Dupuytren: My surgical dive into private Italian healthcare

I started developing Dupuytren about two years ago
I started developing Dupuytren about two years ago. Photo by Marina Pascucci

Ever tried washing dishes with one hand? It’s ridiculous. I squeeze soap on a plate and move it around the sink with a sponge like a cat playing with his food. I squeeze the sponge inside my milk foamer hoping I can still make a decent cappuccino the next morning.

Showering? I’m rubbing myself down with one hand while the other arm, heavily wrapped in two plastic shopping bags, is stuck over the shower like I’m hailing a cab. Brushing my teeth with my left hand feels as foreign and difficult as riding a unicycle. I predict teeth will start falling out any day now.

As a writer, this is like walking with one leg. The words appear on my computer screen followed by a Red Sea of lines indicating typos. My right pinkie is rendered useless under a heavy, thick bandage. I can’t reach the P, asterisk, question mark, dash or return keys. I’m a classically trained typist who typed 92 words a minute in eighth grade and I’m hunting and pecking with random fingers like a keyboard is a new invention.

All the while I have occasional pain shooting up my hand to my fingertips, just to remind me that an ailment that affects 8 percent of the world’s population is not just a pain in the hand. It’s a pain in the ass.

I have Dupuytren. 

The disease

It’s a disease that shortens and thickens the connective tissue in the palm. Over time, a finger slowly and steadily bends to a 90-degree angle. It will not straighten without corrective surgery. If it goes untreated, a second and possibly third finger will also bend. Soon your hand starts resembling a rake.

My right pinkie eventually became a hook. It didn’t hurt. It also didn’t bend. I could still lift weights. It curled conveniently around bars. But shaking hands was awkward and my writing had more typos than a teen’s Whatsapp messages.

I first noticed it two years ago and had it checked. I went to Salute Nuovo Regina Margherita, a huge public clinic in the Trastevere neighborhood, just down the hill from my home. The woman took one look at my right pinkie and nodded her head. 

“Dupuytren,” she said.

What? I’d never heard that word. It didn’t sound Italian. 

“Du-puy-TREN,” she repeated.

She took my left hand and rubbed my palm. She said I had it there, too. I needed surgery or my right ring finger would join the pinkie in a 90-degree salute, followed by my left hand. How could this happen? What did I do to cause this?

Nothing she said. It’s mostly hereditary.

I called my older sister in Eugene, Oregon. Turns out she had it as well. So did our dad. Then it hit me. I do remember his pinkie being constantly bent at a weird angle. I had no idea it was Dupuytren.

Also I had no idea he had seven operations and they never cured it.

That’s when I got nervous. My sister said Dupuytren surgery has made great advancements. It cured hers and she didn’t even have any pain afterward. I’ll be fine.

Living in Rome, I knew surgery would be free. Yes, even non-Italian citizens reap the benefits of Italy’s superb public healthcare. Physical ailments here have soft landing pads. I put myself down for surgery and the hospital said they’d write me when they had a surgery date. I waited.

And waited. And waited.

Italy has the second-ranked healthcare performance in the world, according to the World Health Organization, but among the negatives of socialized healthcare is the wait period for non-emergency surgery can last forever. It took me nine months to get laser surgery on my eye.

This took longer.

The time dilemma

It became problematic. Dupuytren surgery is quick. You’re in and out in a day. However, the rehab is five-six weeks. Don’t plan on anything for a month and a half. I’m a travel writer. I’m never in one place for a month and a half.

I didn’t travel anywhere without cancellation insurance but this July I must attend two events: My 50th high school reunion in Eugene and my nephew’s wedding outside San Luis Obispo, California, the next day. If I didn’t want to fist bump people with a bandaged hand or drive a rental car one-handed, I needed a five-week window after surgery.

Last November I returned to Regina Margherita and told them my dilemma. The doctor nodded, scribbled my July dates and said they’d try to get me in no later than the first week in June. After living in Rome for 10 years, I know waiting for Italians to do anything, whether it’s scheduling surgery or a bus arriving on time, requires patience no human possesses.

Job would’ve burned Rome again long ago.

I had an option, I could have the surgery done at a private hospital. I’d have to pay but how much could that be? All medical costs in Italy are cheap, right? My family doctor recommended Giuseppe Taccardo, the top hand surgeon in Rome.

Gemelli Hospital is where the pope gets treated.

I visited him at Gemelli University Hospital, and I could tell the difference between Italian public and private healthcare. Regina Margherita is ancient, built in the 10th century. Although the current hospital opened in 1970, it looks like an ancient ruin without the historical character. Drab walls. Dark lighting. Overgrown grass in the courtyard. 

Gemelli, built in 1964, is a brightly lit, 10-story mini metropolis, the second largest hospital in Italy and the largest in Rome. It has more parking than a shopping mall. I knew it would be top of the line.

The pope gets treated there.

I met Taccardo, a burly man with a friendly smile and understanding nature. He took one look at my finger and heard my schedule. He said he’d schedule the surgery for the first week in May. Five-six weeks rehab would put me in mid- to late June, plenty of time to regain my grip by my first return to the States in five years. Regina Margherita eventually called and said they’d get me in between mid-May and mid-June.

What year, they didn’t say. After all, this is Italy.

True to Taccardo’s word, I had surgery May 6. How much would it cost? He didn’t know. I wasn’t concerned. Again, this is Italy.

Dupuytren facts

In the meantime, research told me 5 percent of Americans contract Dupuytren and it’s three to 10 times more in European countries, particularly in Scandinavia.

The causes are unknown but case studies show the following can contribute:

  • Smoking. (Never smoked.)
  • Extreme alcohol abuse. (I live in Rome. The biggest social faux pas you can commit is alcohol abuse.)
  • Liver disease (See above.)
  • Diabetes. (Nope.)
  • High cholesterol (Nah. Mine’s 180.)
  • Thyroid problem (Tiny bit of inflammation)

It usually hits men after 50 and women much later. The right hand gets it before the left, and 80 percent of cases are in both. According to a study by the National Library of Medicine, the recurrence of Dupuytren is 3.5 percent. After living in Las Vegas for 10 years, I liked my odds.

The payment

I walked into Gemelli for the first surgery of my life. At 68 years of age, I’d never had a broken bone, torn knee, heart condition or major ailment. I went legally blind in my right eye six years ago and had laser surgery. I hoped Dupuytren surgery would be as painless. Despite looking straight up into a needle working on your eye, you don’t feel a thing in laser surgery. It was the same thing with Dupuytren. Nothing hurt except one place.

The wallet.

I sat down at a desk to go over the payment plan. My Belgium-based insurance company, Expat & Co. Insurance, would cover it but I had to pay out of my pocket first. I knew the average cost for Dupuytren in the den of larceny that is U.S. healthcare was about $6,000. I figured it would be, comparing past medical costs to that in the States, about $2,000-$3,000. She told me the amount.

€8,236.56. That’s nearly $9,000.

I asked her what it all includes. She went through the procedure.

When she finished I said, “What do you mean it doesn’t come with a happy ending?! For €8,200?!”

Declining to first request a lubricant, I handed over my credit card, comforting myself knowing I could use the airline miles.

In 10 years in Italy, this was the first thing I’ve seen in healthcare that was more expensive than in the U.S. Damn pope. He always drives up costs in Rome.

Getting wheeled into surgery. Photo by Marina Pascucci

The surgery

While the pope gets treated on the 10th floor, I went to the fourth, a sprawling maze of waiting areas, elevators, hallways, offices and operating rooms. After getting dressed in a hospital gown and donning a mask for the first time since Italy’s Covid last lockdown ended, I got wheeled in a bed past waiting rooms full of gawking patients and family.

The last time I had anesthesia was when I had a colonoscopy in the U.S. That was a nightmare turned into a dream. They told me to count down from 10. I went “10 … 9 …….8 ……” Boom! I was awake. It was over.

I asked if they’d put me under for a Dupuytren.

“There is no need,” a nurse said.

What went to sleep was my arm. In a matter of minutes, the anesthesia turned my arm from a functioning limb to a limp piece of meat. I couldn’t feel a single finger. A great white shark could bite my forearm and I wouldn’t feel a thing.

“It feels like somebody else’s arm, doesn’t it?” said an assistant, the only one in the room who spoke English.

They put up a blanket between my eyes and arm so I couldn’t see the obviously grotesque procedure of cutting open my palm and rearranging nerves and tendons. My arm was so numb that it still felt up in the air, the last position it was in before it went under. I asked the assistant if it was in the air like I was waving at someone.

“No. It’s flat on a board.”

My hand post-op, before the pain set in. Photo by Marina Pascucci

After an hour, the blanket came off and I saw my hand heavily bandaged. It looked like a boxer’s taped fist before he puts on his glove. The soft cast allowed four fingers to stick out with a little wiggle room. My bandaged pinkie stuck in the air but at least it was straight for the first time in two years.

The arm was still numb. I could pull my arm up with my left hand and it would flop down like a giant prosciutto roll. 

They wheeled me back to the room to wait an hour for observations. But playing with my arm like it was a new toy slowly gave way to growing agony. As the anesthesia wore off, feeling started rolling up my arm until I could move my fingers. 

What they felt was pain I had never experienced before. Suddenly, my hand felt like it was under the tire of a Fiat. When pain shot up through my palm, I had new appreciation for what Jesus went through. 

They discharged me and I waited for Marina to pick me up at the pharmacy where I eagerly bought painkillers Tora-Dol and Tachipirina. Tachipirina? That’s for hangovers. Not hand surgery.

That night, I slept about two hours. The rest of the time I moaned like that Fiat tire was grinding my hand into the pavement. 

Over the next week, as pain subsided, I learned to live one handed. The three movable middle fingers allowed me to dress myself but I drew the line with socks. They were impossible. Taccardo told me if I got the cast wet, I would never heal. Marina gave me a pile of plastic garment bags to wrap around my arm in the shower. 

Slowly I adapted. I got used to stares. I only once joked after an inquiry, “You should see what happened to her.” It wasn’t funny. But trying to explain Dupuytren in Italian was an interesting language lesson.

Taccardo said I couldn’t exercise until the bandage came off. If it got wet with sweat it would be just like soaking it in the shower. So I had an extra 90 minutes every day to write basically one-handed, read and wonder why the pain kept increasing.

My current bandage where another three to four weeks of rehab await.

 The checkup

I returned Tuesday to change the bandage. I stole a peek at my bare palm and a string of stitches zigzagged from near the bottom of the thumb to the bottom of my little finger. It looked like an aerial shot of a long railway. Taccardo said the pain is normal. In fact, I read the pain can last for months. Lovely.

All so I can hit the “P” key on my laptop.

When he finished I asked him if the operation was as complicated as it seemed even though it’s considered routine and takes only an hour.

“It’s very complicated,” he said. “You must cut into the palm, spread out all the nerves and tendons and cut out the aponeurosis.” That is the thin fibrous band that covers the muscle and continues into the tendons.

My new bandage is smaller. My pinkie is indeed straight. I can now exercise, at least my lower body, and I must change the bandage again next week. Overall, my hands are in good hands at Gemelli.

No wonder the popes live so long.