Tuesday, October 30, 2007

Dupuytren's Contracture

Click to enlarge
About 4 or 5 years ago, I developed a condition whereby my small finger on my right hand would not straighten out completely. I visited my doctor and he diagnosed it as a condition called Dupuytren's Contracture (pronounced "doo-PAY-trens"), also called Dupuytren's Disease. He referred me to a plastic surgeon in our area. The photo to the right is of my right hand, palm up, showing the small finger.

The surgeon said it could be fixed with surgery, but the surgery was not without risk – in fact, he said there was a 15% possibility of permanent nerve damage. I did not like the odds, and since the condition was not painful, I chose to not have surgery and live with it. For the most part, it did not impact my day to day life in any way.

However, earlier this year, it began to bother me somewhat. Not so much pain, although it did hurt a bit if pressure was put on it in the area of my palm just behind the finger, but not on the finger itself. No, it was more a nuisance. Because of the continued curvature of the finger, it tended to get caught on things like when I put my hand into my pocket, or when washing my face it snagged on my nose (I know, sounds gross, but on several occasions I ended up with a bleeding nose because of it.)

So I started doing some research on the net. I found that there was a relatively new procedure called Needle Aponevrotomy, or NA for short, that was much less invasive than major surgery. Developed in Paris, very few doctors in North America were practicing it. I found a Dr. David Kline in Oregon that had a clinic to do the procedure and was seriously considering going down there to have it done.

Then, after doing some more research, I found a Dr. Paul Binhammer right here in Toronto that also was doing NA at the Sunnybrook Health Sciences Centre, about a 20 drive from my home. I immediately contacted my doctor to have him arrange an appointment for me. That was back around February.

I finally got to see Dr. Binhammer yesterday, and it looks very promising. He said that he could do the NA procedure in his office and it would take about 20 minutes. Then, I would need to go down to the splint department, where they would make a custom splint for my hand. This splint is to be worn each night when I sleep for the next 3 months. It is not needed during the day, and supposedly I will have full mobility in the hand immediately after the procedure. The cost of the entire procedure is covered by OHIP (the Ontario Medicare program); the only thing that is not covered is the cost of the materials required to make the splint.

He pointed out that the NA procedure does not remove the diseased tissue, but cuts the fibers allowing the finger to straighten. There is possibility the condition will return a few years down the road, in which case, he could perform an operation to remove the diseased tissue. He said he could do this operation now instead of NA, but left it up to me to make the decision. I said I thought the NA procedure would be the best choice first, and if needed, I could come back for the operation.

He said I can expect a call from his secretary to set up an appointment for the NA procedure, which I am hoping will be soon, and I will not have to wait another 8 or 9 months.