Why not perform hand surgery before my Dupuytren contracture gets worse, while it is still small?

Hello: I have just recently been diagnosed with Dupuytren’s contracture. I noticed a small hard bump/lump appear in the palm of my right hand, as well as one on the bottom of my right foot. I have just turned 50 and I am female. If the outcome is ‘black and white’, why not perform hand surgery to remove the bump BEFORE it grows into a long band deforming the fingers / toes?  Why wait ?

 

Greetings,

The answer is simple:  Dupuytren contracture recurrence after surgery. For more discussion of this topic see Dupuytren Surgery and Recurrence of Hand Contracture.

You are a little younger than average to develop Dupuytren’s contracture (hand) and Ledderhose disease (foot), and for this reason you are more likely to have an ongoing problem with Dupuytrens; the earlier in life it starts, the more aggressive and difficult the palm lumps and cords tend to be.  Your doctor is trying to delay your surgery for Dupuytren’s contracture to delay the time when your first recurrence starts.

Let’s say you had hand surgery the way that you propose.   If you had your first Dupuytren’s operation at age 50, it is possible to have your first recurrence start within two years.  Following your idea of early surgery to prevent progression of the problem, let’s say you had your  second hand surgery as soon as the recurrence appeared, and the next Dupuytren’s recurrence again appeared within the next two years.   Following your idea of early surgery to prevent progression of the problem, let’s say you had your  third hand surgery as soon as that next recurrence appeared,  and the next recurrence again appeared within the next two years.   Again, you would theoretically have another surgery for Dupuytren’s recurrence, with another recurrence, and so on. 

The above example does not work for three reasons:

  1. Recurrence of Dupuytren’s contracture tends to accelerate with each surgery, so that if the first recurrence did take two years to eventually develop, the net recurrence would be a little faster or sooner; maybe 18 months.  And if you had another hand surgery after that recurrence, the next recurrence would theoretically be even faster or sooner; maybe 12 months.   Of course, all these numbers are just made up, and could be faster or slower depending on your individual characteristics, family history, life history, clinical information and luck.   Some people wait 10 years for their first recurrence of Dupuytren’s contracture, but some people wait just a year – or even less for their first recurrence to appear.  Once the surgery starts, the process of recurrence starts; it is inevitable.   
  2. Each Dupuytren’s surgery “uses up” or removes normal hand tissue.  You cannot have too many hand surgeries without soon having little normal tissue remaining.  Depending on your individual circumstances you might only be able to have one, two or three hand surgeries in your life before your surgeon would inform you that you cannot have any more.   What do you do at that point?  You allow it to get worse, and perhaps become so bad in terms of pain that amputation is your only option. 
  3. No good surgeon would perform an early Dupuytren surgery, such as you have proposed.  Hopefully you would never find a surgeon who would agree to cut early, because he/she would know that this would be a terrible decision that would lead to a terrible result.  

There are drugs that have risks that can be used, and there is surgery as an option for you to consider. I suggest that you should consider trying to avoid Dupuytren’s hand surgery completely.  Since your problem is early and small at this time you are in a good position to try to reverse this process naturally.  I suggest you do some reading to see if this makes sense to you.  You can always try it for 2-3 months of intense natural therapy while you are waiting for your Dupuytren’s to progress.  If it work, fine – look at what you have gained.  If it does not work, as sometimes happens, you can always have your hand surgery when your surgeon thinks you are ready for it.  

For further information about treating Dupuytren’s contracture naturally you can read What is the best therapy to treat Dupuytren contracture?    TRH

Which home ultrasound unit do you recommend for treating Dupuytren’s contracture?

Which home ultrasound unit do you recommend for treating Dupuytren’s contracture?

Greetings,

First, I do not recommend that a person uses any one single treatment method against a problem so difficult and stubborn as Dupuytren’s contracture.  Using just vitamin E, or just doing hand stretching, or just DMSO applications, or taking just acetyl-L-carnitine, is not going to help recovery very much, if at all. The same with ultrasound therapy.  The palm lumps and cords that develop with Dupuytrens are not going to change if you try a single therapy approach. 

Secondly, it is my experience after working with people from around the world since 2002 that complete or partial recovery from Dupuytren’s is possible when following an aggressive treatment plan consisting of a wide and diverse range of different therapy approaches, as outlined on the DCI website.  Following this kind of approach for a few months works well in a surprisingly high percent of cases.

Lastly, the ultrasound unit that was added to the DCI lineup of treatment methods in November of 2012 is the 3MHz ultrasound machine made by Bellaire Industry, model HS-3040.  It is a great little unit; it is the only portable 3MHz machine that is made with a stainless steel sound head; on top of that it is the only portable 3MHz machine that has received FDA approval as a medical device. Go here to get details about this 3MHz ultrasound machine

Some people make the mistake of trying to use the more popular and more common 1MHz size ultrasound machine but these machines do not put the therapeutic effect of the sound waves where they are needed in Dupuytren’s contracture.  It is necessary to use a 3MHz unit to assure the ultrasound effect is placed toward the surface where the problem of DC is located.  TRH

Does Neprinol replace the Nattokinase, Fibrozym and Quercetin Bromelain Complex in the treatment of Dupuytrens?

Dr Herazy,

Does Neprinol replace the Nattokinase, Fibrozym and Quercetin Bromelain Complex in the treatment of Dupuytrens?

Thanks,

Mike Scully

 

Greetings Mike,

People who follow the Dupuytren Contracture Institute treatment concept use Neprinol in one of two ways – either as a total substitute for the other enzyme products, or in addition to them (usually with the Neprinol being the primary enzyme source and the others being used as a minor role).  The choice is yours.  I have long advised people to try Neprinol both way while assessing for which method brings about best change in the hand lump.

I would consider trying just the Neprinol by itself, and see how it works for you and the palm lumps.  If that is not enough to get your fibrous tissue to change favorably, then bring back the Fibrozym or Nattokinase, or Quercetin/Bromelain if you are also using it, or all of them.  A common strategy that is used is to take about 6-8 Neprinol daily, while taking 2-3 Fibrozym and 2-3 Nattokinase daily; all of these are taken between meals, as I am sure you know.  However, you also must know that Dupuytrens treatment is not just about using systemic enzymes to reduce the lumps on the palms.   You must also use other nutrients as  and treatment strategies at the same time to support the best change possible.

You must keep experimenting to learn what makes your scar respond favorably and then continue with that.   TRH

Can Hepatitis C cause lumps in the palm of the hand?

Can Hepatitis C, which I have had for 35 years, cause lumps in the palm of the hand?

 

Greetings,

Yes and no.

Yes, there is some evidence that suggest a statistical association between liver disease such as hepatitis and Dupuytren’s contracture, which as you know is associated with palm lumps and bumps.  But, not all people who have liver disease develop Dupuytrens, and not all people with Dupuytrens have liver disease, but some studies show a tendency for those with Dupuytrens to have a higher than average occurrence of liver problems for reasons that have not been clearly defined. 

No, hepatitis C dos not cause palm lumps.   TRH     

 

What is the best enzyme or enzymes to take for Dupuytren contacture?

What is the best enzyme or enzymes to take for DC?

Thank you,
Duane

 

Greetings Duane,

There is a variety of different systemic enzymes that are useful as a part of the overall treatment of Dupuytrens contracture.  Neprinol, Fibrozym, Nattokinase and Bromelain are the enzyme products that can be used.

Each person will respond differently and so I can offer no magic answer to your question.  The best one for you is determined over time by observing the response of your palm nodules and cords, and the changes in your finger contracture while you are under self-treatment.

If you are looking to isolate the very best single therapy and concentrate your efforts with that one product, you will not be successful.  The best treatment results are seen when a broad and diverse group of therapies are used to support and encourage tissue healing.   These are not drugs that we suggest for Dupuytren treatment, these  most closely can be thought of as foods. 

The current thinking – since this kind of thinking does change as we all know – is that perhaps one of the best foods you can eat is salmon (or broccoli, or blueberries, or walnuts or…).  What if you concentrated your entire diet to that one food?  What would happen to you if you ate nothing but salmon?  Or just broccoli?  Or just…?   Would that be the best way for you to eat to sustain life and health?  No, of course not.  Even though some people would say that you are eating the “best” food, you need a broad and diverse diet to meet all your nutritional needs. 

The same way with Dupuytrens treatment.  You need a broad and diverse intake of a variety of nutrients and enzymes to help your body rid itself of the palm lumps that plague you.  

I cannot tell you which enzyme or enzymes would work best for you. That is best determined on an individual basis while monitoring the condition of your lumps and cords for changes.  TRH

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