Are these several health problems and surgery related to Dupuytren’s contracture?

Doctor,

I was recently diagnosed with Dupuytrens on my right hand, VERY mild.  A year later, I had a pyogenic granuloma on my left second toe. It was removed a month ago. A few weeks after it was removed I noticed a lump on the arch of my foot seemingly attached to the tendon that attaches to my big toe. It does not hurt and is soft and moveable (for now). It is sounding like it may be Ledderhose disease since one in 4 people that have dupuytrens also gets Ledderhose? My right shoulder also suddenly started hurting and my doctor thought it was an injury from exercise but now I am wondering if the pyogenic granuloma, dupuytrens, growth on arch, shoulder pain are all related somehow signifying that something else is going on in my body. Most Doctors tend to treat each separate but I read where dupuytrens may signify some sort of liver or lung problem. I want to cure these things naturally and do NOT want the recommended radiation for the Ledderhose nor do I want to have this foot growth enlarge causing pain when walking. It does not hurt now. Do you know if these are all related or perhaps something else is going on in my body I should convince a doctor to pursue?

Thank you for your help.

 

Greetings,

Without getting into a lot of the details, pyogenic granulomas are small, red/pink to purple  bumps on the skin that bleed easily due to an abnormally high number of blood vessels they each contain.  The name pyogenic granuloma is misleading for two reasons:  It is not a true granuloma, but it is actually a capillary hemangioma.  And it is not infectious as the pyogenic part of the name would indicate since the origin is typically hormonal or traumatic.  What concerns me about your story is the fact that pyogenic granulomas are almost always found on the top half of the body (75% occur int he mouth) and most often in pregnant woman (they are sometimes called pregnancy granulomas) as well as in children or younger adults.  If this is not the case with you, I strongly suggest that you get a second opinion if there is any other irregularity about your health or extremities in general that arises to give you concern.

Many times I encounter people whose Dupuytren contracture starts after some type of trauma– not only trauma to the hand as you would naturally assume, but to trauma elsewhere in the body.  It is almost as though the trauma (like the trauma of surgery) somehow triggers a latent tendency for excessive fibrosis to occur elsewhere in the body as with Dupuytren’s contracture in the hand or Ledderhose disease in the foot.

Yes, Dupuytrens and Ledderhose often occur together in those who are genetically predisposed.

If you have to convince your doctor to purse a course of action or investigate your problem further, you have the wrong doctor.   Medical doctors by their training and personalities as a group tend to be “team players” and to not think outside of the box. Please.  I am not saying that MDs do not think; I am saying that they think within a narrow and pre-defined range of information that has been approved for them to use.  Anyone who is a medical doctor and prefers or needs to think independently, or to use innovation, will go into research.  Those MDs who are comfortable doing what they are told and following the narrow paradigm of how the AMA, FDA, hospital review boards tell them they MUST practice, will go into practice where they will work like everyone else in their profession. This is why when you go to four different MDs with a problem they will all want to do the same tests and they will want to know what the other MDs said about the problem, and will come to pretty much the same conclusion.  Organized medicine does not want and cannot afford to have MDs going out on their own and experimenting with patients; they must interpret test results as they are told to do by their peers and regulators; they must use drugs only as they are allowed and told to do; they must not operate in new and novel ways.  To put it another way, an MD will get into trouble if he or she does independent thinking and digs too deeply into the practice of medicine and the healing arts beyond what is given to him or her as the standards of practice.  This is why some MDs get so frustrated and discouraged with the practice of medicine; this is why a few will either eventually quit or go radical by engaging in “holistic health care” in which they declare themselves independent and rather radical in their approach to healthcare.    

Ask your average MD,Do you know if these different things – Dupuytren’s contracture, pyogenic granuloma, surgical removal of pyogenic granuloma, Ledderhose disease are all related or perhaps is there something else is going on in my body”?   By his or her education, training and personality characteristics he or she will not do much if any independent thinking, but will only say something like,  “I have not read anything like that.  And the research says that it is not possible.  So therefore I do not have any information for you about that.”  MDs work with information that has been given to them by others.  If an idea is not an approved idea they are not comfortable with it, and they are safest not using it and actually ridiculing it. This is the only safe answer that the average MD can use to practice medicine because they all know that if they think or act independently they can get into trouble. Heck, they have hospital committees watching what they do, how they test, how they diagnose, how they prescribe, how they operate, and what kind of results they get.  If they practice outside the standards of medicine they have a whole lotta explaining to do.  No one wants trouble,eh?

Since I am not an MD, but a retired Chiropractic Physician, who has thought independently all of my professional life, I will say that my experience says there is something to what you have observed.  It suggests to me a weakness or irregularity of the immune response perhaps related to a systemic allergic reaction.  My recommendation is that if you see larger health issues at play in your life that you should seek out a local holistic MD who will look at you with a different set of eyes and ears than the garden variety MD possesses.

In the meantime I also suggest that you read a bit more from the DCI website about the use of Alternative Medicine to support and enhance your natural ability to reverse the soft tissue changes of Dupuytren’s contracture.  Many people have slowed down, or reduced, or even eliminated their Dupuytrens this way when it is done as described here using an aggressive and faithful treatment approach of several months care.

Please let me know if I can do anything more to assist you.  TRH

How should I change my Dupuytren’s contracture treatment plan for best results?

I have been applying the recommended Dupuytrens therapy for about four months with increases to try to get to the maximum.  Currently I am taking both E vitamins internally and vitamin E, copper and DMSO externally.  I started with Neprinol a few weeks ago and currently take 2 querecitin/bromelain, 4 Neprinol, fundamental sulfur and PABA twice a day. After the DMSO treatment I stretch and massage my fingers and the palm of my hand that has some blister-like areas over the palm where I think I should be massaging but it concerns me that I may be increasing the blisters by so doing.  I hope I am proceeding correctly with the massage. I have not seen any appreciable improvement except that before the DMSO and massage I get a reading of 122 and then it has gone to 126 – 128 after the stretch and massage however it reverts to 122 by the next treatment time. I have been getting good reduction of an external scar from a previous surgery on my other hand by an aggressive stretching and massage as well as scraping (as though it was a callous) after the DMSO treatment. I am not sure if the internal and external therapies are working as they should although I think I am using a pretty aggressive plan. Hopefully I am on track.
DLB

 

Greetings DLB,

Yes, you are on the right track for your Dupuytren’s contracture treatment but I think you need to be more proactive with your plan. 

You are using your assumption for what an aggressive plan might look like, and you are counting pills to tell yourself that you are following an aggressive plan, to tell yourself that your plan is active and aggressive when in fact it is not.   Based on my experience with plans that have been developed over time that are getting results, I see that they are larger and more aggressive than what you are taking currently. 

If you have followed this plan for four months with increases as you say, then you have either started at an extremely low dosage, or you have increased your therapy intake very slowly with many weeks or even months between increases, or you have increased at a very low level of intake per increase.  Perhaps all of these are true, since you did not give information how you came to be taking this current dosage level.  This lack of information of how you have been working these increases puts me at a disadvantage to guide you to make increases going forward. 

I do not know what you mean by a blister on your palm.  When you mention blister in your email I would have to assume you know what a blister looks like and what to do about that.  If you mean a nodule or lump of denser than normal tissue that is consistent with Dupuytren’s contracture, then I can comment about that type of finding.

There is early indication of progress in that the increased temporary movement from 122 to 126/128 is not small.  A lot of people would like to have that change happen in the early part of their treatment course.   Over time, and with appropriate increase of your intake you should see these numbers increase as well as notice reduction of size, shape, density and adhesion of the nodules and cords.

Overall, your plan is rather modest in spite of it being applied for the last four months.  It seems you are being very conservative and slow in your response to the results that you are earning. I suggest that you consider increasing the Neprinol intake to 9/day, following the directions that are given to you with each order.  I cannot describe that long detailed procedure to work up to 9/day in this email response.  All you need to do is to read and follow the directions you already have that explain how to increase therapy levels safely and effectively.  I also suggest that you contact me about a phone discussion so I can get down to some of the details of how you should be stretching your contacted palm tissue.  I suspect you might be going about this incorrectly, and if so this might be an additional factor in your slow response.    TRH

What is the correct way to take Scar-X, enzymes and use DMSO for my Dupuytrens?

For 5 or 10 minutes before and after applying scar x I do not have food or drink and have had nothing to eat for 2 hours but after waiting for 5 or 10 minutes I need to take some liquid to swallow the enzymes (Neprinol, Nattokinase and Fibrozym). In most situations drinking black coffee or tea is still considered OK for an empty stomach, but are they OK to use as a way to take enzymes? Also it seems that I need to apply the DMSO and E in the palm of my hand not just on the contracted finger and massage both areas.  Is that the correct procedure?

 

Greetings,

When you ask about “applying” Scar-X it sounds like you are applying it to the skin, and not placing it under the tongue to be absorbed.  The correct way to take Scar-X is by placing approximately 10 drops under the tongue and leaving it there for about 30 seconds.   All of this is explained in the instructions that come with your order of Scar-X.  If you are not using the Scar-X in this way, please read again the instructions that you were given with your order. 

Yes, you can use black coffee or tea to help you swallow any of the therapies that must be swallowed, since these two liquids represent no food value to the body.

The DMSO you are using should be applied directly over all abnormal fibrous tissue, not only in the finger but also on the palm of the hand.  When you say that you massage the DMSO and vitamin E into the area where you are applying it, you are not doing it correctly.  Again, all of this is explained in the instructions that come with your order of DMSO.  All you have to do is to quickly apply a thin layer of vitamin E and then DMSO, using anywhere from 1-3 drops of each, by running the tip of your finger over the area of contracted tissue.   Massaging is not only unnecessary, but it can reduce the amount DMSO and vitamin E that is available to the area of involvement because the prolonged contact of the tip of your finger will cause the DMSO and vitamin E to go into the tip of your finger where it is not needed.  Please read again the instructions  for DMSO that you were given with your order.  TRH

What is wrong with my hand? Could it be Dupuytrens contracture?

My dog has been pulling the leash in my hand. I’ve also been getting swollen fingers/hands in the morning and joint pain but one day my dog pulled really hard. I developed bad pain along my middle finger and a lump in the palm next to the joint at the base of that finger. I could also see that there is redness over that lump. Gradually the acute pain in the finger nearly subsided even though I still could not straighten that finger. I then went to a hand surgeon. He x-rayed my hand and saw no joint swelling. He examined my hand and saw the inflamed lump but said nothing except it would take a few weeks to heal and if it didn’t to return for a steroid shot.The pain has returned and has spread to my wrist. I’m wondering if this is dupuytrens contracture. My brother has it and my father had it but it wasn’t painful for them. I was really upset that a hand surgeon did not give me a diagnosis. What could it be?

 

Greetings,

To begin with, there is no way I can offer you a direct answer to your question and tell you what is the problem causing your hand to be painful and swollen.  However, I would be happy to speculate a bit with you and offer you a suggestion.

Since I will assume you love your dog, I will further assume that you are taking him for a walk twice a day and perhaps more.  That is a lot of tugging and abuse to your hand and wrist.  Your email makes it sound as though your hand surgeon thinks you have local trauma to the hand that has caused local inflammation and swelling of the tissue, like a tendonitis or palmar fasciitis.  That makes sense.

Most of your complaints are only similar to Dupuytrens contracture and there are others that are clearly not related.   Not all lumps in the palm mean the problem is DC; other things can give rise to a lump and bump in the palmar tissue.  The greatest single factor that would suggest that your hand problem is Dupuytrens is the fact that two of your immediate family members have this problem. However, it appears that you were seen by a good doctor who took your problem seriously, and did not brush you off with a cursory office visit and little examination; it appears your complaints were examined well.  If the person who saw you and your hand  said you do not have Dupuytren’s contracture, that is probably correct. 

At this time I am more concerned that you protect your hand from the further trauma of being pulled constantly while dog walking, or you will so aggravate your hand that you will develop Dupuytrens.  It does happen, certainly not from specifically being pulled on a leash, but Dupuytrens can start after significant hand trauma in general.  Since you have DC in your family history it is easier for you to develop this problem than if it was not in your family.  You need to be proactive and stop abusing your hands in this way.

If your pup is abusing you to the extent that your hand tendons and other soft tissue are so inflamed that you have to go to a doctor, you need to correct your canine friend before your problem becomes as serious as DC –because it is possible for this progression to happen.  Go to a few dog obedience classes together or get a professional to show you what you are doing wrong when your dog takes you for a walk!

Is it normal to have numb fingers after Dupuytren hand surgery?

hi doctor.
i had a fasciectomy 8 days ago for dupuytrens, yesterday i returned to hospital for re-dressing and hand clinic. When i returned home i felt my little finger and it was slightly numb around the tip and nail. i had not noticed this the previous week due to the dressing and splint holding my little, and ring fingers up. i’m just now wondering is this normal after that type of surgery and is it likely to return to normal. thank you
p.s i’m 31 years old

 

Greetings,

Palmar fasciectomy for Dupuytren’s contracture is typically a rather extensive and difficult  surgery; all hand surgery is complex because of the nature of hand anatomy.   Hand surgery is complex because the hand is such a tightly packed area in which muscles, tendons, ligaments, nerves, blood vessels – and of course fascia are extremely close together with no open spaces or extra room in which to maneuver.   This complexity is better understood when you consider that in Dupuytren hand surgery there is foreign tissue in the handthe internal Dupuytren cordswhich are not supposed to be in the palm of the hand.  This extra tissue crowds into an already crowded part of the body.   Thus, a hand surgeon is faced with an especially complex and difficult task when she enters into such a situation.

A certain degree of temporary numbness and pain is to be expected after such a operation like a palmar fasciectomy.  A lot of delicate tissue was cut up, handled, stretched and probed, moved around, sewn up and altered in ways that the tissue have never experienced before.  Any numbness is understandable because delicate nerve tissue was traumatized in surgery, but these ares of numbness should pass in time; perhaps a month or two or more.  There is also the possibility that all or a portion of the numbness that you now have will remain.  The numbness might even increase because of tissue changes within the palm that might take place over the next several months as the hand heals after surgery; there is always a possibility that internal scar tissue will develop that can apply pressure or traction on nerves that could result in more numbness or even pain.  Anything is possible.   

It is unfortunate that you have not had any of this explained to you by your surgeon, for two reasons.  First, this would be especially true if your doctor knows you had a relatively easy and uneventful hand operation and it should have been explained that any numbness would be temporary and limited, so that you would not worry unnecessarily as you are now doing.  Or, second,  perhaps if the surgeon knew you had a relatively difficult and nasty hand operation.  It should have been explained to you that permanent numbness was unavoidable under the circumstances, so you would be prepared for the future – as you are not now prepared because apparently none of this was discussed with you.

Assuming that you surgeon is not a good communicator, I will further assume that something very important was also not explained to you.  Allow me to caution you that palmar fasciectomy is never a permanent correction or solution for Dupuytren’s contracture.  After any kind of Dupuytren’s surgery there is a tendency for the hand problem to recur; some types of Dupuytrens hand surgery have a faster recurrence rate than others, but they all are plagued by recurrence eventually.  You did not mention the type of of palmar fasciectomy you had, but for example in a partial palmar fasciectomy the recurrence rate is 66% in five years.   This means that after a palmar fasciectomy 2/3 or 66% of those patients will have recurrence by the 5th year.  What about the other 1/3 or 34% who do not have recurrence by year five?  They will likely have a recurrence in the 6th, 7th, 11th or later year, but it will recur.

This  Dupuytrens contracture recurrence after hand surgery is the reason why you will hear of so many people who have more than one had surgery on the same hand.

This number does not express the fact that of the 66% whose Dupuytren problem comes back within five years, not all of those patients have the recurrence happen in the 5th year; some have recurrence in the 4th, 3nd or 2nd year, and some even in the first year.  

You might say to yourself that this is a risk you are willing to take because you might be one of the lucky ones who does not have Dupuytrens recurrence until the 10th year or later after the palmar fasciectomy.  Yes, this is possible and perhaps you are willing to take that risk.  But, it is also true that after having the first hand surgery, the recurrence rate increases or gets faster for the second and all succeeding surgeries.   This means that  after developing a recurrence of Dupuytren’s contracture, in two years or 12 years or whatever,  if you choose to have a second palmar fasciectomy the recurrence rate will be sooner or faster than it was after the first hand surgery.   Further, if you have a third recurrence and have another hand surgery the recurrence rate will be even faster than after the second surgery.   Some patients who have a fast recurrence rate after the first surgery get into trouble rather quickly.

At age 31, as young as you are, you have many long and wonderful years ahead of you.  Because you have a lot of time to eventually have a recurrence of Dupuytren’s contracture, I caution you to take especially good care of both hands, do everything  you possibly can to keep your hands healthy and to do all that you can to avoid that second hand surgery.

The Dupuytren’s Contracture Institute is devoted to the non-surgical and non-drug treatment of this terrible hand problem.  It might be of interest and treat value to you to spend some time reading about the Alternative Medicine method we have researched to assist the self-repair of Dupuytren’s contracture.