TheifofNight is right about this. It's the collagen that would harden - not the
PMMA itself. I had 2 successful rounds & very good results with no long-term hard spots (just one for 2 months that went away). The third round led to much different & concentrated hard nodules all over the place, many of which were surgically removed after trying every injection therapy under the sun (5fu,
Kenalog, sterile water, saline, etc...) and some topical things like DMSO.
This was not calcification. Although the pathology showed tiny calcium particles (they show up based on a stain that is used), this was from the old
PMMA from round 1 and 2 which never hardened - and again they were microscopic little fragments buried in there with the normally dispersed
PMMA, causing no issue. You'd find the same thing in your arteries, unfortunately....which is where it would cause a problem (and far more than in the
PMMA-triggered collagen)
The only theoretical way to dissolve excess collagen is with collagenase. This enzyme has been around since the 70s or earlier, but it was recently patented by a company now owned by Endo Pharmaceuticals, and was $4000 for 0.57 mg, last I checked. One of the uses is for Peyronie's disease (where a collagen band forms on your tunica albuginea and impedes a normal, straight,
Erection). The tunica is even deeper than where the
PMMA is. No doctor that I know of would inject collagenase into
PMMA because it is not very controllable, and it's still a new drug on the market. The nodules are also quite close to the skin which could lead to severe blistering (there are some bad side effects even for on-label use). The doc I was going to at the time (who did the surgeries to remove the
PMMA and close the wounds) did use collagenase for peyronie's, but he absolutely would not use it off label. And insurance would not have covered it since it's off label.
Based on the slides / slices of the nodules I had, the 3rd round of
PMMA was clumped together and then surrounded by collagen, rather than dispersed with collagen threaded through the beads of
PMMA. You could see some of the "old"
PMMA on the borders of the nodules, and it was normally distributed, leaving it soft and normal (which some still is, but the third round triggered the older
PMMA to harden also in some spots - it's hard to tell one round from another).
Collagenase doesn't know when to stop & might have dissolved all of it - or dissolved it incompletely. But it would've left the
PMMA behind, so what would my body have done? Made the nodules all over again? Never replaced the collagen with anything? Nobody can say because it's not studied and far off label... but in theory, that's the only injection that could attempt to resolve the problem...sorta. You'd still have the
PMMA in there. Collagenase also triggers unusual antibodies to the enzyme and to other matrix metalloproteinases (nobody knows the significance of this yet).
If you have $4000 and can find a plastic surgeon or
Urologist to do this off label (good luck) and have them inject a fraction of the dose, you can be the first guinea pig for this - but it's a scary proposition. Oh also - injecting into a hard
Nodule is not easy. This is why a lot of doctors screwed up in the clinical trials and missed the plaques. They went too high because the plunger on the syringe simply would not go down when the needle was in the plaque. Of course, more experienced doctors can get the injection in place & Dr. C obviously knows how to do it with
Kenalog - but in the clinical trials for collagenase, you had a handful of docs who were just in it for the money and didn't really care what happened. Many were great, but a handful were ass holes who had about 20 clinical trials a year (just for the easy money / no insurance to deal with / no patient follow up or personal liability). I know one of them in particular, whose patients also cannot stand him. He's the type who'd inject it in you off label - but he'd name the price... I'd guess 6k or more. Surgery to cut it out is covered by insurance and you'd have your co-pay or whatever.
I had
Kenalog and 5fu quite early too, in an effort to stop this, but it did not work. It's all in my old posts. I have a whole thread just dedicated to nodules maybe 2 years old now.
