[Johnny Brown]

Saw my Dad last night, and noticed he has it is his right hand (same as mine). Never knew before, guess the inheritance thing is true then! He reckons he's had it at least ten years, hasn't really climbed in that time though he does a lot of sailing, guess the rope handling might affect? It doesn't bother him anyway, which makes me feel better. Its not as advanced as Bonjoy's though. Hopefully my left will follow his and never be affected either.

[SA Chris]

Mine is about an inch long, halfway between little and ring fingers, and extenidning from "lifeline" on palm downwards. Now got a wierd callous forming on the top end. Doesn't restrict movement at all.

Maybe we should start a thread "Quality Dupuytren's pics"?

[GCW]

Mine is about an inch long, halfway between little and ring fingers, and extenidning from "lifeline" on palm downwards. Now got a wierd callous forming on the top end. Doesn't restrict movement at all.

Maybe we should start a thread "Quality Dupuytren's pics"?

Erm thanks, but I don't want to see photos of you one incher thanks.

[Tim Broughtonshaw]

FYI

Just been to see specialist (Mike Hayton) about my Dupuytren's. He confirmed it was early onset and said he would only operate when i couldn't put my hand flat on the desk. He echoed bonjoy's comments about the enzyme injection and said its difficult to get hold of someone who would do it and its expensive and not available on private heathcare either. 

So now thoroughly in the knowledge that i am of viking descent anyone know a good horned hat shop?





Cheers
tim

[Ru]

Did he mention the Radiation therapy for the initial stages?

[Tim Broughtonshaw]

Hi Ru,
            knew someone was going to mention that. I forgot to ask him about that specifically however i did say i was keen to get it sorted whilst i wasn't able to climb and he didn't volunteer the procedure on private. So maybe it isn't available or on the list of approved treatments. Or maybe they only treat it as worthy of operation when its acute.




Cheers
Tim

[SA Chris]

So now thoroughly in the knowledge that i am of viking descent anyone know a good horned hat shop?

No, but I'm up for a spot of pillaging if anyone else is keen to join in.

Erik?

[Johnny Brown]

Whilst researching this I came across a possible link with Vitamin c supplements, which I coincidentally have been taking the last 6 months. Have since stopped...

[Tim Broughtonshaw]

Whilst researching this I came across a possible link with Vitamin c supplements, which I coincidentally have been taking the last 6 months. Have since stopped...

Well for me personally i don't think this could be a contributing factor as i have not taken these for ages. I am however taking them now for other reasons but for 6 months before it first appeared and for a month after it was most obvious i wasn't popping any vit c pills or those soluble fizzy drinks.

Cheers
Tim

[SA Chris]

Whilst researching this I came across a possible link with Vitamin c supplements, which I coincidentally have been taking the last 6 months.

The only two supplements i evert take are Vitamin C and Glucosamine Sulphate. Now find either (or both) can be responsible. Bugger.

[jfw]

JB can you post a link to the vit C thing (if you can remember where it was) ta!

[Johnny Brown]

First thing to say is, after a bit of googling the other day, there doesn't seem to be any proper research going on. There is a lot of hearsay knocking about between sufferers though. Couldn't find anything more concrete about Vitamins than falls into that category. Enough to put me off though, never been keen on supplements. Best source of info I came across in a very quick search:

[GCW]

I'm not aware of any link between Vit C and Dupuytren's.  If there is you'd better avoid citrus fruits etc etc

Also, UKC is on the subject.

[Bonjoy]

Just read a very interesting article citing compelling eveidence to suggest a link between insulin deficiency and/or insulin resistance and DC. Would highly recommend folk with DC read it http://www.dupuytrens-a-new-theory.com/
Interesting info about possible link to Vitamin D deficiency at the end. More sunshine and prawns please doctor!

[dave k]

Just got this from the same website

"Persons taking the glucoseamine/MSM/Condroitin complex have been anecdotally associated with DC:  Research has shown that glucoseamine can cause insulin resistance and infertility.  Furthermore, histologic findings have discovered that DC tissue samples contain a large amount of chondroitin sulphate, along with myofibroblasts, fibroblasts, type III collagen, and reducible cross-linkages.  This indicates that condroitin might be unsafe for those persons who are predisposed to developing DC." 

Could this be a possible link to climbers. I have certainly taken glucosamine over the last 3-4 years and during which DCT has developed on both hands. during the last 6 months I have also been taking Condroitin- although I actually stopped taking it and gluco a few months back as I felt it was not helping with my tendonitus

[Johnny Brown]

I took it for a couple of months following a knee op, it soon seemed to be having wierd effects with clicking joints and joint discomfort so I stopped. Similarly my DC appeared and was most aggresive during a period whilst I was taking Vit C. I stopped and it hasn't flared up for a long time. I'm pretty cynical of supplements generally now.

[SA Chris]

I took GS/MSM/Condrotin for about a year, over which time what was a minor DC lump got to about a cm long. I stopped taking them when the last bottle ran out about 6 months ago, and it hasn't got any worse (or better for that matter).

[SA Chris]

http://www.ukclimbing.com/articles/page.php?id=1312

I think mine is pretty minor by comparison!

[stevie haston]

hello havent got much to add, Laurence and I both have DC, both have had more than our fair shair of A2 injuryies. A mate Steve Downs had it bad, was worsening so went for the op, despite the risk of accidental damage, good result after long rehab, he couldnt really climb before, coudnt really climb after(old joke) . He had to do lots of finger stretching after,kinda yoga for the fingers and rubbedvitamine E into the skin and did loads of ultra sound.I am terrified of the op and have been using daisy oil(I can hear you laughing) it seems to have had some result or I am being dellusional I  also now look like a small flower.Laurence eats some kind of daisy pill, I rub oil into the thing itself and  she has had possibly better results. I think doing something about it is a good idea as the clawed hand in the really badly affected is awful.There seems to be a very strong link between climbers and DC and people who train their hands have also reported an unusual and alarming incidence. hope this helps.  Stevie.

[Bonjoy]

So many climbers with DC! I just don’t understand why many medical types are so adamant there is no link.
Why the daisy oil/pills? I’ve not heard about this before. Am always keen to hear about any/all possibly helpful practices.

[slackline]

So many climbers with DC! I just don’t understand why many medical types are so adamant there is no link.

Its all rather anecdotal and no one has formalised a proper eidemiological study into this.  You need SCIENCE to answer these questions reliably (whilst it might be "obvious" I'd still argue that there are many intricate facets to the scientific methodology that need to be addressed before a clear conclusion can be reached).

Ideally a prospective cohort study (a bit over-simplified but should give the gist of it) would be required to investigate, but given the long-term nature of the onset and development of the disease its not going to get you any answers very quickly, and this sort of study design is quite expensive, but it does overcome the main problem of the other study design that could be used which is a cross-sectional case-control study.  The main problem with this when applied to DC will be the massive recall problems of asking someone how much they were cranking 20-30 years ago, so its still going to be tricky to draw any a solid quantitative conclusions as to how much climbing results in how much of an increase in risk.  Any results will be very crude.

Studies may be under way, but it all comes down to funding, and thats a very competitive area, with many worthwhile studies not getting funding.  I had a colleague at Manchester Uni when I worked there who was a plastic surgeon who was interested in investigating the genetic contribution to the aetiology* of DC, but he didn't get the funding.  How much funding is going to be thrown at DC?  Well probably not a lot, yes its relatively common, but its not life threatening, and what burden does it place on the NHS (or other medical bodies)?  Nowhere near as much as that of obesity (and associated diseases such as non-IDDM)/cancer/hear-disease which is where most of the money goes.

* From stuff I looked up and posted in the UKC discussion of the article.  DC is a complex disease, it has a genetic component as the sibling recurrence risk of 2.9 (95% CI 2.6-3.3) (see http://linkinghub.elsevier.com/retrieve/pii/S0363502305008142 )  (this means that if your sibling develops DC you have a 2.9 times greater risk of developing it over someone in the general population).  There is also evidence from a five-generation family that were strongly affected by DC that indicated there is a putative locus has been identified on an ~6Mb region of chromsome 16q11.1-q22. But this was identified based on one famliy alone and this had a very strong effect (LOD score of >3 in one pedigree is indicative of a very strong effect). This is only a region of the genome, it hasn't identified any disease gene itself, let alone polymorphisms within the gene that result in susceptibility. There will be many other loci associated with disease, and thats before you start factoring the environment into your model.

Thats not to say that DC is purely genetic, its not, its a complex disease with both genetic and environmental components that will interact with each other to give an overall risk of developing the disease.  Its not just as simple as "climbing causes DC", it might increase your risk, but what baseline are you as an individual coming from (i.e. your genetics gives you a different pre-disposition from your mate who's got a different genetic make-up and might not climb).  How much cranking do you have to do to increase your risk by a given proportion?  All very intricate and tricky to work out, and it requires money funding and people to go out and recruit participants (not all of whom will be willing to take part, but those affected generally are), you then need to age and sex-match them to controls (who haven't got DC, often harder to recruit these people) etc. etc.

[Bonjoy]

Yes, yes, yes. I know that you can’t state something as fact/science without studies to back it up, but like you say such studies are not that likely to be forthcoming or very definitive if they do, etc. What I mean is, why do medical types so adamantly dismiss the anecdotal evidence? Is it the case that nothing, even the most self evident everyday occurrence is not accepted by medics unless there is a paper to back it up? Is there a paper to prove that the sky is blue? Do medics dismiss the anecdotal evidence of that too? Or is this rigid mindset only applicable to things medical, if so why?
When I say, ‘I believe intense climbing over a period of years causes the early expression of DC in pre-disposed individuals’, which is pretty much the boldest claim anyone is making, I’m interested in the opinions of people in related fields, not a blanket, ‘I’ll believe it when I read the paper that no one is ever going to write’ type answers. Is it anathema for medical people to form judgements based on compelling observable evidence in the world around them, when the likelihood of back-up SCIENCE is highly unlikely in the near future?

[slackline]

Actually until recently medicine has progressed through anecdotal evidence and trial and error.  It was only in late 19th century that the field of epidemiology was started after Dr John Snow plotted out the location of cholera incidences and as a consequence had the handle removed from an infected water pump.

Even then that wasn't really the true start of the use of SCIENCE in medicine, and its only in the late twentieth century that you started to hear the term "Evidence based medicine" which has been a great buzz pharse, but really (in general) just means the scientific method applied to medicine.

The judgements based on compelling observable evidence is the starting point for investigating an area and serves as the basis for the formation of a testable scientific hypothesis.  You still get case-reports written up in the BMJ, and they are very useful, and the more reports there are the more compelling the evidence becomes, but at a certain point you need to say right, lets formalise this and control for confounders which may be making it look like theres an association between climbing and DC, but in actual fact its another aspect thats strongly correlated with the activities of climbers thats causing the onset of DC in susceptible individuals, and this won't be revealed until you've done a well-designed epidemiological study.  Cconfounding is a hugely problematic area and worthy of tons of papers in and of itself, what might be confounding in this situation is anyone's guess, it could be nothing in which case hard climbing will be a big risk factor, but it could be lots of things but until you investigate it you won't know.  The more data (in terms of people recruited to a study and the information collected about them) the better suited you will be to investigate this.

Whats really interesting is being able to identify those people who are pre-disposed to developing DC if they spend periods of years climbing intensely, that way you can advise them that they are free to indulge in climbing intensively, but they are more likely (or less based on their genetics) to develop DC.  This was in part what my ex-colleague wanted to start investigating, and its where people who have DC can help researchers by agreeing to particpate in studies.

Its all very well saying in retrospect that you've developed DC as a consequence of climbing, but the horse has already bolted for someone who has the early signs.  What should perhaps be of greater intrest for people who already have DC (and there is some research/epidemiology out there on this*) is how effective the different treatments are, that way those affected can make an informed choice as to which treatment they feel will suit them.  Anyone seeing a doctor/clinician/surgeon about DC should ask them if they are aware of any studies that they can get involved in.

Not trying to be an arse about this, but with a background in epidemiology I felt I could shed some light.

P.S. - Blue sky is subjective, what if your colour blind?  It was science that determined that the water-molecules in the air reflect wavelengths of a given frequency which appear blue to most people without damaged or dysfunctional rods/cones in their eyes.

* I might be able to dig up some papers if interested.

[Bonjoy]

 The possibility of cofounders exists, I struggle to envisage what they may be, toxic rock, bad reaction to chalk, something in Sheffield water....
You must admit that if a well over average number of climbers express DC, at an unusually early age, with an added bias toward people doing a greater quantity and intensity of climbing over a period of years, the balance of probabilities is that the intense climbing is a causative factor.

[lagerstarfish]

Slackline,
without reference to a reliable source like Lagerpedia ^tm, I just can't take you seriously.