August 1, 2014 PDI Newsletter
Greetings to all PDI and DCI Warriors,
Welcome to this August 2014 PD Institute newsletter. What great summer weather we are having here in the Midwest. And to make it even better, I have lately been getting many more reports than usual from people who are making good progress with their DC and PD – good for all of us.
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Every now and then I get an actual letter in the mail (with a real stamp on it) from a DCI or PDI Warrior. A few weeks ago I received such a letter written in beautifully artistic script from someone asking about Dupuytren’s treatment. I have used this communication as the featured subject of this newsletter because it brings out for discussion many helpful ideas and insight about successful treatment, and asked a great question that comes up often about treatment of both Dupuytren’s contracture and Peyronie’s disease. The letter also has many examples of how I wish more emails and letters should be written with details about treatment and great examples of how this person evaluated the physical characteristics of her palm nodule (size, shape, density and surface features of the fibrous palm nodule, plus a little bit more). Such is the communication I received from Yvonne that is the main subject of this month’s PD Institute Newsletter.
Most of the time I use one or two emails I receive about Peyronie’s disease treatment in our newsletters and ask that the people with DC try to interpret how the PD information applies to the hand. This time around it is the opposite. You will read this month a DC letter and I ask those men who have only PD to interpret how this information applies to the fibrous tissue of the shaft. It should be very easy to do so, especially the part of Yvonne’s letter about forcefully trying to straighten out her fingers – and how this is sometimes thought to be helpful to straighten out a curved or bent shaft. And it should be very easy to gain some insight how changes in this person’s DC supplement dosage are directly applicable to PD treatment.
As you read Yvonne’s letter you will see that this DC Warrior uses a simple method of describing and abbreviating (“3/3/1”) to tell me how she takes her dosages during the day. This notation method was described in a previous newsletter several months ago. However, since we have added a great number of readers to our newsletter mailing list in the last few months I have included a section at the bottom of this newsletter that again discusses the “0/0/0” method of writing daily dosage for any supplement. All of this is explained toward the bottom of this newsletter so you can learn how to quickly and accurately make notes about how you are taking your various supplements – it is extremely helpful.
The reply I sent to her was rather long and detailed because it just happens to be the subject of a chapter about Dupuytren’s contracture treatment I am currently writing for a new book. I created my response to her by pulling a particular chapter out of the book outline and change it a little to make it a personalized answer to her questions. In this way this month’s newsletter is so long and detailed because it is a sneak preview of one chapter of this new Dupuytren’s contracture book. Lately, I just do not have the time to write this kind of long response accept when I can modify it in this way from my library of pages from the PDI and DCI websites.
Here now is Yvonne’s letter to me in black, followed by my email response to her in red:
Dr. Herazy,
I am sending this letter to you because I need help with my Dupuytren’s plan. First I will give you some information about me, then ask to please let me know what I should do next to improve and expand my plan. I have run out of ideas to increase my plan .
Nine years ago I was diagnosed with Dupuytren hand contracture on my left hand. My problem started after that arm was severely pulled and almost dislocated when I was mugged in Central Park. I am a classic pianist. I learned that Dupuytren’s contracture could be devastating to my dreams of a career in the concert hall. Six months after the mugging a nodule appeared on my left palm at the base of the index and little fingers. This bump developed slowly for several years, but accelerated about a year ago. I do not have any cords at this time but these two fingers do not move as easily as before. When I have my left hand resting I notice that only these two fingers are slightly more curled than the others. I also notice that I cannot pull them back as far as the same fingers of the right hand. My doctor recommended I should have a fasciectomy surgery to remove the diseased tissue. I could not agree to this because something inside me said if I tried a more conservative measure first I might be able to avoid surgery. I was raised to use natural remedies and went on the internet hoping to find information how I could help my hand. Four months ago I started the large plan on your website. I carefully followed the directions that you sent with my order about increasing the dosages until I saw some sign of my hand improving. After seven weeks on the program and the 3rd time I increased different dosages I noticed a change in the nodule on my palm. It went from feeling dense like the rubber armrests on my desk chair to feeling softer and squeezable like the tip of my nose, and it also got smaller, going from 5/16 inch at the widest part to 3/16 inch. My fingers move more freely and my hand is less tired after my daily three hour practice.
Every day I take the following:
Unique-E capsules – 0/1/1
DMSO Dusa-Sal – once a day now, but I tried to use it twice a day for a few weeks and my hand got to dry and itchy
Unique-E oil and Super CP serum – applied before the Dusa-Sal once a day
Fundamental Sulfur – 2/2/2
Acetyl-L-carnitine – 1/2/2
Quercetin-Bromelain – 1/2/2
PABA – 1/3/3
Inflamazyme – 2/4/5 – I think I will switch over to Neprinol when I run out of my current Inflamazyme since my sensitive stomach is doing well with this dose of Inflamazyme
Scar Free homeopathy – spayed six times under the tongue, twice a day
Ultrasound – three times a week, 10 minutes to the nodules only
In addition to continuing to take the above vitamins and enzymes, I think it would be helpful if I would deeply rub and stretch the lump on my palm and force my fingers up straight to reverse the tightness I feel in my hand. Sometimes I look at my hand and I get so anxious to get better that I just want to pull up hard on the fingers to break up and loosen all the tightness I feel in there once and for all. Is there any problem with this idea? Since you say you favor an aggressive therapy approach do you think this would this make my problem improve faster?
I do not like to send impersonal emails, and I thought I would get your attention by sending a letter to you, so I send this letter to you. If you respond by email you can reach me at PXXXXXX@gmail.com Thank you.
Yvonne G.
Greetings Yvonne,
Yes, there is very real potential for a huge problem to develop with the kind of massage and stretching you propose to do. Please do not do as you propose. In my opinion you should not do the kind of aggressive rubbing of the palm nodules you describe, and you should not do not forcefully stretch or straighten those fingers that DC has caused to curl under. Strong physical force directed toward your Dupuytren’s contracture could possibly injure your hand further by tearing the tissue, resulting in a worsening of your current DC or creation of new nodule formation.
Even if you try to rub and stretch just a small amount or to a limited degree, it is difficult to judge what is happening below the surface as you do your stretching and rubbing. Dupuytren contracture massage must be done with caution since it can easily be misused, and you only realize your error when it is too late. Just like someone going out to sunbathe at the beach, it is easy to miscalculate and injure yourself. You only know you have a sun burn when it is too late. It is easy to overdo stretching because you cannot see or feel the microscopic tears in the fascia and other deep tissue of the palm that could trigger more Dupuytren’s development.
You sound frustrated and angry about what is happening to your hand. While you might think it makes sense to forcefully reverse and straighten your bent fingers, keep in mind that it is not the bending or stiffness of the fingers that is the actual problem you should be concerned about. What is wrong with you is that you are developing extra collagen and fibrin (foreign fibrous tissue) in the deep and superficial tissue layers of your palm – and this results in the bending and stiffness that you notice – and can be seen on the surface of the palm as the nodule or lump that is slowly getting larger. By applying excessive force to reverse the flexed finger position it is possible to over-stretch, irritate, tear and even rupture the tissues of your palm – causing more fibrous tissue to be laid down in your palm as part of a new healing response for any new injury you might sustain. All of this would only result in even more bending and stiffness than you have now. Forceful reversal of your bent or flexed fingers will not make them do things they are not ready or capable of doing at this time. I believe your problem can be helped by working directly with the tissue, but in a different, and gentle, way.
I have read several Dupuytren’s forum discussions on the internet in which people have recommended deep and forceful pushing and gouging of the internal fibrous tissue to “break it up.” This is a mistake that can lead to aggravation and spreading of of the initial problem. The best kind of soft tissue work is extremely light and passive manual stretching – so light that while you are doing it you might think it is too light to be effective. To work with the deep and superficial soft tissue of your hands requires a special technique that can get the job done and at the same time avoid the possibility of injury.
Both massage and stretching should be done with a light and gentle touch that might make them ineffective if they were done occasionally; the secret to making these two gentle physical therapy procedures work well is that in spite of doing them with only minimal force they are done often – as often as possible throughout the day. This frequent repetition of these two techniques throughout the day is the reason they can be effective to bring about the desirable tissue change that is your goal.
In the DCI therapeutic model for at-home physical therapy that is used for Dupuytren contracture, it is the combination of massage and stretching that are considered as one combined therapy. Doing only Dupuytren massage will not be very effective; the same can be said for doing Dupuytren stretching by itself. Both stretching and massage work together in a synergistic way just as with the vitamin, mineral and enzyme supplements that are also used for Dupuytren treatment.
While the Dupuytren massage has a direct therapeutic effect on the soft tissues around the nodules and cords, it also has the indirect effect of increasing local blood circulation, relaxing muscle tension, and increasing lymphatic drainage in the upper extremity. So in this sense Dupuytren massage has a dual action, but it still is not as important therapeutically as direct slow, gentle and frequent stretching of the palmar fascia (extremely thin sheets of connective tissue). Both the stretching and massage must be done together, but the stretching is the more important of the two.
During the early phase of Dupuytren development the greatest beneficial effects of direct physical treatment comes from using light and prolonged lengthening stretches of the palmar fascia (hand soft tissue). This soft tissue technique also increases lymphatic drainage and local blood circulation, stimulates cellular activity to assist cartilage reabsorption and mobilization of fibrin producing cells. These efforts can be beneficial for reducing or eliminating the Dupuytren cords and nodules on the palm of the hand.
Frequent repetition. The key to benefitting as much as possible from two techniques is repetition. Do them as often as possible. This is best done if you try to make a frequent habit out of stretching and working with your hand.
The negative habits of smoking, biting your fingernails, playing with the hair on your head, humming the same tune over and over again or fiddling with the pencil on your desk are mostly done during free time that we get during the day, at irregular times all day long These habits are things we seem to do to fill our idle time, especially when we are bored. If the habit is strong we can even do the repetitious action while we are doing other things or while we are relaxing. Soon the habit can be such a part of our daily routine we do not even realize we are doing it. This is the kind of repetition you should try to develop with a habit of gently stretching your stiff and contracted fingers.
If you make use of those little pieces of free time that come your way throughout the day you will soon see you have literally dozens of three and five minute blocks of time all day long during which you could be stretching your DC. Here are just a few common examples of opportunities you are now wasting during which you could be using to help your hand:
1. Watching TV, or at least during all TV commercials
2. Talking on the telephone
3. In the car while waiting at red lights
4. Sitting on the toilet
5. While doing things at work that do not require concentration
6. Standing in line at the store
7. Waiting to fall asleep at night
8. Reading mail, or the newspaper
9. While the computer is booting up
We all have a hundred opportunities during the day, lasting from a minute to several minutes, during which we could be gently stretching the dense tissue of our Dupuytren’s disease. Just look for them, and use them when you find them.
Gentle palm and finger stretching
The beauty of this simple little method is that you can do this all day long in a crowded room with everyone watching you, and no one would notice or think much about what you are doing. You could do this during a wedding ceremony, while you are getting your teeth cleaned, while you are serving on a jury, or while driving a 16-wheeler through Wyoming at 70 MPH. Here is all you have to do:
1. Do this stretching while sitting is best, but you could also do this while standing near a small flat surface.
2. Place the four fingertips of your involved hand on the top of the thigh about mid-way up, or on a small flat surface that is at your waist height. Even if only one finger is involved stretch all four of the fingers on the involved hand. You will find that stretching the tissue of the fingers next to your contracted fingers has a definite beneficial effect.
3. Raise the wrist of the involved hand so that the fingers are arched backward slightly. If you feel nothing when you raise the palm you can press all the fingertips downward just slightly. Relax the hand so the fingers bend backward slightly more. You will find that your knuckles will come down toward your thigh not much more than an inch or so, from their usual position when you are holding your hand as you usually do. But you should not force the knuckles down – they will just come down by themselves as you raise the wrist and press the fingertips downward at little.
4. Try not to press down with the knuckles of your involved hand very much at all; try mostly to raise the wrist as the primary force that stretches the palm of the hand. If you are very relaxed while doing this you will feel slight stretching not only in the involved fingers, but also across the wrist and forearm. The strongest sensation you should feel is the very minimal pressure of your fingertips pressing down on the thigh and a very minimal stretch across the palm.
5. Once you feel a pleasant sensation of a slight gentle stretch, just hold it for as much time as you have available – the longer the better. But this is not to say that doing only a minute of this kind of stretching is not effective when it is combined with dozens of other minute-long opportunities that you take to stretch your hand during the day. Again, repetition is the key.
6. Do not add any other kind of stretching method or technique to this one; it is enough all by itself to assist lengthening and relaxation of the contracted palm and finger tissue.
7. When this gentle stretching is done correctly for several days to a week you will notice that the hand will soon feel more relaxed and it will arch back further; you will also notice less pulling sensation in the fingers and palm when you stretch your hand. At this time slightly increase the amount of stretch that you are applying so that the fingers and palm are arched back further. Try to make your fingers and palm as relaxed and stretchable as possible with minimal force. The idea is that you want to use minimal force to gently stretch and pull all the contracted tissue and developing cords of your palm and fingers. You are trying to gently lengthen the contracted tissue, as well as disrupt and tug at the attachments of the nodule to the tissue below it. If you stretch too roughly or too fast, you might cause tearing and more fibrous tissue to be created, so go slowly and easily.
8. You should never feel discomfort, or any sensation that approaches discomfort. And you definitely should never feel pain while doing this kind of stretching.
Gentle nodule massage
1. Hold the involved hand so the nodule or lump is palm-side up. Keep the hand relaxed and comfortable, with the palm naturally flexed slightly. You should be able to see the DC nodule.
2. Place the other hand also with the palm up, but put his hand below the involved hand so the uninvolved hand is holding the involved hand; your uninvolved hand will be cupping the involved hand, with the involved hand on top.
3. Place the tip of the thumb of the uninvolved hand on top of the palm nodule of the involved hand.
4. With the tip of your thumb of the opposite hand, place a small amount of downward pressure on the palm nodule. Apply about a pound of pressure on the lump on your palm with your thumb, or about as much finger pressure as you could tolerate on your eyeball if your eyelid was closed.
5. While maintaining that same downward pressure on the palm lump with the thumb tip, move or rotate the nodule around in a small circle. You should find that the nodule will slide from side to side and be “moveable” in a small circle of a quarter to half of an inch, maybe more and maybe less; you will likely find the lump on your palm can move a little when you press down on it while at the same time you try to slide it over. You might also find that the nodule moves better, or worse, in one direction or area than the others. It might be that your palm nodule does not move very much in one particular direction; it is common for these palm lumps to seem “stuck” in one particular area. Occasionally the nodule moves about the same distance when pressed in all directions, but usually there is some restriction of movement due to the development of fibrous tissue below the lump. Examine closely to learn if your nodule has this kind of restriction.
6. Pay close attention if there is one area or direction in which you can move the nodule more than in other directions, or less than in other directions. Let’s say that if the palm nodule was a face of a clock, that the top end of it could be called “12 o’clock” and the bottom end of it could be called “6 o’clock,” the middle of the right side of it could be called “3 o’clock,” while the middle of the left side of it could be called “9 o’clock, and all the points in between would be numbered just like the face of a clock. In this way, we might find that the palm nodule might feel very tight and restricted when you push it up in the direction of “1 and 2 o’clock,” and most free and loose feeling when you push it down in the direction of “7 and 8 o’clock.” If you find this kind of restricted movement that suggests you have some tight tissue below the surface under the palm nodule, you should then work the nodule with the same one pound downward force and a slight lateral movement toward the direction of 7 and 8 o’clock. Do not waste your time massaging or rubbing in any other way than in that particular direction in which the lump seems to be restricted or held down by fibrous tissue.
Of course, if you find other areas or directions on the face of a clock, or larger or smaller areas, in which your palm lump does not move as easily or as far, those would be the directions that you would work on your DC nodule.
7. Any area of restriction is the direction and area you will gently move and massage the nodule around during the day. Basically, look for areas of restricted nodule movement, making note of the area like the face of clock. Massage the lump by gently pushing and rolling it toward the direction it is restricted.
8. Over time you will notice that the area of restricted nodule movement will improve, becoming easier to move in the previously restricted area. Eventually you should find that the restriction will improve, and the nodule will move the same in all directions.
9. When the palm nodule moves the same in all directions, then massage the nodule in all directions. Just push and roll it around as far it can be gently and comfortably moved all around the clock. Play with it gently in a wide circular fashion all day long. The idea is that you want to use minimal force to gently tug and pull the base of the lump from the tissue to which it is attached. You are trying to gently disrupt and interfere with its connections from below. If you do it too roughly or too fast, you will cause tearing and more fibrous tissue to be created, so go slowly and easily.
10. Do not give in to the temptation to force the nodule with heavy pressure to move in the direction it is not moving well. A light touch and gentle pressure will accomplish much more than a heavy and forceful pressure.
This is a lot of information to take it, but I know you will use it well. I hope this helps you to understand how to modify your plan over the next few months and bring yourself to a conclusion of your hand problem. Please let me know if you run into any other problems or questions.
Regards,
Dr. Herazy
Now to help you understand how these 0/0/0 dosage notations are used to describe variable dosages, I have included notes from a past newsletter:
Dosage information using the “0/0/0” method: Simplified dosage notes
I try to get people to use a method I developed several years ago to concisely describe how each of the three (or more) daily doses of any supplement is taken. When I describe to someone how they should vary their dosages during a day, I want to do so in a fast and easy way that everyone can understand. So when I write emails and notes back to DCI and PDI Warriors I use a series of numbers separated by diagonal lines to indicate daily dosages. In these emails I will use descriptive notations like “2/2/3,” “1/0/0,” “3/3/3,” or “0/0/1” to indicate when and how much a person should be taking a particular supplement product. This system quickly, easily and exactly keeps track of how any therapy is taken during the course of a day. Usually a person will take a therapy – it could be PABA which is usually taken with meals or it could be Neprinol which is taken between meals – three times a day:
1. Sometime in the early AM
2. Sometime in the mid-afternoon
3. Sometime in the later part of the day, usually after supper or around bedtime
In the first example, 2/2/3, means that this therapy, whatever it happens to be, two are taken in the early AM, two are taken in the mid-afternoon, and three are taken around the supper meal or near bedtime; so rather than just saying that this person is taking or should take seven of these pills a day, “2/2/3” gives a lot more information by saying how those seven are divided up during the day.
In the second example, 1/0/0, means that this therapy, whatever it happens to be, one is taken in the early AM, and no more are taken that day after that one; one is taken in the early AM and then no more for the rest of the day.
In the third example, 3/3/3, means that this therapy, whatever it happens to be, three pills are taken in the early AM, three are taken in the mid-afternoon, and three are taken around the supper meal or near bedtime; a total of nine are taken by spreading them out equally throughout the day.
And the last example, 0/0/1, means that this therapy, whatever it happens to be, only one is taken at the end of the day.
I think we all can agree that this additional information is much more helpful and exact than writing a note that only says, “4 a day” or “4/day.” The important value of this notation system is that it not only allows you to keep track of your total daily dosage, but that it helps you to experiment with the idea of variable dosage during the day. When you write 12/day, it only gives you a total, but 4/4/4 tells you how you are taking that 12/day and it gives you a tool if you should decide to switch to a 3/4/5, 2/3/7 or other pattern.
Many times when a person wants to increase her Neprinol dosage I will suggest not only taking one or two more Neprinol during a day between meals, but I will also suggest that the pattern of taking the Neprinol should be experimented with. Let’s say someone is taking six Neprinol by taking them between meals in a 2/2/2 pattern. You now know this means this person is taking between meals two Neprinol early in the day, two in the mid-day and two toward the end of the day, for a total of six.
But, I might suggest to this person that they increase their Neprinol to seven a day by following a 2/2/3 pattern, which of course means adding the extra one at the end of the day. When that one additional Neprinol is taken during a day can be important; it is not always best to take it when it is convenient, but when it might do the most good. If taking an additional Neprinol does not cause a reduction in the size, shape, density or surface features of the fibrous tissue after 7-10 days then I usually suggest they increase their Neprinol dosage by following a 2/2/4 pattern which again means adding yet another Neprinol at the end of the day. Next, if this does not cause a reduction in the size, shape, density or surface features of the fibrous tissue after 7-10 days then I again might suggest they increase their Neprinol dosage by following either a 2/2/5 or a 2/3/4 pattern.
Some people who take higher doses of Neprinol might be taking 12 Neprinol daily – not unusual for some who need to get into a higher level before positive tissue changes happen. Twelve Neprinol can be accomplished in a variety of ways, besides the common 4/4/4 that people usually follow. Here are just a few of the wide range of patterns for taking 12 Neprinol– or any other high dose enzyme product – during the course of a day:
1. 1/4/7 = 12/day
2. 2/4/6 = 12/day
3. 2/3/7 = 12/day
4. 2/2/8 = 12/day
5. 3/3/6 = 12/day
6. 3/4/5 = 12/day
The above are just a few of the possible ways of taking 12/day of Neprinol. A person could also use a 1/3/8, 3/2/7 Neprinol pattern, etc. Each different pattern represents a way of changing the pattern of a therapy plan that contains the same dose of Neprinol. These pattern changes – even though the dosage is the same – can have a different effect on the fibrous tissue. By making these changes every 7-10 days a person with Dupuytren’s contracture or Peyronie’s disease is experimenting to discover the most effective presentation of his or her plan to the tissue that might cause the foreign fibrous material to be broken down.
The benefit of following these different patterns of the same total dose of 12/day is that each one represents a significant change in the treatment plan that could make a difference in how the body is affected by Neprinol in the total plan to break down the fibrous tissue of the hand or shaft. In my 13 years of doing this work with PD and DC, I have seen time and time again that a person who might not benefit from a straight 4/4/4 pattern of Neprinol (or Inflamazyme or bromelain) might benefit if those same 12 capsules when delivered in a 3/3/6 or some other pattern.
Of course, a variable pattern can be created if someone is taking any dosage of enzymes or other therapies, not just 12/day. At the beginning of treatment, If you are taking 3/day of a therapy, you can use a 1/1/1 pattern, a 0/1/2 pattern, or a 0/0/3 pattern as a way of creating therapy changes to attempt to rouse a greater healing response from your immune system If you are taking 6/day of a therapy, you can use a 2/2/2 pattern, a 1/2/3 or a 0/2/4 pattern for treatment variations. And the same would be true about a variable intake for 5/day, 8/day, 10/day or 14/day, or any other number. Yes, it is sometimes necessary to go into these higher enzyme dosages. I have never encountered anyone who follows my system of slow increase to have any problem taking high levels of Neprinol or other enzymes; it seems it is not so much the size of the dose that causes gastric distress, but how quickly a dosage is reached and how it is used within the plan. I can help if you want to know more; just ask.
Further, concerning the use of any of the systemic enzyme products being taken in a DC or PD treatment plan, there is one additional modification of a dosage pattern that can be applied. In addition to the typical approach of taking enzymes between meals on an empty stomach, there is another way to increase dosage and use variety in a treatment plan. Some people increase their schedule of enzyme intake by taking advantage of the nighttime or early morning hours. I have people who also take one or two enzyme capsules in the middle of the night while the stomach is completely empty and will remain empty for a few hours longer. So, when you go the bathroom in the middle of the night it can be seen as an opportunity to take 1-2 additional enzyme capsules so that the levels stay high in the blood all night long. In this way the notation would be something like 2/2/8/1 or 2/3/7/1 – with that last one representing the dose taken in the middle of the night.
Regardless of the dosage being used, the point I wish to make is that this simple notation method is a great way to accurately keep detailed records of what you are taking, or to communicate with me about the dose of any internal therapy you are using. Lastly, use of this system of notations encourages frequent experimentation and change in a treatment plan by simply making it fast and easy to describe different patterns of intake rather than continuing to take your supplements at the same dose each time.
This concludes our discussion and newsletter for this month. I hope everyone found this issue of the PDI Newsletter interesting and informative so you can do a better job of helping your own PD or DC condition.
If you want to contact me about your problem, or questions about treatment, please send an email at info@peyronies-disease-help.com TRH
