MY HEALTH EXPERIENCE:Dupuytren's contracture can become a major irritation, writes JOHN MORAN
OVER THE years, some of you will have occasionally noticed a small protuberance or nodule beneath the skin on the palm of your hand. No pain is involved, so it is easy to forget all about it until the next idle moment when it again comes to your attention.
As time goes by you begin to notice that the nodule has been slowly increasing in size and length. Eventually it stretches from the heel of the palm to between your little and ring fingers in a cord that contracts and begins to bend the fingers. By now you will be concerned enough to bring the matter to the attention of your doctor.
In Mercer’s Medical Centre, not far from St Stephen’s Green, Dr Judith Kavanagh immediately recognises the condition. She asks if she can test out the diagnostic skills of a student doctor, who correctly guesses: “It’s Dupuytren’s?”
Dupuytren’s contracture is named after Baron Guillaume Dupuytren – “the Napoleon of surgery” – who first identified the disease in the early 19th century. It is found mostly among northern Europeans, which is why it has sometimes been called the “Viking disease”. It has also been dubbed the “Celtic hand”.
While the name may be little known, Dupuytren’s is not uncommon. Most at risk are: those whose family members have been affected, men over the age of 40, diabetics, smokers and heavy drinkers. Its characteristic nodules produce excess collagen – a protein that makes bones, tendons and skin – which forms a cord, congeals and pulls the fingers towards the palm.
As Dupuytren’s advances, it can become an increasing irritation in your daily life. Bent fingers can snag when you are trying to put your hand in your pocket. Wayward fingers can poke your eye when putting on glasses. Shaking hands can also be awkward because of the bent fingers. (Knew it, he’s a Freemason.) There is also the increasing difficulty of trying to type with two crabbed fingers.
Kavanagh suggests I see a consultant in Blackrock, Phil Grieve, an orthopaedic surgeon with a sub-speciality interest in hand and wrist surgery, whom she has heard deliver a lecture on the subject.
Cost is a key consideration. I discover from the VHI that the two of the three treatments for Dupuytrens carried out in Blackrock Hospital are covered under my Plan B, so I travel over to check it out.
Having taken a close look, Grieve applies the “table-top test” whereby the hand is placed palm down on a surface. If it can’t lie flat, surgery may be required – mine cannot because of the bent fingers.
Grieve then outlines the appropriate treatments: 1. Minor surgery using needles to break up the knots and cords causing the contracture; 2. Full surgery to remove the diseased tissue (palmar fasciectomy). 3. A new treatment involving the injection of a collagen serum.
We settle on option number two, which has been referred to as the gold standard in Dupuytren’s treatment.
So at 7am on a Friday, I’m in the eerie operating zone in the basement at Blackrock Hospital. A surprisingly brisk breeze blows through the area. Theatre staff provide an extra blanket, reassurance and an injection, which is followed by a pleasing sense of drifting away.
Next thing I know I’m on a trolley bed with one hand attached to a saline drip and the other wrapped in bandages and fixed to a contraption above me. Because of considerable pain, morphine is applied.
As the day progresses, Sister Morphine comes around again. Grieve also calls by and advises an overnight stay. I’m then wheeled into an en-suite room with a view, complete with television, an electronically controlled reclining bed and a buzzer for any emergency.
Next day, I leave hospital with my hand protected in a large cast and sling. To get my strength back, I walk into town.
Over the next few days, apart from the healing wound, my biggest problem is having the use of only my left hand, so difficulties arise with all sorts of things, from bathing to tying shoelaces and dressing.
I return to Blackrock three days later for a check up – and 10 days after the operation, I’m back to have the stitches out and for a workout with Grieve’s occupational therapist, Louise Murray. The drill is painful because it involves trying to bend the fingers as much as possible. She gives me a smaller splint that frees up all fingers except the little one.
The next day I feel well enough to work and text my immediate editor who advises me to wait a while. Her advice turns out to be prescient because the following day I feel weak and dizzy and the hand has become swollen and painful.
Grieve advises me to go straight to casualty in Blackrock where he is waiting. The wound is thoroughly swabbed and additional medicines prescribed. Work is out for another week, which made it 14 days off in total.
It is now more than three months since the operation and I have excellent use of the hand. The little finger is still unable to fully close and there is occasional pain along the wound when trying to grasp an object.
I apply moisturising cream and massage every two hours and the scar is becoming a little less ugly. I must also wear the splint at night for six months at least.
Because of the scar, I no longer feel comfortable shaking hands and I also offer my left hand when taking change. However, I am assured that over time the scar will improve.
Looking to the future, there is a strong possibility that the disease will return to my right hand. And I also have early stage Dupuytren’s in my left. Furthermore, the condition is linked to contractures of the foot and the penis. So, fingers crossed then . . .
