Dupuytren’s

Guillaume Dupuytren, born 1777, was a highly esteemed anatomist and surgeon in post-revolutionary France. He gained his fame by treating Napoleon Bonaparte’s haemorrhoids, amassing piles (sorry) of cash in the process. Away from the pint-sized Gallic despot’s derriere, he laid claim to having performed the first successful drain of a brain abscess and became head surgeon at the Hotel Dieu, Paris’s oldest hospital. With his much renowned Treatise on Artificial Anus now a distant memory, the great Dupuytren is known chiefly for one thing: lending his name to a condition called Dupuytren’s Contracture, a disease first described by the great man in 1833.

Dupuytren’s Contracture is a condition where a finger becomes permanently bent in a flexed position. Nodules appear in the palm of the hand and over time the connective tissue hardens causing the finger to curl towards the palm. If this is news to you, it certainly was to me two or three years ago when I first noticed a nodule in the palm of my left hand. Slowly but surely, the ring finger began to bend and over a period of several months it became quite noticeable. I was packed off to the GP who referred me to the orthopaedic hand specialist at Ayr Hospital, Miss Gibson. I duly pitched up at the appointed hour where Miss Gibson prodded and squeezed the offending digit before getting out a protractor and measuring the angle of flex. It was about fifteen degrees. Thanks to being married to a nurse and also googling the subject, I had already assumed it was a Dupuytren’s Contracture and Miss Gibson, who sees more curly fingers in a day than most will see in a lifetime, confirmed the diagnosis. She then told me to go away and come back once the bend had reached thirty degrees.

Dupuytren’s is seldom in a hurry and it was the beginning of this year, two years after the initial consultation, that I was back. By then I had estimated that the angle had gone up to forty-five degrees which impressed Miss Gibson as her protractor proved that I was correct. A lifetime of vectoring aircraft around the skies was obviously not wasted. She informed me of the various procedures to correct the bend and said that they were all rubbish apart from surgery. Surgery would take place under a general anaesthetic and the hand on which it was being performed would be out of action for quite some considerable time afterwards. Oh, and it might hurt a bit too. Not wanting to take time off work for some bizarre reason, I was told to come back in the summer. By this time Miss Gibson’s trusty protractor was entering territory it seldom treads with nearly sixty degrees of bend. That sealed it, I was on the list.

Dupuytren’s is not a life-changing condition. There is seldom any pain involved and as you have nine other digits to choose from your ability to do stuff is not really impaired. In my case it happened to the ring finger on my left hand which, as I’ve never worn my wedding ring, is perhaps the least important of the ten digits I have at my disposal. The only thing that was remotely annoying about it was that I sometimes caught it when I put my hands in my pockets. As such I felt a little guilty about taking up precious NHS resources for what is, effectively, a cosmetic procedure. It was only going to get worse though and it could have got to the stage where putting gloves on was impossible so my guilt was assuaged. The reason fingers spontaneously start to curl is not known but there are a number of contributory factors – smoking, alcohol abuse, liver disease, diabetes, epilepsy and so on. As an anti-smoking fascist who drinks in moderation and is a fine specimen of healthy manhood (stop sniggering at the back) none of these apply to me. Previous hand trauma is also a factor – the disease is common amongst cricketers for that reason – but as far as I’m aware my hands have not been subject to any violent actions (I told you to stop sniggering). It also runs in families. Bingo! My mum has got it, as did her brother who got his fixed with one of the rubbish treatments Miss Gibson had mentioned. Rubbish or not, his pinkie is now straight as a die. The condition is also prevalent amongst the Nordic people, so much so that it is also known as Viking Finger, which sounds a bit rude but is a damn sight easier to spell than Dupuytren’s.

Having retired in September, I would have all the time in the world to get the operation done. Well, not quite. Regular readers of these blogs will realise I’ve been quite a busy boy since throwing off the shackles of servitude and the first date I was offered didn’t suit. The alternate was last Monday, 17 December. That was hardly convenient either for Christmassy reasons but Miss Gibson’s secretary was a bit scary so the 17th it was. The deed was to take place at the Day Surgery Unit, Ayr Hospital, a place Elaine knows well as she used to work there. Alas, she was working at her current place of employment on the 17th so I had to get a taxi to the place. ‘Are you worried?’ asked the taxi driver. It was a question I’d been asked on numerous occasions previously and the answer had always been ‘erm, no, not really’. I was beginning to get worried that I should have been worried. Once clerked in, I was told to get changed into rather fetching hospital garb ‘but keep your pants on’. I was pleased about this as the gown is a bit draughty up the back. Miss Gibson came to see me and drew a large arrow on my left forearm and a black dot on the offending finger. I was glad to see she was taking no chances. She described the incision she was going to make. I thought I detected just a tad too much enthusiasm in her voice but perhaps I was mistaken. I was second on the list and left to ponder my fate whilst the woman in the adjacent booth was wheeled in to theatre.

• 

• 

When it came to my turn I was asked to walk to the theatre and park myself on the operating table. I put this down to them realising I was a prime physical specimen, the finger aside, rather than NHS budget restraints but who knows? Next came the insertion of the Venflon. I can’t say I’d been looking forward to this as shoving a tube through a hole in the back of your hand – the right hand in my case of course – is not going to be achieved without a significant amount of pain. Indeed, it stung like buggery but it was over in an instant and I was all ready for the off. A syringe of something or other was pumped through the Venflon which made me feel a bit weird and it was followed with another, bigger syringe of something different which made me feel zzzzzzzzzzzzzz. If you have never had a general anaesthetic, just imagine what it might be like being dead for an hour or so. No sensation, no dreaming, just nothing. I was back on the ward when I came round with my forearm in a cast resting on a pillow to my side. Hardly any drowsiness, I opened my eyes, got my bearings and felt I could have got up, dressed and taken the bus home. I didn’t of course, I thought it better for one of the nurses to come and check that I was OK first and besides which I was getting a lift home an hour and a half later. I was brought buttered toast and icy cold blackcurrant juice which was very nice and asked to change back into my civvies. Not that this was easy with one hand, the left one being totally useless in a cast and under all its wrappings. I could see the tips of the fingers though, all present and accounted for, though there was absolutely no sensation whatsoever in the one that had been operated on. I was informed that once the numbness wore off it would hurt so strong painkillers were dispensed for me to take home. Elaine arrived, gave the staff the large tub of Cadbury’s Heroes that I’d been looking forward to as a Christmas treat, and off we went, just like that.

This is not the end of the story, however. The cast only remained on for forty-eight hours which proved to be two days of awkwardness. Certain things one takes for granted become rather tricky when all you have to use is one good hand and at a push the thumb of the other. You’ve got to be prepared to look a bit of an idiot – an old sweatshirt, even older tracksuit bottoms and my summer slip on shoes were the only things I could wear as the operation of buttons and laces was somewhat beyond my abilities. Luckily, I’m no stranger to looking like an idiot so I didn’t feel particularly self conscious as I pitched up at Ayr Hospital again on the 19th, another twenty quid taxi journey complete with suitably inquisitive driver. There, a very nice and rather amusing physiotherapist removed the cast, showed me the wound which was most interesting, applied a fresh dressing and made a splint from some special material that looks like it belongs on the face of the Phantom of the Opera. I’ve got finger exercises to do twice a day but otherwise the splint stays on until the 27th when another twenty quid taxi will deliver me to the hospital for the removal of the stitches. On pain of death I must keep the splint dry otherwise bacteria will reproduce and digest my hand, which means two things: I get out of the Christmas washing up and as the hand will be a stranger to soap and water it is likely to pong a bit by the 27th. Being a tight Yorkshire git I took the bus in to Ayr and the train to Prestwick to meet Elaine rather than a taxi. I’m unable to drive until at least the 27th, possibly longer than that.

Having now taken the splint off to do the exercises, which were bloody painful thanks for asking, it does appear that I have a ring finger that is just about straight. There’s still a degree or two of flex but if I keep bending and pressing it as the exercises suggest it may well go totally flat. The splint went straight back on as instructed. Once the stitches are out, and there appears to be quite a few of them, the splint is only worn when in bed. That could go on for several months. It’s a lot of hassle to straighten out one curly finger but hey, at least I’ll be able to get my gloves on. Would I do it again? I might have to. There is a suspicious looking nodule forming on the palm of the same hand next to the original one. I’m guessing in two or three years time the middle finger will no longer have the ability to flip the bird…

Many thanks to Ms Gibson and all the team at Ayr Hospital’s Day Surgery and physiotherapy departments. The care has been first rate throughout.