Permanently bent finger can be surgically freed
DEAR DR. DONOHUE: I have Dupuytren’s contracture, as did my father. Although less severe in my left hand, it has severely affected my right ring and little fingers. It hampers some of my activities, especially typing. Is there any medication or treatment that can reverse this ailment? — S.G.
ANSWER: Dupuytren’s (do-pwee-TRAHNS) contracture, a fairly common disorder, often is a family affair. Beneath the skin, the palm of the hand has a dense covering that protects finger tendons and hand bones. That tissue sprouts a nodule, a little lump, under the hand crease at the top of the palm. From that nodule strands of fibers, like the cords on a parachute, attach to finger tendons. They draw the finger down to the palm. In the extreme, the finger can become locked flat against the palm. Any finger can be trapped, but the little and ring fingers are the ones most often targeted. Both hands can suffer from it.
In the early stages, you might be able to keep the finger flexible by putting your hand on a table and then lifting your palm upward while maintaining the fingers flat on the table. Hold the stretched position for 10 seconds and repeat the exercise 10 times.
For more seriously affected fingers, a cortisone injection into the area of the nodule might free the finger. Collagenase injections also have proven useful. Collagenase is a substance that dissolves the collagen strands binding the fingers. On Aug. 28 of this year, the Food and Drug Administration instituted a priority review of this substance, so it may be widely available in the near future.
Needle aponeurotomy, a minimally invasive procedure in which a needle frees the finger from the tethering strands, has been used in Europe for some time and is now catching on in North America.
Standard surgery for releasing the finger or fingers has been around for a long time and is quite successful. My brother-in-law, an avid golfer, had the surgery. His game improved. Now he gets around the course in 150 strokes.
DEAR DR. DONOHUE: You have written about irritable bowel syndrome and have twice mentioned Align and Xifaxan. Neither is available in Canada. Can you recommend any substitutes? — E.Z.
ANSWER: Align, marketed by Proctor and Gamble, is a probiotic — material containing good bacteria that aid in food digestion. The name of the bacterium in Align is Bifidobacterium infantis. You might be able to find it in another product. Other probiotics have different bacteria that can be substituted. Culturelle has the Lactobacillus bacterium. I’m sure you can find similar products in drugstores or health-food stores.
Xifaxan is the brand name of the antibiotic rifaximin. In the United States it is approved for the treatment of traveler’s diarrhea. Its use in irritable bowel syndrome is an off-label use, one not approved by the FDA. Don’t feel deprived because you can’t get it. Many doctors don’t use it.
Have you tried peppermint oil? It’s simple, cheap and often works. It’s best taken in the form of enteric-coated capsules, which prevent stomach irritation.
DEAR DR. DONOHUE: I can’t go into all the details of my mother’s health history for the past two years. However, your article on cardiomyopathy gave hope to my sisters and me for our mother. She is breathless whenever she moves, and she is tired all the time. Can you tell us what can be done for her? — V.W.
ANSWER: Cardiomyopathy is only one cause of breathlessness and fatigue. It’s a weakness of heart muscle due to causes other than the usual cause of heart problems — clogging of heart arteries. Your mother could have heart failure, anemia or an underactive thyroid gland. Cardiomyopathy is possible, but it’s not high on the list of candidates for her symptoms.
Your family doctor is the one best able to come up with the answer or the one who can make a definite statement about cardiomyopathy.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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