Dupuytren'S Contracture

[Ratsima]

I've had a mild case of Dupuytren's contracture (<-Wikipedia Link) since I was in my mid 30s. (I'm 61 now.) It has gotten to the point now where I have difficulty typing and doing other simple tasks requiring manual dexterity. I'm thinking of having it treated either with surgery or injections.

If anyone has experience with this sort of treatment in Bangkok or elsewhere in LOS I'd be interested in hearing how it went.

TIA

[Sheryl]

I haven't had this specific problem nor do I know anyone who has, but the foremost hand specialist in Thailand is Dr. Panupan who is a Professor at Siriraj and has private practice at Phyathai 2 hospital Sundays 9 - 11 Am and at Chao Phya Hospital Thursdays 6-7 PM. Call ahead as he is sometimes abroad for conferences. In addition to being very skilled, he is also a very nice and sincere person and I think will advise you well.

i think steroid injection would be tried before surgical intervention, it often gives relief although it may require a series of injections to do so

[Ratsima]

Thank-you Sheryl. Just the sort of information I was seeking.

[TravelerEastWest]

Ratsima,

Did you find any good specialists for dupuytrens in Thailand?

I can tell you that you want to avoid surgery and try the needle procedure if possible.

Less painful, cheaper and faster recovery.

Steroids are of little or no help for this condition.

Edited January 30, 2012 by TravelerEastWest

[TravelerEastWest]

I finally found a hand doctor who treats Dupuytrens with the French Na procedure in Chiang Mai - Dr Kanit Sananpanich who has his own clinic and teaches at Chiang Mai University.

His operating room is very clean and comfortable.

He was friendly and did the procedure for me in less than an hour. He also visits several hospitals each week where the cost is higher.

Two days later my hands are halfway healed and quickly getting better.

His email address: <email address removed>

He is probably the only doctor in Thailand doing the procedure.

Edited June 4, 2012 by Scott
: 13) Not to post email addresses in posts due to potential spam problems.

[23962323]

Would not have thought there was any need for Thailand to have such a specialist,only the Nordic type seem afflicted. Got mine done about 6 years ago,surgery, OK now, again why restrict yourself to Thailand? get some prices from Malaysia too,only an hour away from BKK

[giddyup]

I have the same thing, as did my father and brother, so one can assume it's hereditary. I've had mine for the better part of 20 years, I'm nearly 70 now. Thing is, it seems to have stabilised. I've never had treatment for it and it doesn't prevent me doing most things. It's the right hand ring finger and it's pulled in towards the palm, but only by about 10 degrees. The palm looks pretty ugly though, like the face of a sharpei dog.

[TravelerEastWest]

Would not have thought there was any need for Thailand to have such a specialist,only the Nordic type seem afflicted. Got mine done about 6 years ago,surgery, OK now, again why restrict yourself to Thailand? get some prices from Malaysia too,only an hour away from BKK

I don't understand your comment, many people from outside Thailand live in Thailand. And when you have small children travel is not always an option....

As for Malaysia I am not aware of any docters who have experience with the NA procedure are you aware of any?

[simple1]

Yes my specialist stated having Nordic genetics is the trigger. I have Dupuytren's Contracture in both hands & to date have required three operations over ten years (in Australia). Therefore you will be aware that it doesn't just require one operation as Dupuytren's Contracture does reoccur albeit it different places in the hand. Getting to the point, is anyone aware of a suitable specialist in Chon Buri area as looks like I'll need another procedure.

[23962323]

Would not have thought there was any need for Thailand to have such a specialist,only the Nordic type seem afflicted. Got mine done about 6 years ago,surgery, OK now, again why restrict yourself to Thailand? get some prices from Malaysia too,only an hour away from BKK

I don't understand your comment, many people from outside Thailand live in Thailand. And when you have small children travel is not always an option....

As for Malaysia I am not aware of any docters who have experience with the NA procedure are you aware of any?

I don't understand your comment either....I suspect many people from inside Thailand live in Thailand,the same as living outside Thailand do not live in Thailand..Oh well ? I look after many soi dogs too,but it never stops me from travelling.I was not aware either that there are surgeons in India that performed this type of operation either ..UNTIL I STARTED ASKING

For one I would not consider the NA procedure,for two I had surgery (far superior) with positive results,.... three Chinese surgeon who relished this form of operation,.... four Nah not bothered with Malaysia for this one,already have had it done thanks,so no asking south of the border

[TravelerEastWest]

Yes my specialist stated having Nordic genetics is the trigger. I have Dupuytren's Contracture in both hands & to date have required three operations over ten years (in Australia). Therefore you will be aware that it doesn't just require one operation as Dupuytren's Contracture does reoccur albeit it different places in the hand. Getting to the point, is anyone aware of a suitable specialist in Chon Buri area as looks like I'll need another procedure.

I am not sure that Nordic genes are the cause perhaps only one piece of a large puzzle as the exact causes are not currently know per most specialists.

This site is helpful: http://www.handcenter.org/index.html

I have not heard of any hand doctor in Thailand other than Dr Kanit in Chiang Mai who does NA but traditional surgery is probably widely available and realtively painful, expensive and slow to heal. Try calling your local teaching hospital.

Good luck and let us know what you find.

[simple1]

Yes my specialist stated having Nordic genetics is the trigger. I have Dupuytren's Contracture in both hands & to date have required three operations over ten years (in Australia). Therefore you will be aware that it doesn't just require one operation as Dupuytren's Contracture does reoccur albeit it different places in the hand. Getting to the point, is anyone aware of a suitable specialist in Chon Buri area as looks like I'll need another procedure.

I am not sure that Nordic genes are the cause perhaps only one piece of a large puzzle as the exact causes are not currently know per most specialists.

This site is helpful: http://www.handcenter.org/index.html

I have not heard of any hand doctor in Thailand other than Dr Kanit in Chiang Mai who does NA but traditional surgery is probably widely available and realtively painful, expensive and slow to heal. Try calling your local teaching hospital.

Good luck and let us know what you find.

Thanks for the info; just one questions what's NA?

[TravelerEastWest]

Yes my specialist stated having Nordic genetics is the trigger. I have Dupuytren's Contracture in both hands & to date have required three operations over ten years (in Australia). Therefore you will be aware that it doesn't just require one operation as Dupuytren's Contracture does reoccur albeit it different places in the hand. Getting to the point, is anyone aware of a suitable specialist in Chon Buri area as looks like I'll need another procedure.

I am not sure that Nordic genes are the cause perhaps only one piece of a large puzzle as the exact causes are not currently know per most specialists.

This site is helpful: http://www.handcenter.org/index.html

I have not heard of any hand doctor in Thailand other than Dr Kanit in Chiang Mai who does NA but traditional surgery is probably widely available and realtively painful, expensive and slow to heal. Try calling your local teaching hospital.

Good luck and let us know what you find.

Thanks for the info; just one questions what's NA?

NA is short for Needle Aponeurotomy which in many cases is the best way to treat Dupuytren's Contracture

Look here for more information:

http://www.handcenter.org/newfile23.htm

[crobe]

Sorry for not replying to this earlier,

I have Dupuytrens and have had surgery both in the UK and in Thailand.

I had the last surgery at Bumrungrad hospital in Bangkok, and I found this was better and healed faster than the surgery in the UK, however, it was private.

The surgeon was Dr Somrung and I can recommend him.

The surgery only takes one day - they ask you if you want to stay in if you have the general anaesthetic, but you don't have to - on my last visit I had a more localised one by needle in the neck and was awake for the operation.

They usually put around 40 stitches in per surgery, and these take 1-2 weeks to heal up enough to be removed, during which time the hand is bandaged up, and the arm in a sling

After the stitches are removed there is usually a plaster cast to keep the fingers straight and this has top stay on for around 6 weeks - after that it is exercising the fingers and a splint at night to stop you contracting your hand while you sleep - it is usually around 3 months until the process is complete.

Crobe

[crobe]

I forgot to mention

The surgery cost around 70,000 baht four years ago, not sure what the price is now, but it should not have gone up too much

Crobe

[23962323]

Sorry for not replying to this earlier,

I have Dupuytrens and have had surgery both in the UK and in Thailand.

I had the last surgery at Bumrungrad hospital in Bangkok, and I found this was better and healed faster than the surgery in the UK, however, it was private.

The surgeon was Dr Somrung and I can recommend him.

The surgery only takes one day - they ask you if you want to stay in if you have the general anaesthetic, but you don't have to - on my last visit I had a more localised one by needle in the neck and was awake for the operation.

They usually put around 40 stitches in per surgery, and these take 1-2 weeks to heal up enough to be removed, during which time the hand is bandaged up, and the arm in a sling

After the stitches are removed there is usually a plaster cast to keep the fingers straight and this has top stay on for around 6 weeks - after that it is exercising the fingers and a splint at night to stop you contracting your hand while you sleep - it is usually around 3 months until the process is complete.

Crobe

Gees,that seems an awful lot of after treatment. Was in UK years ago,asked about this op as my finger too was getting bent,was told 2 year wait at least,told them I was only in UK for a few days,booked me in the day after. That needle in the back of the hand hurt like hell,so was gassed and then given general ,took about one and a half hours,perhaps two before I opened my eyes up,hand stuffed into a ball ,for two weeks,then stitches out about 15,all fine and dandy ,no splints or anything. Stayed in hospital about two hours after waking up,was free in UK,but was having it done in India if no luck in UK quotes of £300

[TravelerEastWest]

Sorry for not replying to this earlier,

I have Dupuytrens and have had surgery both in the UK and in Thailand.

I had the last surgery at Bumrungrad hospital in Bangkok, and I found this was better and healed faster than the surgery in the UK, however, it was private.

The surgeon was Dr Somrung and I can recommend him.

The surgery only takes one day - they ask you if you want to stay in if you have the general anaesthetic, but you don't have to - on my last visit I had a more localised one by needle in the neck and was awake for the operation.

They usually put around 40 stitches in per surgery, and these take 1-2 weeks to heal up enough to be removed, during which time the hand is bandaged up, and the arm in a sling

After the stitches are removed there is usually a plaster cast to keep the fingers straight and this has top stay on for around 6 weeks - after that it is exercising the fingers and a splint at night to stop you contracting your hand while you sleep - it is usually around 3 months until the process is complete.

Crobe

I have heard that surgery at times can have a better result which lasts longer.

However, NA is a much simpler option - around 3,000 baht, one hour out patient procedure, no stitches, local in your palm which hurts like a wasp sting for a few seconds not pleasant but not so bad.

Most of the time good results (not always perfect) with less complications than surgery, less pain less cost, little or no therapy needed and faster healing (around 10 days for healing but you can drive etc from the first day).

[Ratsima]

I finally found a hand doctor who treats Dupuytrens with the French Na procedure in Chiang Mai - Dr Kanit Sananpanich who has his own clinic and teaches at Chiang Mai University.

If anyone knows how to contact this doctor, please send me his phone number of email address via PM. I found an email address for him at Chiang Mai University, but never got a reply. I sent a PM to TravelerEastWest asking for the email address which a mod had deleted. No luck.

I've done lots of research now and have found no one in Thailand who can do this procedure, other than the elusive Dr. Kanit....

[jrtmedic]

Treatment of Dupuytren's depends on the extent of disability.

Needle Aponeurotomy is usually only undertaken for those with limited disease.

Recurrence rates are approximatly 50% with cases treated by NA deteriorating more quickly than those treated by more extensive "open" surgery.

It is best to seek out a specialist hand surgeon and follow his/her advise in relation to treatment.

[Ratsima]

It is best to seek out a specialist hand surgeon and follow his/her advise in relation to treatment.

Any suggestions?

The thing that terrifies me about surgery is the recovery time. I can't imagine being without the use of my right hand for six weeks.

I've been putting this off for years for that very reason. At the moment, I can still do everything I want to do; but it's getting to the point where touch typing is difficult and opening my hand wide enough to grip some garden tools is becoming problematic.

But, six weeks in a cast?

[jrtmedic]

Ratsima

Sorry. I have no specific recommendations for a specialist hand surgeon here in Thailand.

I note Sheryl, in an earlier post, suggested a Dr. Panupan maybe you wiil consider a consultation with him/her

Edited January 15, 2013 by jrtmedic

[Ratsima]

My wife finally found Dr. Kanit's web page at CMU: http://www.med.cmu.a....=200046〈=e

It is in Thai, but it does have his email address and phone number.

[TravelerEastWest]

Treatment of Dupuytren's depends on the extent of disability.

Needle Aponeurotomy is usually only undertaken for those with limited disease.

Recurrence rates are approximatly 50% with cases treated by NA deteriorating more quickly than those treated by more extensive "open" surgery.

It is best to seek out a specialist hand surgeon and follow his/her advise in relation to treatment.

Very softly gently and politely I do not agree.

NA is done in France in perhaps all but the most serious cases and even then it may be very helpful.

Talking to a traditional hand surgeon can be a very bad idea as until recently many had not even heard of NA and where not supporters.

[TravelerEastWest]

My wife finally found Dr. Kanit's web page at CMU: http://www.med.cmu.a....=200046〈=e

It is in Thai, but it does have his email address and phone number.

I did not see your message until today - check your messages.

[Ratsima]

I have now consulted with both Dr Sumroeng at Bumrungrad (in person) and with Dr. Kanit (via email).

Dr Sumroeng told me:

• The procedure (open surgery) can be done on an outpatient basis with local anesthesia.
  
• It takes about two hours.
  
• I'd only need to stay in Bangkok one night.
  
• A follow up visit would be required in one week to remove stitches and lean some stretching exercises.
  
• I'd have limited use of my hand after a day or two and full use after a week or two.
  

Dr Sumroeng made no mention of needing a cast or extensive physical therapy.

After considering both options I have decided to go with NA. I have an appointment with Dr Kanit at his clinic, next week Tuesday.

The cost is 3500 baht.

[simple1]

I have now consulted with both Dr Sumroeng at Bumrungrad (in person) and with Dr. Kanit (via email).

Dr Sumroeng told me:

• The procedure (open surgery) can be done on an outpatient basis with local anesthesia.
  
• It takes about two hours.
  
• I'd only need to stay in Bangkok one night.
  
• A follow up visit would be required in one week to remove stitches and lean some stretching exercises.
  
• I'd have limited use of my hand after a day or two and full use after a week or two.
  

Dr Sumroeng made no mention of needing a cast or extensive physical therapy.

After considering both options I have decided to go with NA. I have an appointment with Dr Kanit at his clinic, next week Tuesday.

The cost is 3500 baht.

Did Dr Sumroeng indicate pricing for the procedure? Also can you also forward his contact info - believe TV requires you to send a PM. thanks

[Ratsima]

I didn't ask Dr Sumroeng about the cost.

You can make an appointment to see him via the Bumrungrad web site.

His personal page on the Bumrungrad site is here: Dr Sumroeng Neti

[jrtmedic]

TravelerEastWest

I am not sure where you obtained your information from !

However in the UK the technique of NA is well known to specialist hand surgeons as it is in most (if not all ) of the Western/Eastern world !

The technique in its present form has been utilised for well over 20 years!

Some hand surgeons prefer not to offer NA because they percieve the (often) early recurrence of contracture to be unacceptable.

There are in addition to NA and open surgery other treatment options.

Look here,,,,,,,,,,,,,,,,http://www.nhs.uk/Co...es/Surgery.aspx

The choice of treatment is a matter for discussion between a patient and the surgeon. Having a fixed thoughts as to what is the "best" treatment, based on internet searches is , perhaps , not the best of ideas

Edited February 3, 2013 by jrtmedic

[TravelerEastWest]

TravelerEastWest

I am not sure where you obtained your information from !

However in the UK the technique of NA is well known to specialist hand surgeons as it is in most (if not all ) of the Western/Eastern world !

The technique in its present form has been utilised for well over 20 years!

Some hand surgeons prefer not to offer NA because they percieve the (often) early recurrence of contracture to be unacceptable.

There are in addition to NA and open surgery other treatment options.

Look here,,,,,,,,,,,,,,,,http://www.nhs.uk/Co...es/Surgery.aspx

The choice of treatment is a matter for discussion between a patient and the surgeon. Having a fixed thoughts as to what is the "best" treatment, based on internet searches is , perhaps , not the best of ideas

I understand and respect your point of view but strongly disagree.

I have never been to the UK and I do not understand the options of the UK medical system but I can comment on real life experience (not internet) in America, France and Thailand.

After talking to others with this condition the general consensus (not a statistical survey - smiling) is that in most cases NA is the best treatment in terms of speed, cost and pain.

The injections that have been under development in America are a promising new treatment but are very expensive and not widely available.

Thank you for your link - are the injections free in the UK?

When they become available in Thailand I would be interested in trying them.

I remember before moving to Thailand talking to very experienced expert hand surgeons and most of them had not heard of NA and were not interested until after it became widely accepted in the medical journals.

The medical system in America has many challenges so perhaps the UK is ahead of America with treatment? How many UK doctors are trained in NA I wonder?

Also perhaps in the last 5 years there have been changes in the West?

But I can assure you that when I first had this condition almost no one in America was using NA - actually perhaps zero doctors were using it. There is a good doctor in Florida currently who is a hand surgeon who is using it and a few here and there in America but not many as far as I know.

I would be very pleased to find out that I am behind the times (I have not been to America in over 5 years) but I think mainstream medicine does not favor NA yet and they are wrong based on my personal experience.

Edited February 3, 2013 by TravelerEastWest

[jrtmedic]

TravelerEastWest

Just a few links which seem to suggest America has indeed entered the modern world !

http://www.mayoclinic.com/health/dupuytrens-contracture/DS00732/DSECTION=treatments-and-drugs

http://dupuytrens.org/

http://www.assh.org/Public/HandConditions/Pages/DupuytrensDisease.aspx

http://www.aaos.org/news/aaosnow/oct10/clinical2.asp

http://www.aafp.org/afp/2007/0701/p86.html