Thursday, April 3, 2008

Needles and knives

Back in the days when the Vikings were the terror of Europe the folks that came in contact with them noticed that the Viking men often had hands that were unable to be opened completely. It was thought then that the cause was all those hours pulling on an oar in their boats. Their claw-like hands became known as Vikings Disease.

Hundreds of years later a fellow in France named Dupuytren discovered the reason for the limited mobility of the fingers was caused by scaring in the hands near the tendons that eventually involved the tendon, thus limiting the fingers travel. He developed an operation that freed the tendon from the scar tissue, thus restoring mobility to the affected finger. The disease was dubbed 'Dupuytrens Disease'.

The fingers most likely to be a problem is the ring finger and sometimes the little finger. Nodules can be seen in the palm of the hand on the tendon that serves the finger. The tendency for this condition is now known to be genetically passed on, most often occurring in men. The origin of the disease is still thought to be those Viking sailors, with the most affected populations being those that had contact with them. Apparently there is a Viking sailor in my family tree (or the nearby bushes) as most of the male members in my family are afflicted with this problem.

The disorder is progressive and over time the finger can curl to the point of being unable to open at all. Its progression makes little things like washing ones hands or face very difficult. Fishing your car keys out of your pocket becomes a two handed exercise, pushing the keys up with one hand and snagging them with the forefinger of the other. Tying a lure on the end of my line is darn near impossible, especially on a cold morning. So it was time to consider what to do about it.

There are presently two methods of correcting the problem. The 'standard' procedure in the US is to fillet the skin near the affected tendon and expose the underlying fascia, a membrane covering the tendons. This is lifted and the scar tissue is cut from the tendon and removed. The hand is then sewed up and the patient sent home to recover. The work is done in a hospital operating room under general anesthesia with several attending persons. Recovery time is several weeks and due to the local trauma of the operation, it is a one-time procedure.

About 30 years ago a doctor in Paris developed a procedure that uses a needle. The needle is inserted under the skin/fascia and moving it laterally along the tendon, the surgeon cuts away the connecting scar tissue around the tendon. Several insertions are made along the length of the tendon until it is cut free and mobility is restored to the finger. This is an out-patient procedure that is performed under a local anesthetic. Upon completion of the procedure the patient can observe the restored mobility of the finger and is sent home with a bandage on their hand. No further visits to the doctor are usually required for follow up treatment.

So what are the differences in the results of these two types of treatments? I searched the web for info and found little to hang my hat on. The disease is not cured by either operation, and it is possible (likely?) that the scar tissue under the fascia will continue to develop until the tendon is again involved, and mobility of the finger is reduced. How long will that take? I could find no answers, perhaps years, perhaps months. Both operations involve risk of infection, nerve damage, skin trauma that requires grafting and so on.

The Needle procedure leaves far less scaring in the hand and it can usually be repeated if necessary. The procedure is also far less invasive and recovery time is less. Being an outpatient is far more attractive than 'going under the knife', especially at the medical facilities we have available up here in So Oregon. So I searched the web for doctors that use the Needle procedure (it is abbreviated - Dupuytrens N.A.) To my astonishment, there are only a few doctors in the US that are trained to use this procedure. You can find a listing of them on the web under Dupuytrens NA . We had a choice of Dr Kline in Boise ID or a doctor near San Fransisco CA. You can't get to Boise from here so I opted for Dr. K Denkler in Larkspur CA.

The procedure was much like going to the dentist. The needle used for the local anesthetic was the worse part of the procedure and I had both hands done in about 1 hour. During the procedure we could talk about kayaks, fishing in Alaska and even Dr stuff, and in the end I could enjoy the mobility of the ring finger on both hands. That was 2 days ago. Today the needle punctures are closed over and there is no pain at all. I will keep my hands clean and bandaged for a few days, and see if I can stay away from strenuous activity. This is the first time in a while that I can type using more than 3-4 fingers and it is a pleasure. Fishing will be even better.

I am not a medical guy and don't even take an aspirin unless I am in serious pain. So medical things are not all that interesting to me. I have found that a positive attitude, healthy food and activity and reliance on my immune system for 70 years has worked pretty well. Of course there are times when intervention is a must, and this was one of them. So I offer this experience in hopes that it will be helpfull to others with this disease. Please do not take it as a recommendation for you. Learn all you can about your condition and then make an informed decision.

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