Roland's
HyperHydrosis
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Fig.1 The author — Pre Op
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Roland's
HyperHydrosis Page
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Fig.1 The author — Pre Op |
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Fig.2 Stunt-double hand exemplifying excessive sweating
Fig.3 Stunt-double skin |
INTRODUCTION I have had Hyperhydrosis for as long as I can remember. Mostly on hands, and to a lesser extent on feet and underarms. I remember as a kid of 5 yrs old thinking, "Gee, I don't understand why the commercial says M&Ms melt in your mouth, not in your hands. They melt in my hands!" The problem got worse when I "discovered girls" because this condition is exasperated under high-stress. Shaking hands with anyone was generally a nightmare. Luckily, the problem got better as I got older, likely because I became a more confident person. Nevertheless, it was still bothersome. When I discovered there is a relatively safe, fast, and very effective treatment out there, I figured I might as well be done with this friggin' problem forever! I underwent the Endoscopic Thoracic Sympathectomy (ETS) on Monday, August 27th, 2001 at 11:37am. Everything happened nearly as my conversations with people had indicated it would. Although it had been described to me by so many, I couldn't believe it really worked. It was as if someone had flipped a switch inside my body. I came out of surgery with dry, warm hands, and they have not sweat since! Hyperhydrosis results from an overactive sympathetic nervous system. This part of the nervous system communicates with the hypothalamus and controls sweating. Those of us with this problem (<1% of population), typically have more of these types of nerves. So, the idea is that blocking the nerve impulses corrects the problem. These nerves branch from the spinal cord at T2 and T3 (T=Thoracic at top). These major sympathetic nerve trunks branch further into what are called "Kuntz" nerves. Most surgeons only affect the main trunks, while others (only 1 I have found) also manipulate the Kuntz nerves, resulting in more precise control of where sweating is stopped while minimizing side effects. |
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TREATMENTS — NON-SURGICAL There are a number of non-surgical treatments out there, and I've tried most. None seem to really work. When I was about 15, I tried Drysol topical antiperspirant and the Drionic electric-shock-stimulus device. Neither worked very well, and were a pain due to having to apply once per day or more. Recently, I tried Maxim with little success. I never tried Botox, but have read that its results are on the order of the other non-surgical treatments. |
Fig.4 Non-surgical treatments |
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Fig.5 Gender-impaired stunt-double with MicroETS entry points indicated |
TREATMENTS — SURGICAL As a kid, I remember asking the doctor about surgical procedures. He told me there was one, but it was quite invasive. He likened it to open-heart surgery--crack open chest, collapse the lungs, long recovery period, major scarring, etc. (in-patient to say the least!) Not sure what possessed me, but about a month ago I decided to do a search on the net. Discovered that in recent years with the advancement of endoscopic techniques, there is now an outpatient procedure that takes about 1 hour, requires a 1/12 to 1" incision under each armpit, and there are a few surgeons that have performed more than 2000 times with 98% success rate, and little or no side effects. |
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TREATMENTS — SURGICAL (CONT.) Only notable side effect is Compensatory Sweating (CS)--the body gets upset because it can no longer sweat thru hands. It compensates by excessive sweating elsewhere. Nearly everyone I talked to (or read comments posted by) (95%+) have indicated that this has not been a issue or the problem is less of an issue than hand sweating. There are 2 acceptable surgical techniques today. Both are considered Endoscopic Thoracic Sympathectomy (ETS)—"clamping" and "clipping". ETS is a bit of a misnomer for the 1st technique because the nerve is not really severed. Instead a titanium clamp is place on the nerve to shunt impulses. The 2nd technique does actually involve cutting of the nerve. I opted for cutting. Although clamping is claimed to be more reversible (in case CS is severe), it must really be done within 1-2 wks. However, excessive CS may not arise until after that. After 1-2 wks the clamps have also shunted blood supply to nerve (so nerve is dead) and scar tissue has likely formed, which could lead to complications resulting from bleeding if a reversal were attempted. Of all the folks I talked to or read about, only 1 has wanted a reversal. However, as it turned out, he opted for a redo. |
Fig.6 Stunt-double with sympathetic nerve, T2/T3, and MicroETS entry points indicated |
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Fig.7 Stunt-double undergoing MicroETS
Fig.8 The author's actual insides (Before) Sympathetic Top, Kuntz Bottom
Fig.9 The author's actual insides (After) |
THE BIG OPERATION When we returned to the hotel, although groggy, I felt I just had
to do everything I could to test out my new hands! Unfortunately, I was a
little sore, so exercising was a bit out of the question. I decided to
drink several cups of coffee to see what would happen! Although I got
jittery, no sweat! Incidentally, soreness from surgery was very mild. I would liken it to a feeling of being sore after having worked out too hard the previous day. |
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DAY 1 —
FOLLOW-UP I had my follow-up mtg with Dr. Neilson the next morning. To further push the limits, I wore sneakers without socks. In the past, this would have triggered my feet which would have set off my hands. But, no problemo! I spent about 45 minutes with him. He asked me how I was doing. I told him I was doing great, but still couldn't believe the results. I told him I keep waiting for my hands or feet to start sweating or for CS to kick in. He said if I were going to have CS, I should have noticed it by then. That was encouraging. I also confirmed a few things with Dr. Neilson that thru my research I thought were true. 1) He is the only doctor that uses the Micro procedure that only req's the 1/12" incision. 2) There are relatively few surgeons in the world that do ETS, unbelievably, there are still surgeons out there performing the very invasive procedure! |
Fig.10 Peanut M&Ms (What is it about the green ones?) |
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Fig.11 The author's actual sweat-free hands |
WEEK 1 — RESULTS — "NO SWEAT" My major concerns were effectiveness of the procedure, possibility of CS, and recovery period. I have been lucky on all counts! I'm sure that at it's worst CS is probably pretty
bad. For me, it has been minimal. In fact, I would even venture to guess
that this might be how non-HH ppl sweat. Furthermore, it only happens when
I'm exerting myself (at the gym, etc.) and not when I'm just sitting
around. I believe the key is Dr. Neilson's approach to working with the
Kuntz nerves while other doctors deny their significance. I trust Dr.
Neilson particularly because he takes a closed-loop approach to treating
HH. During my follow-up, he gave me several surveys that he asked me to
return to him over the course of the next year (1wk, 1month, 6mos, 1yr).
They will provide him with feedback on how effective my specific surgery
was. This allows him to fine-tune his technique, thereby mitigating secondary effects. |
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INSURANCE — "DON'T SWEAT IT" I have found that insurance pays for anything from 0-100%! Mine (Blue Shield of California, $35 Copay Plan) pays for 70%, but I have a $3,500/yr stop loss, so that is the extent of the damage on my pocketbook. Total cost for operation including anesthesiologist, hospital fees, etc. is about $15-20k. In most cases, you can call or write the doctor's office, give them your insurance info, they will contact your insurance, and reply to you with the amount your insurance will cover. Most can get back to you in about a day. My PPO did not require a pre-authorization on the surgery, but some might. |
Fig.12 NorthEast Baptist, San Antonio, TX (Way too early in the morning...) |
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Fig.13 The author — Post Op |
ET CETERA Raynaud's Disease — A related condition that causes cold, dry hands. Apparently, there is an inverse relationship between sweat glands and arteries in the hands. When sweat glands are active, arteries are constricted. Constricted vessels and evaporation of sweat both cause cold hands. Ppl with hyperhydrosis can experience these conditions separately or together. Both are cured by ETS. Under the Knife — Two major concerns were how bad the procedure itself was going to be, and how unpleasant recovery would be. Taking a look at my post-op picture to the left should help calm any concerns regarding both. I can't believe I looked and felt so "normal" after having just been in surgery 30-45 minutes prior... Evangelism — While at dinner the day of my surgery, I asked our server to shake my hand (shaking hands is my new hobby). At first she looked at me like I was a bit off my rocker, but then I explained that I had just had this surgery. Her jaw nearly hit the ground, and unbelievably she immediately sat down and told me she and her father have the same condition! She went on to say that they had been told by their doctors that the very-invasive procedure was their only option. Needless to say, the opted out of that procedure. We spent a while chatting, and I gave her all the info I could. Don't be ashamed of your former condition! You may be cured, but many ppl still don't know about ETS. Disclaimer — I don't claim to be an expert on Hyperhydrosis (or anything else mentioned on this site). The information presented here has been distilled from research on the web, corresponding with former HH patients, surgeons, and personal experience. So far, I feel I'm very lucky--my procedure resulted in all of the good effects without any of the negatives. (Keeping my fingers crossed.) Your situation could be different. Get the facts for yourself. |
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OTHER RESOURCES http://dreamwater.org/etspatients
http://www.hyperhidrosisusa.com
http://www.sweaty-palms.com/facil.htm
http://sd-neurosurgeon.com/diseases/hyperhydrosis.html
http://www.excessive-sweating-hyperhidrosis.com
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Fig.14 The sky with sun, clouds, and lens flare |
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© 2001 WhazzupB?! —
Roland J. Lewis — All rights reserved
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Last Updated 2001.Labor
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