Vail Health Magazine 2013 - page 55

Better than surgery,
faster than rehab
It was the little things that were beginning to
bother Vic Hauser. It was embarrassing to shake
hands with someone and difficult to perform
mundane tasks such as fishing car keys or
change from his pockets.
Both hands were starting to curl due to a he-
reditary condition called Dupuytren’s Disease.
“It was causing my golf swing to shorten a little
bit and I was having trouble tying my flies,” says
the avid golfer and fisherman.
Dupuytren’s Disease is a condition almost en-
tirely restricted to people of Northern European
descent and is most common in patients over
the age of 60. Unless you’re among the 3 to 6
percent who suffer from the condition, there’s a
good chance you’ve never heard of it or the new
therapy recently approved by the FDA to treat
the debilitating condition.
Dupuytren’s Disease affects the fascial layer
of the palm, between the skin and the tendons.
The fascia thickens and develops first nodes,
and eventually long strands of fiber that extend
into the fingers. The fingers are forced to clench
inward toward the palm, starting with the small
and ring fingers and oftentimes affecting the
entire hand, including the thumb.
Traditional treatment has been through
surgery wherein the thickened tissue is cleared
from the palm and fingers. The technique, how-
ever, presents the challenges and risks inherent
in any extensive hand surgery. The healing time
can be drawn out, and therapy after Dupuy-
tren’s surgery is extensive.
When Vic started noticing problems, he went
to see his doctor to find out what was going
on. “I didn’t know what I had, but my doctor
explained what it was and recommended I see
Dr. Erik Dorf, a fellowship-trained orthopaedic
surgeon. I was very comfortable going to see
him since I was familiar with who he was.”
Dr. Dorf, who grew up in the Vail Valley, is
one of the few physicians in Colorado offering
a new non-surgical treatment, Xiaflex, for
Dupuytren’s Disease. The Xiaflex injections are
relatively simple, effective and allow patients
to get back to normal activity much more
quickly than through surgery. Xiaflex uses an
enzyme called collagenase to break down the
nodes and fibers that restrict the motion of a
Dupuytren’s sufferer. As the fibers melt away,
the fascia is released and the fingers straighten
and move naturally.
“I had no pain with the injections,” reports
Vic. “I got a shot of something that numbed it;
then he worked my hand and got in there and
got after the solidified stuff.”
As a doctor specializing in hand and upper
extremity injury, Dr. Dorf says the ability to offer
a new and less invasive treatment for Dupu-
ytren’s is pure joy. He is the only practitioner
between Denver and Glenwood Springs to offer
Xiaflex for Dupuytren’s Disease.
Vic, who is in his 80s, is now back doing
everything he loves to do, such as fishing and
golfing. “I haven’t had any problems at all. I’m
able to do everything again. My golf swing is
loose again and my hands are just about totally
straight again.”
To fuse or not to fuse
For Joshua Summers, a 46-year-old yacht cap-
tain and avid skier and kite-surfer, ankle fusion
wasn’t the solution to the crippling pain he felt
at the joint.
And yet, that’s what doctors back home in
Savannah, Georgia suggested. It would have
limited his professional abilities and much of
his recreational life.
“The thought of a fusion was making me
sick to my stomach and keeping me up at
night,” Summers said. “Being able to ski and
kite-surf for me are the most important activi-
ties in my life. My job is super dependent on my
mobility. Now, (they were) frankly threatening
my profession. It was really difficult for me to
get my head around.” Given the choice of fusion
or no fusion, Summers opted for the third
choice: Call other doctors.
The injury happened in Silverton in February,
where Summers collided with a large piece of
avalanche debris early in the day. Eventually,
it was diagnosed as a fractured lateral process
of the talus and a subluxated peroneal tendon.
When the ankle moved, the fracture caused
pain, but so did the tendon, which could snap
up over the bone and shoot pain up the leg.
As the ankle worsened, so did Summers’
knee; muscle atrophy in the upper leg affected a
pre-existing minor knee injury.
A former Vail Valley resident of eight years,
Summers tapped friends for referrals, and land-
ed on Vail-Summit Orthopaedics.
He made an appointment that fit into his
travel and work schedule, and prepared to fly
to Vail on July 4. During the consultation, Sum-
mers breathed a sigh of relief when Dr. William
Sterett and Dr. John Paul Elton said fusion
might not be necessary.
“It was a huge glimmer of hope for me,”
Summers said, adding that Elton helped him
figure out how to continue to work as a captain
throughout the summer by prescribing a brace.
Surgery was scheduled for just prior to
Thanksgiving for both knee and ankle surgery,
difficult as that was. Summers credits the sup-
port staff for being kind, helpful and understand-
ing as they sorted through logistics, including
insurance, which Summers was happy to hear
would fully cover the surgery.
Photo by Christine Hall.
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