Let’s start with a horror story. Ken Wallace a 21-year-old sports management trainee from Wichita Kansas was diagnosed with axillary hyperhidrosis (excessive underarm sweating) when he was 14. After various treatments had proved unsuccessful in controlling his sweating he and his parents decided to take the surgery route. Ken’s dad Raymond who wrote to me sometime ago describes the after effects of surgery as “a nightmare”.
Ken it turns out developed such severe compensatory sweating that his back and thighs were perpetually drenched in sweat. “The situation” wrote Raymond “made us feel that Ken had been better off earlier.” After almost eight months during which Ken took several courses of medication to treat the compensatory sweating it was felt that his surgery would have to be reversed. Though this meant a return to his original condition the Wallaces were relieved. Post-reverse surgery Raymond claims that though Ken’s axillary hyperhidrosis has shown up again the degree of sweating is apparently lesser though that may be pure imagination.
Elements of a nightmare
The very nature of surgery causes it to have various side effects. In the case of hyperhidrosis the surgical procedure is known as endoscopic thoracic sympathectomy (ETS) and compensatory sweating like the type Ken experienced is one of its most common side effects. The condition is also known as reflex sweating and occurs primarily on relatively large body surfaces like the lower legs thighs abdomen or back though the upper half of the body typically remains relatively sweat-free.
According to doctors some degree of compensatory sweating will be seen in all patients who undergo ETS. However of these the majority will probably accept the compensatory sweating rather than go back to the state of hyperhidrosis. In about 10% of cases however the compensatory sweating is so severe that it may necessitate additional medical intervention as with Ken Wallace.
Another fairly well known side effect is gustatory sweating whereby the patient’s face breaks out in sweat upon eating spicy or sour foods. This happens to about 10% of all patients who undergo ETS with the degree of sweating varying from person to person. In cases of severe gustatory sweating once again medical attention is required.
Among the other side effects are: a reduction in heart rate following strenuous physical activity a tingling sensation in the upper arms initial night sweating and weight gain though in many cases these are temporary in nature and may disappear on their own. There are also a few recorded cases of loss of stamina and hair fall though these side effects are relatively rare.
The ETS procedure
ETS is essentially an invasive procedure that goes something like this: while the patient is under anesthesia a minute incision is made in the underarm regions. Air is pushed through the incision into the chest cavity to push the lungs away from the operation site. Then the endoscopic equipment (a fiber optic camera and a working instrument) is inserted to locate the sympathetic nervous system which lies within the thoracic cavity and controls sweating.
The endoscopic instrument is then used to clamp a certain segment of the sympathetic nerve node that causes excessive sweating using titanium clips. This interferes with the transmission of nerve signals and thus reduces sweating. Some surgeons use the cutting method which involves making minute cuts in strategic neural locations with the objective of blocking transmissions. However clamping is a reversible process because a clip may be extracted in future if not required while cutting is irreversible. Mercifully for Ken Wallace his surgeon favored the clamping method because in case of the cutting method a nerve graft reversal is required if a patient wishes to arrest the compensatory sweating.
ll in all ETS ought to be an extremely well thought out step for a hyperhidrosis sufferer because it cannot be said with any certainty that s/he will not suffer severe side effects. Indeed it should be seen only as a last resort only if all methods to control the hyperhidrosis are perceived to have failed.