Will this Dupuytrens treatment keep the hand lump from getting larger and my fingers from curling?

Hello Dr. Herazy, I have a question about dupuytrens treatment.  I am a 51 yr old women who was just told the small lump in my hand is dupuytren’s contracture. I was told right now there is nothing that can be done because I can still put my hand down flat on a table. My husband found your site and wants me to start the treatment. Can I start the dupuytrens treatment at this early stage of the disease?

Will this keep the lump from getting larger and my fingers from curling?

Thank you for any information you can give me.   Roseann

Greetings Roseann,

Sorry to hear of your hand problem.

From my experience in working with this form of natural Dupuytrens treatment for almost 11 years I can tell you that the earlier you start self-treatment, the better the results tend to be.  All we are attempting to do is to support and reinforce the natural ability of the body to remove foreign tissue; an early start when the problem is as small as possible, makes most sense. 

This concept is different from the standard medical approach your doctor is suggesting, because that approach is for radical removal of tissue.   The standard medical model is based on the hand contracture being as advanced, debilitating and severe as possible before surgery, so that the surgery is not done too soon in the course of the disease.  All surgeons know that the surgery is not a cure, and that Dupuytrens recurrence is inevitable after each surgery, no matter how well done.  By waiting to do surgery as  long as possible the number of recurrences is minimized.

Our concept is that if surgery can possibly be avoided by doing everything possible to help the hand lump heal with natural Dupuytrens treatment, then a real service has been provided.   There is no way for me to tell you if this approach will work for you.  I can tell you it has worked for many people, especially when started early in the progression of the contracture.  I suggest to you that you use the largest and most aggressive therapy approach you can afford to apply for at least 2-3 months to see if your body is capable of making this Dupuytrens treatment work for you.  If it helps you, look at what you have gained.  If it does not help you, you will know you have at least tried to do something conservative before undergoing aggressive hand surgery. 

Please let me know if I can help you in any way.  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

Dupuytren Radiotherapy

Dupuytren treatment with radiation therapy for small hand nodules only

Dupuytren radiotherapy is the medical use of low-level x-ray radiation directed specifically at the involved hand lump and nodules, spread out over several sessions with a few month interval of non-treatment between each.   The effectiveness of Dupuytren radiation rests on its use as a preventative measure when used early in the disease process to prevent progression, not as an active treatment for later phase hand contracture.

Dupuytren radiotherapy is a fairly recent innovation for medical treatment of Dupuytren contracture before it evolves into finger contractures and limited hand usage; all other medical treatment is applied later in its progression.

According to the German medical clinics who are currently performing the bulk of these procedures, Dupuytren treatment with radiation therapy has a favorable outcome and is said to be able to stop the development of a tiny bump in palm either permanently or for a reasonable length of time; they report that occasionally the Dupuytren nodules disappear entirely if they are tiny when treated.  The significant drawback of Dupuytren radiotherapy is that once someone with Dupuytren contracture develops finger contracture or bending, this procedure is not able to produce any tissue changes.   It is not clear why clinics or universities in the U. S. are not performing Dupuytren radiotherapy.

Radiotherapy for Dupuytren contracture

Generally, radiation therapy (RT) is that branch of medical practice concerned with cancer treatment by means of high-energy beams of ionizing radiation directed at the intended diseased target tissue.  RT functions to server to control cancerous tumor growth while limiting and minimizing radiation exposure to the adjacent normal and healthy tissue.

The most common technique of radiation therapy for Dupuytren contracture is to deliver one radiotherapy series of five sessions performed five days in a row, in which five GY of radiation are delivered, followed by a pause in therapy that could be anywhere from six to 12 weeks, after which another radiotherapy series of five sessions performed five days in a row, in which five GY of radiation are again delivered.  Some medical clinics deliver 3 GY or 4 GY daily for a five day total series dose of 15 GY or 20 GY.

A GY (gray unit) is the international system (SI) unit of an ionizing radiation dose expressed in terms of absorbed energy per unit mass of tissue.   A gray (GY) is the unit that expresses the absorbed dose of radiation.  The GY has replaced the older term, rad. Now, one GY equals to one Joule/kilogram and also equals 100 rad.

Radiation therapists who perform this treatment justify its use in Dupuytren contracture explaining that radiation damages a special soft tissue cell, the fibroblast, which is an important cellular component for the progression of the disease.  Yet, this same group of doctors admits that it is very difficult to find scientific evidence to prove that radiation selectively destroys or alters fibroblasts.  They also admit radiation therapy is unproven for Dupuytren contracture since it is impossible to collect verifiable data about their controversial therapy because hand  nodules and cords are known to be dormant or stagnate for months or years at any time during the course of the disease, with or without Dupuytren treatment.

Interestingly, it is in the guidelines of the German Association for Hand Surgery (Germany is where most Dupuytren radiotherapy is performed) that call this use of RT in Dupuytren treatment as  obsolete and out of use.  Among the reasons for their position is the potential for negative unintended consequences of radiation therapy:

  • Radiation burn injury to the skin
  • Cumulative radiation exposure from and/or treatment either before or after Dupuytren RT may cause cancer
  • Unknown consequences of this procedure, such as interference with later surgery of the hand due to tissue weakness created by the RT for those who do not respond favorably
  • Very few clinics or facilities that perform this procedure have sufficient experience and knowledge or correct equipment, to perform Dupuytren radiotherapy –yet do so.

As a result of RT exposure those who conduct this procedure report a typical softening of the nodules or cords so treated that prevents later contraction of the hand.

A significant difficulty of Dupuytren radiotherapy is that few people consult a doctor in the very early stage of Dupuytrens when this method of treatment is primarily beneficial.  Dupuytren RT is not used after the hand nodules are larger than a few millimeters across.

If your Dupuytren contracture is advanced beyond the early stages, or you are not interested in using ionizing radiation as a treatment option, consider Alternative Medicine to reduce the density and contraction of your Dupuytren hand problem.

Dupuytren Cause Could Be Related to Drugs

Prescriptions drugs indirectly related to Dupuytren cause

The cause of Dupuytren contracture remains unknown, but is logically most often attributed to trauma to the hand.  However, it is age, genetic predisposition and liver cirrhosis related to alcoholism that are more strongly associated with the causation of this problem.  While trauma (either small repeated injuries as with a bricklayer, or a large one-time injury as with a fall or crushing trauma), can be implicated in some cases, its relationship is not statistically significant.

Refuting the idea that trauma is a casual factor for Dupuytren hand and finger contracture are a few simple observations.  It has been frequently noted that the hand that actually develops the hand lump of Dupuytren is very often the side opposite the side of handedness; it is assumed that right handed workers would sustain more trauma to their right hand, yet these right handed people often develop a Dupuytren contracture on the opposite or left hand, and vice versa.    Also, it has been observed that people who have sustained significant past trauma to a hand will later develop a bump on palm of the hand on the opposite side to which significant trauma cannot be recalled.

In those who already have age, gender (male), genetic predisposition and liver disease in their history working against them, it would be wise for this group of people to pay close attention to drug intake that might potentially overwhelm the immune defense response to allow development of Dupuytren contracture.

While no single drug or drug family has been implicated in causing Dupuytren hand contracture, there is a potential for many drugs to initiate this problem via the indirect mechanism by causing liver disease and cirrhosis usually associated with alcoholism.

As a general guideline, this list is provided to demonstrate some of the many drugs that affect the liver to one degree or another.

Drugs that may cause acute dose-dependent liver damage

  • acetaminophen
  • salicylates (doses over 2 grams daily)

Drugs that may cause acute dose-independent liver damage

  • acebutolol
  • labetalol
  • quinine
  • indomethacin
  • phenylbutazone
  • allopurinol
  • isoniazid
  • phenytoin
  • lisinopril
  • atenolol
  • ketoconazole
    • piroxicam
      ·  carbamazepine
      ·  cimetidine
    • maprotiline
    • pyrazinamide
    • dantrolene
    • metoprolol
    • quinidine
      • diclofenac
        ·  probenecid
      • cimetidine
      • maprotiline
      • pyrazinamide
      • dantrolene
      • metoprolol
      • quinidine
        • diclofenac
          ·  penecillins
        • mianserin
          ·  phenelzine
        • tricyclic antidepressants
        • halothane
        • phenindione
        • valproic acid
        • ibuprofen
        • phenobarbital
          • verapamil
  • ethionamide

The bottom line concerning all these drugs is that every one of them has side-effects and ways of complicating the problem of someone who is already sick.  Drugs should be used with great reserve and discretion, and avoided if at all possible.

If you are man in a higher age, with a history of Dupuytren contracture in your family and you have a history of cirrhosis or heavy alcohol consumption, you would be wise to speak to your doctor if you are taking any of the above drugs because you could be stressing our liver and putting yourself at further risk of Dupuytren contracture.

Once Dupuytren contracture is present and someone learns that there is no known medical treatment available other than risky surgery, consider using Alternative Medicine as a Dupuytren contracture treatment option.  This is an option that the Dupuytren Contracture Institute has researched and developed since 2002, with considerable success.

Dupuytren Release

Dupuytren release is not one type of hand surgery

The term Dupuytren release refers to either of two types of hand surgery: fasciotomy or fasciectomy.  Either of these can be provided to release the thickened and shortened contracture of the hand lump associated with Dupuytren’s disease, resulting in a temporary reduction or release of the tightening and flexion of one or more fingers.

When considering undergoing a Dupuytren release, remember that no release procedure offers a permanent correction; all are a temporary solution because recurrence of Dupuytren contracture will happen sooner or later, usually within three to five years or so.

Dupuytren surgery should be reserved for situations in which the hand contractures keep the involved finger(s) at 30° flexion, or when the individual has a positive tabletop test in which both the palm and fingers  cannot be held flat against a tabletop.

A Dupuytren release involves making one or a series of incisions into the palm to remove the  thick, contracted and inflamed soft tissue (fascia) that surrounds, supports, and separates the tendons and tendon sheaths of the fingers and hand, while preserving the uninvolved skin, arteries, veins and nerves, correcting joint deformities, and maintaining proper flexion and grip strength.

There are five different surgical methods that are termed a Dupuytren release:

  1. Partial or selective fasciectomy – most common Dupuytren release, during which one or more incisions are made across the palm, dependent upon the size, depth and location of the nodules, cords and contractures, as well as history of prior Dupuytren release surgeries and hand trauma, age and occupation. Recurrence  somewhat more frequent than after other types of Dupuytren surgery.
  2. Subcutaneous fasciotomy – Less common Dupuytren surgery.  Single or multiple incisions (usually in a zig-zag pattern) for widespread dissection over the contracted tissue, but diseased tissue is not removed.  Recurrence is slightly more frequent than a regional fasiectomy.
  3. Complete fasciectomy – Rarely indicated because of frequent complications and frequency of recurrence. .
  4. Fasciectomy with skin grafting – Less common Dupuytren surgery.  Surgical removal of diseased skin and fascia overlying Dupuytren cords, in which diseased soft tissue of palm replaced with a skin graft from patient’s forearm.   Recurrence is somewhat less frequent than regional fasciectomy.
  5. Amputation – performed after failed Dupuytren release surgery or after multiple recurrences where no additional surgery is possible.

Dupuytren release not a cure

A Dupuytren release does not cure or eliminate the disease.  When it works out well it will only temporarily modifies the progression of the disease and temporarily improves hand function. When it does not work out well it can result in a worse problem than before the release surgery.  Recurrence is still likely after Dupuytren surgery

Since 2002 the Dupuytren Contracture Institute has maintained that an initially conservative approach to treatment is most prudent and defendable.  If after following a moderate term course of intense non-invasive Alternative Medicine treatment of Dupuytren contracture there is a lack of sufficient response, then more radial invasive measures can always be explored.

The normal and full use of your hands can be taken from you as Dupuytren contracture progresses.  There is an alternate way to do all that you can, as early as you can, to allow your body the best opportunity to naturally reverse this problem.

For ideas and suggestions to organize an effective Alternative Medicine treatment plan, to possibly avoid the need for Dupuytren release surgery, click natural Dupuytren Treatment Plan.

For more information about trying to avoid Dupuytren surgery:

>> Dupuytren Contracture Treatment – FAQs

>> Testimonials from Dupuytren Contracture Institute

>> Dupuytren surgery