and you have monitored your own progress along the way. We have worked together with me supplying information and ideas, and you in charge of making the decisions about your own DC treatment. for about four months and I have seen considerable reduction of the thickness and density of the major cord in my palm. I have gained about 1-5/8 inch finger more movement to open my ring finger from a fist, and my palm flattens out now down to the tabletop to 7/8 inch, from 1-3/4 inch when I started using DCI products. Good for you, young lady. After a slow start you finally decided to become less conservative and get serious about your care. I see this with many people. You made some good decisions and now things are coming around because you are working hard at it. I hate to think that all of this trouble I have lived with after hand surgery could have been avoided if I found your site earlier and never had that painful surgery. We will never know what might have been. That is a game that can get you into a lot of trouble by creating negative thinking and a bad attitude. I advise that you simply be grateful for the progress you are making now and do not stew about the past. What is done is done. And to think that they have the nerve to say that collagenase injections are not hand surgery when it was so terribly painful and caused so many problems. Better late than never thought, right? I hope I can get back to where I was before the surgery to my hand. Do you think that is possible? Anything is possible, but I cannot predict the future. I can tell you that I do not see any reason that your hand tissue should slow down from the current pace of recovery you are on. You might not make any additional progress, or you might also become just a lady with scars on her hand but full finger and hand movement. I cannot predict. I say keep doing what you are doing and wait to see how far your progress will continue. Be prepared for anything to happen. You will know exactly when your recovery starts to plateau because you are keeping good records of the hand structure and movement capacity. This is a key element of all successful plans – you know where you are right now so you can accurately identify progress or lack of progress.
Now, to my question. Do you think I should apply the US to the palm side of my hand or to the back part. It appears to me that the cord is somewhere the middle of it all about half way between front and back of the hand, so how should I approach it? I suggest you first treat only the palm side for a few weeks, and make no other changes in your total or overall treatment other than what to you change with the US part of therapy. Then treat the back side of your hand for a few weeks, while again making no other changes to your plan. You might also consider alternating one time treating the palm side, and the other time treating the back side, and the next time back to the palm. After a few weeks see if that alternating pattern might provide greater improvement of the cords and range of finger movement than doing just one side or the other. In other words, I suggest you explore and experiment to see what works best for you. If that approach does not work for you, please ask me again in a few months and we can discuss more options. OK? And if so, do you think that I can do a double 10 minute treatment, once from the palm side and once from the other side? No. Definitely not. At least not until you talk to your hand surgeon about this and get his/her opinion about your US treatment in general and this particular question of yours specifically. My educated guess, not knowing the thickness of your hand, is that considering you are a woman who I know is in her early 70s, is that your hand is probably too thin to take that kind of double treatment. It would probably be like a double treatment to a thin hand and that is not good and too risky considering you have had surgery already. If you were a 250 pound truck driver with beefy hands I think the question might have a different answer, if you know what I mean. But for you, I suggest you make the error of being very conservative with all US treatment decisions for your hand since it has had tissue removed already and would not respond well to the additional trauma of overtreatment with US. TRH
Thank you so much for your time and help.
PXXXXXXXXXXX
Another email Q/A about ultrasound treatment:
Greetings AXXXXXXX,
See below for comments…
Regards,
Theodore Herazy, DC, LAc
From: AMXXXXXXXXXX
Sent: Saturday, December 22, 2012 8:57 AM
To: Theodore Herazy, DC LAc
Subject: Re: PDI and DCI instructions for US
Hi Dr Herazy,
My device arrived yesterday (21/12/2012) – UK Customs enjoyed delaying my delivery by taking an eternity to inform me of import duty. They are good that way.
I will be looking to start my US treatments from Monday – I need to get an adaptor for UK mains.
When you started discussing US in your monthly newsletters I jumped onto Google like many would and I recall an item which generates a question –
Should treatment be performend on a flaccid or erect shaft? Either would work, but by far flaccid would be better and easier because you should have as much contact as possible to the area of skin touching the flat surface area of the metal sound head. Your erection is like a cylinder, meaning it is curved along the longitudinal axis, but the sound head is flat. For this reason you will not have full contact with the flat sound head when doing the US treatment if the shaft is erect and shaped like a cylinder. To make the point a little more obvious, even though it is a gross exaggeration, imagine trying to do an ultrasound treatment on a golf ball. The actual contact area of the flat metal sound head to the round golf ball would be very small. This would result in two problems: 1. Concentration of the sound going to the limited contact area with the golf ball, causing a concentration of sound to that small contact point. If this was done to human skin tissue it would cause pain, burning and possible injury to the tiny tissue area that receives the concentrated sound energy. 2. Overheating of the sound head and eventual damage to the internal quartz crystal. For purposes of treating PD it is far easier and more effective to treat while flaccid so the shaft can be flattened a bit under the sound head. As far as the hand is concerned in treating Dupuytren’s contracture, the hand should be held in such a way that it is relaxed so the surface is as generally flat but also compliant to the flat sound head as much as possible; hold your hand so the skin surface is in fully contact with the sound head. Many people make the mistake of holding the hand rigidly during US treatment; it is better to keep it slightly relaxed so that the rounded areas of the hand can conform to the flat sound head. I'm not interested in working on size but I did find a discussion thread where somebody was using US as part of their 'training' programme to increase shaft size. It discussed use of US on an erect shaft. These are laypeople who often do not know or understand the technicality of this subject (or for that matter, many other subjects that they write about on their forums) and so can pass along goofy and dangerous ideas to each other.
I simply want to resolve my PD issue to restore what I once had (as best I can). What are your thoughts on use of US on an erect shaft? Might it help target the US device to the curve? Only in an indirect way. Ideally you should carefully and specifically target the PD scar. But knowing where the scar is located is best accomplished when you are flaccid. If you absolutely cannot find the PD scar, then treat the broad area of the deepest part of your PD curve or distortion that you determine while you are erect, but treat while you are flaccid. If you are one who cannot locate your PD scar, please arrange for a telephone discussion and I will talk you through the process of how to find it; it is seldom that someone cannot find the nasty bugger once we discuss the procedure in depth.
Lastly, I get the impression from communicating with a few of the PD folks that they are approaching this treatment concept as a standalone or solo therapy; it is not. Please incorporate US into your overall diverse and complex plan of internal and external therapies. I hope this is clear, otherwise you will likely be quite disappointed. Keep me posted how you are proceeding, please. TRH
Thanks in advance,
AXXXXXXXXXXXX
Another email Q/A about ultrasound treatment:
Greetings JXXXXXXXX,
See below for comments…
Regards,
Theodore Herazy, DC, LAc
From: JMXXXXXXXXXX
Sent: Friday, December 21, 2012 10:23 PM
To: Theodore Herazy, DC LAc
Subject: Re: PDI and DCI instructions for US
I have questions on the ultrasound machine usage. Your instructions say to use 3 days per week. Are you concerned that more frequent usage could cause problems? This is yet another area of controversy in medical practice. While there are those who suggest daily US treatment might be appropriate, others limit the frequency of US treatment to three times weekly care. The greatest concern is usually for excessive US treatment over bone tissue in cases of arthritis, causing increased uptake of calcium and resulting in bone weakness with possible fracture. For Dupuytren’s contracture treatment with US being applied over the small metacarpal bones of the hand, daily US treatment is a real concern; for Peyronie’s disease US treatment being applied over the shaft and far removed from bone so this is of less concern. Having said that, there is always room for user error, over-enthusiasm, miscalculation and bad luck. For these reasons you must always be cautious when using US and ask your local MD for his/her opinion since they know your current situation directly. I always advise to use a broad range of therapies (including US) first done at a conservative level for both DC and PD. If after reasonable time the desired tissue changes are not forthcoming when done at a modest level, it is then possible to consider slowly and cautiously increasing the range of treatment of these therapies. In the case of US it might be reasonable to consider increasing the individual treatment time from 10 minutes per application to 11 minutes per application for a few weeks. Later, if the 11 minute application does not have a good impact on the problem to possibly increase to a 12 minute treatment time. These treatment changes are done all the while assessing for changes in the size, shape, density and surface features of the target tissue. Increasing US treatment time by several minutes all at once, or doubling the time of treatment, is dangerous and foolish. Alternately, instead of increasing the time individual treatment, a person could consider increasing the frequency of treatment from 3 days/week to 4 days/week for a few weeks to assess for tissue changes.
Please do not consider that going from 10 minutes to 11 minutes is a small or trivial increase. It is a great increase; it is a 10% increase, and that is a lot. Be cautious and careful with these one minute increments of treatment time.
How many 10 intervals per day of usage? 3, 4, 5,…etc? Sorry, but I am not sure I understand what you mean here… If you are asking about using US treatment for 10 minutes to one area, stopping for 10-15 minutes, and then doing another US treatment for 10 minutes TO THAT SAME AREA – the answer is NO, NONE, DO NOT DO IT THAT WAY. The 10 minute wait after a 10 minute treatment is to allow the quartz crystal in the sound head of the US machine to cool down. It is not for the purpose of letting one BODY AREA rest briefly before you treat that same tissue or SAME BODY AREA again. Some people have PD in so many isolated areas of the shaft, or have DC in isolated areas of two hands, that they can treat one area for 10 minutes, let the machine cool off for 10 minutes, and then go to an ENTIRELY DIFFERENT AREA of the shaft or hand to do another 10 minute treatment to a DIFFERENT BODY AREA. The purpose for the proviso to stop treatment between 10 minute treatment applications is to cool the machine, as you first treat one area before treating another totally different area. Never treat the same area twice in the same day or in a few days. If you have only one lesion and you treat it once with ultrasound for 10 minutes, then you are done for the day or even a few days with that area. This, of course, assumes that you have treated your problem for a while without change of the tissue and have made the conscious decision to up your plan to an 11 minute application. OK? If I have muddied the water for you in this area of treatment, please let me know and I will take another stab at it.
Should the intervals be spaced out throughout the day (morning, afternnon and night) or all at once (with 10 minutes between each session)? No; see above. A few hours interval is not sufficient time between treatments for the tissue – but it is enough to cool the machine. We have two considerations going on at the same time when we are talking about US treatment: 1. Giving the tissue enough time to rest and respond (usually several days), and 2. Giving the US crystal enough time to cool off (at least 10 minutes or more). Obviously we have to be concerned with both, however I am sure we all agree the condition and safety of the tissue always being the most important.
Keep me posted on your progress. TRH
Thanks. JXXXXXXXXX
So there you have it.
Only one type of vitamin E to use in the future – Unique-E.
Lots of additional ideas and information about using US for both Dupuytren’s contracture and Peyronie’s disease.
See you next month. Stay in touch and send your treatment questions to me so I can give you some ideas to work with.
Regards,
Theodore R. Herazy, DC, LAc
