Three cheers for the NHS (again)! (Dupuytrens 1)

The day started badly. OK I had to get up earlier than I like these days and there was slow traffic at first on the M11 but I arrived at Addenbrookes, Clinic 7 shortly after 0900 for my 0930 appointment. That’s when the receptionist told me that my appointment had been cancelled and rescheduled for next year. She checked and confirmed that this was not my doing but a ‘system error’ and in response to me saying ‘well I’m here now can’t we fit me in?’ she responded positively. That’s when common sense overcame bureaucracy.

After seemingly typing War and Peace on the computer she told me to wait in waiting room B whilst she went and sorted something out. Action and a little person to person interaction clearly did the trick and the nurse in charge of the clinic set me up with a new appointment and sat me down in one of the consulting rooms where I was quickly seen by Ian Grant and Lucy Maling. And all this well before the 0930 of my original appointment.

Medical etiquette requires me to refer to Ian Grant as Mr Grant because he’s a consultant. And Lucy Maling is just plain Lucy Maling because although she is a doctor she’s not yet a consultant.

I was there because the little finger on my right hand, my mouse finger (!), is displaying Dupuytren’s contracture. It’s bent and won’t straighten and that means I cannot put my palm flat on the table and putting gloves on is not easy. It’s not going to kill me and there’s nothing I can do to stop it getting worse. It can be hereditary and I recall my paternal grandfather being so afflicted.

Lucy came equipped with a protractor to measure the bend at the knuckle and at the first joint, both were significant, and explain my options.

The simple option is a needle fasciotomy whereby a needle is inserted into several places along the palm and finger to loosen and straighten it. This would sort out the knuckle joint but would not be a long term solution. It can’t be used on the first joint because there’s a risk of damaging the local nerve.

The more complex option is a fasciectomy in which a cut is made along the palm and finger so the surgeon can straighten it. That’s serious surgery and it seems that if you were to get it done privately it would cost about the same as a small car. However it would straighten both joints and have a longer term benefit.

Lucy said I could be put on a waiting list for the latter which might result in an operation within 12 months or so. ‘But’ she said ‘I could do the needle one now to give you some temporary relief whilst you’re waiting’. Well that’s a no brainer.

We started with an injection of a local anaesthetic/adrenaline cocktail to numb my hand (see the red dot in the photo above). That was pretty painful at first but of course it meant that the later poking around with a needle would be pain free. I then got to sit down an wait for 10 minutes or so. That gave me a chance to do today’s Wordle.

After 10 minutes by hand was well and truly numb so it was back to the consulting room for Lucy to set about breaking up the knots of scar like tissues under the skin (along the line indicated by the ball point marking, see the photo above) which are the cause of the Contracture. I felt nothing but odd movements within my hand and occasionally heard a snap as a bit of hardened tissue fibre was broken. Within 10 minutes or so, during which time we’d talked about wedding venues and commutes to Addenbrookes, it was all over and shortly after 1000 I was paying my parking charge and on my way.

So. Well done the NHS. From the receptionist to the nurse in charge to Lucy. One satisfied customer.