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Enzyme injection

Discuss any treatments you have received or any opinions you have one them

Enzyme injection

Postby Tom1970 » Sun Aug 21, 2016 9:50 pm

I've read about a treatment with enzymes combined with a small amount of steroids. Does anybody have any experience of this?
It's described as follows on http://www.ledderhosedisease.com :

I am a podiatrist in private practice in San Antonio, Texas with about 30 years of experience. The last surgery I performed on plantar fibromatosis was a bit over 15 years ago at which time I concluded that most available surgical treatments are not effective. Simple excision of the nodules has about a 70 percent recurrence rate. Wide excision, that is, excision of the nodules with a portion of the plantar fascia can provide a higher success rate but is relatively disabling.

It is important to focus on the composition of the nodules, scar or fibrotic type tissue. The more specific one can be with treatment, the potentially more effective the treatment and the less potential for side effects. I feel that surgical approaches or use of radiation on a benign lesion is too aggressive.

There are enzymes that have the capability to break down scar tissue. Our body produces such enzymes and other such enzymes can be synthesized or derived from animals. It is normal for scar tissue to be produced by the body as a component of tissue repair. The fibromas appear to represent a local lack of scar tissue modulation resulting is marked overproduction of scar tissue. The introduction of enzymes to reduce that process has been our primary approach for a number of years and one we have had good success with.

The primary enzyme we utilize is called hyaluronidase. We mix hyaluronidase with a local anesthetic such as lidocaine or Marcaine plus a small amount of a repository steroid, triamcinonlone acetonide and inject the solution into the nodules to gradually soften and shrink the nodules. Accuracy of the injections is augmented by use of sonography or diagnostic ultrasound.

The amount of fluid that can be injected into a nodule at one time is limited so the procedure is generally perform three times at an interval of three weeks between injections.

We are pleased with the success rate of this treatment and have had a number of patients from out of state visit us for the procedures. Treatment failures are rare but we have had a small number of patients obtain incomplete relief due to an insufficient number of injections.

The number of injections is proportional to lesion size. We have performed as few as two and as many as four on larger lesions.

More recently, we have added a means to achieve more rapid shrinkage of the nodules via a new technology that uses directed ultrasound to "emulsify" the lesions called TenexTX.

Adjunctive treatments may increase the effectiveness of the primary treatment and include use of topical Verapamil cream or gel. Topical verapamil has been shown to effectively shrink smaller nodules of Ledderhose disease. Its addition to more aggressive treatments may bring speedier shrinkage of nodules.
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Joined: Sun Aug 21, 2016 9:26 pm

Re: Enzyme injection

Postby IdaChen » Sun Sep 11, 2016 6:06 pm

I am new to this forum (just found it) and will be posting this elsewhere, but it is a direct response to your query, so I am posting it here too:
I am writing this very long message because I want to describe my situation in detail in the hopes it may help others who are suffering from plantar fibroma.
Having tried many treatments as detailed below, I am finally very hopeful given the results that I have experienced from my enzyme injections from Dr. Davis. If you don’t have the time or inclination to read all of what I’ve written, my conclusion is that this is the only treatment that has unequivocally helped me and if you have not had any improvements from your current treatment, I urge you to consider contacting Dr. Ed Davis in San Antonio.
I have had plantar fibroma lesions since 2011. In 2011, I noticed a small pea sized lump in the arch of my left foot. After ignoring it for some time, I consulted an Ottawa (Canada) foot doctor when it started to grow who said I had plantar fibroma. It is not known what causes it, though heredity is believed to be a factor. I live in Canada which currently has no treatment for plantar fibroma. I did try one session of shock treatment which I was told might help, but that made the lesion more painful.
In doing researching on the internet, I came across PDlabs in Texas. I found a wonderful foot doctor in Toronto (Canada), Dr. Neil Naftolin who helped me by prescribing it and I started using their Transdermal Verapamil in April, 2012.
Their literature said it would take months to see any effect. Having no other alternative at the time, I religiously followed the schedule. About 6 months later, I felt a constant tingling sensation on the arch of my right foot. As I feared, about a month later, I could clearly see and feel another lesion on my right foot.
Both lesions continued to grow. I did stop the Verapamil to see if there would be any effect and when I found that I experienced more pain and the lesions appeared to harden, I went back onto their regime.
In 2013, I was starting to wake up in the night due to the pain from the lesions, especially from my right foot. It was painful to walk when I got up, though the pain would disappear as the day wore on. My right big toe was constantly numb and tingling.
My husband and I live a very active life, exercising vigorously daily and hiking and biking whenever our work allows. I could see that if the lesions continued to grow and harden, it would make doing the things I love impossible and negatively impact both of our lives very much.
Having searched the internet, I contacted Dr. Spilken in New Jersey in November, 2013 about cryosurgery for the lesions. He said he had had success, and so we drove there (>9 hours one way) and stayed for 3 nights. After 3 months there was no improvement that I could see.
In early 2014, in Canada, I contacted a Chinese herbal doctor who said he could help. He supplied me with a daily mixture of various dried herbs which I was to take. Although it might have improved other aspects of my health, like circulation and digestion like he suggested, it is hard to determine as I was having no known problems with either. I was told it would take a long time, more than a year given the size of the lesions, to see results on my feet. The herbs cost about $65 US a week. After my first injection in 2016, I stopped taking them after 2 years of no effect.
In February, 2014 I contacted Dr. Katz in Tampa and had cryosurgery with him. I had a second treatment by Dr. Katz in February, 2015. Both Dr. Spilken and Dr. Katz had said that it might take several cryosurgery treatments to be effective.
I give my opinion of cryosurgery at the bottom.
During much of 2015, my lesions remained static. I couldn’t say what was responsible for this, but I used the Verapamil and took my herbs every day without fail. I still had some pain in the mornings, but the pain during the day was negligible.
In early 2016, my lesions began to grow again. The pain in the night came back and getting out of bed in the mornings was particularly difficult. My right big toe and second toe started to give me more pain and tingling and my lesions began to hurt at a low level throughout the day.
I contacted Dr. Katz’s office twice via e-mail in the hopes of some other treatment. The first time, I was told that I would get a reply after Dr. Katz was consulted. After a month with no reply, I e-mailed again and never got a response.
Desperate, I did more research on the internet and came across Dr. Davis’ blog concerning his enzyme treatment. I contacted his office and was immediately impressed with the professionalism of his office staff. I was able to get an appointment within 2 weeks on March 30, 2016.
Dr. Davis is extremely knowledgeable and very patient oriented. His care extended to his recommending hotels close to his office and suggesting I stay over the day of the treatment – just in case the freezing made walking difficult. Dr. Davis told me that it would probably take 2 weeks to see any effects and would take at least 2 treatments, maybe 3 or 4 to be fully effective.
The treatment itself was virtually painless, especially compared to cryosurgery, and the post-op effects negligible. I did not have any pain during or after the treatment. The freezing of my feet wore off within a few hours. By all accounts I have a very high pain tolerance, so I can’t say if my results were normal, but given only an injection is involved, the pain must be far less than cryosurgery which is much more invasive and painful.
A week after the treatment, I thought I could see a change in the lesions, they appeared a little smaller and were softer. I was afraid this was just wishful thinking and did not want to get my or my husband’s hopes up. He has watched me with sympathy try all these treatments, rearranged his schedule for anything I needed, cheerfully made medical travel plans and never questioned any amount I spent as he is aware how important finding a solution is to me.
Two weeks after the treatment, I was quite sure the lesions were smaller and flatter. I also realized that I had not been awakened during the night from pain for a few nights. The pain from the lesions during the day had diminished and the pain and tingling in my right big toe was considerably decreased.
My injections were March 30, April 18, May 27 and my fourth will be October 4, 2016.
As of today, September 11, 2016, my lesions have shrunk by 80 – 85% on the left foot and 75 – 80% on the right. What lesions that are left on my feet are soft and flat. The pain is down to just occasional nuisance level and being awoken at night because of foot pain hasn’t occurred in many months. I don’t miss the immense frustration that came with the pain either.
I’m able to wear shoes I haven’t been able to wear in > 5 years. Nothing drastic, just 1 inch heels on a dress pump or sandals which I couldn’t even put on before, much less walk in.
I’m going back to San Antonio for my fourth shot. Because the lesion was around the nerves in my right foot, I am still having some numbness in my big toe and I’m more conscious of the lesion on that foot. I don’t expect to eliminate it completely, though Dr. Davis says that has happened in many of his patients, I’d just like to try to normalize my big toe if I can.
For anyone contemplating treatment, be aware that Dr. Davis says that it is critical that the second injection be within 2 to 4 weeks of the first. There is more leeway for the third injection – 3 to 6 weeks after the second. Make sure you don't start if you can't make this timing as you will lose ground if you wait too long in between. The timing of the fourth is not important and some patients with small lesions don’t even need it.
I can unequivocally say that the injections have made a huge difference in my life. I don’t know if it will work as well for anyone else, but I have tried so many things and none of them gave me any improvement, much less 75 – 80%.
If your life has been adversely affected by plantar fibroma like mine has been, I hope you will look into treatment with Dr. Davis.
“Regular” surgery for plantar fibroma is not recommended in Canada due to the difficult recovery and the high recurrence rate. Cryosurgery for plantar fibroma is not available in Canada at all. Dr. Naftolin had no opinion on it, but said that Dr. Katz had an excellent reputation in the field.
One of the problems with trying to determine the effectiveness of a treatment is the inability to know what would have happened without the treatment. I have had 3 cryosurgeries. I have not seen a noticeable improvement because of them, but I cannot say what condition I would be in if I had not had them.
What I can say is that the last treatment for both feet cost $5,000 US. The cryosurgery itself wasn’t super painful, but it was definitely an unpleasant experience for an hour or so. Although cryosurgery is much less invasive than regular surgery, there is a recovery period that lasts for weeks. I could not fly for 3 days due to the swelling and the need to see Dr. Katz for follow up, so my husband and I had to stay in a hotel in Tampa for those days both times.
For several weeks after both surgeries, Dr. Katz told me not to use my elliptical cross trainer which I normally use for at least 45 minutes every day. (I really missed it.) Although walking was relatively normal after about a week, the first few days were quite uncomfortable due to the swelling and the need for constant icing.
All of this would have been acceptable if I was sure there was some benefit. Perhaps there was some temporary improvement, but my lesions had become very painful again less than a year after the last cryosurgery.
My conclusion is that cryosurgery did not give me any benefit, but cost me considerably in time, money, pain and disappointment.
I so wish I had seen Dr. Davis before I wasted so much on cryosurgery which was useless to me.
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