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The Oregonian: Medical Relief Tried for Deluge of Sweat Caused by Hyperhidrosis
By Andy Dworkin for The Oregonian:
Most of Oregon has been sweating the hot weather for days. Chantel Howell has suffered similarly her whole life.
The West Linn woman is among as many as 8 million U.S. residents who sweat, profusely, during much of their waking lives.
The condition, called hyperhidrosis, usually affects sweat glands in the hands, feet, armpits or face. Sufferers sweat five times more than the average person, according to the Philadelphia-based International Hyperhidrosis Society.
Howell's feet sweat so much she can't wear sandals. Her palms get so wet from anxiety or mild warmth that she seldom holds hands with her husband or two children.
Now Howell hopes many of her problems have dried up. Tuesday morning, a doctor damaged the nerves that control her hands' sweat glands by bathing them in a solution of phenol. It's a rare treatment, recently developed in Belgium. Howell, 36, may be the first person to have this procedure in the United States.
"I hope to have dry hands a lot more often," she said a few minutes before her procedure. "But honestly, I'm pessimistic."
Howell's hands and feet have been extra sweaty as long as she can remember. In school, she would grab paper towels during exams to keep the test papers dry. She couldn't hold hands on dates. She avoids shaking hands.
The condition goes past inconvenient to painful. Heat swells Howell's hands so much she goes up two ring sizes. She set notches on the inside of her wedding ring to accommodate the change. The swelling and shrinking make her hands crack and bleed. She can't soften the skin with lotion. The heat from rubbing the lotion into her hands causes too much sweat.
"I hope that everybody will have sympathy for this problem, because it can be debilitating," said Dr. Jeremy Weiss, the interventional radiologist who did Howell's procedure at Providence Portland Medical Center.
7.8 million patients in U.S.
A 2004 survey estimated that 7.8 million U.S. residents have hyperhidrosis, and more than a million of them have barely tolerable cases that interfere with daily life.
The problem runs in families. Howell's mother, two brothers and 10-year-old son are affected. Researchers are looking for a gene tied to the condition, said Lisa Pieretti, executive director of the International Hyperhidrosis Society: "That's where the hope is for a cure."
Today, no one knows just what causes the problem, Pieretti said. Clearly, there's a glitch in the sympathetic nervous system, which controls involuntary functions including dilating pupils, raising the heart rate and sweating. But it's not clear whether the problem lies in the brain, nerves or sweat glands, Pieretti said.
Treatment starts with rubbing antiperspirants on hands, feet and other affected areas. Bigger steps include Botox injections and iontophoresis -- bathing hands or feet in water with a mild electrical current that somehow eases sweating.
Surgery a serious step
The most serious step is surgery to cut the nerves wiring affected sweat glands. That procedure, called a sympathectomy, sometimes causes side effects including increased sweating in the torso and Horner's syndrome, nerve damage that causes droopy eyelids and enlarged pupils. Because of those effects, Pieretti said, she hears "every single week from people who have the surgery who regret it."
Howell had a sympathectomy using needles and chemicals instead of scalpels and surgeons. Weiss learned of the procedure in December at a radiology conference, where Belgian doctors were discussing their first 50 patients. They said 47 quit sweating just after their injections, and the other three improved after a second treatment.
Doctor's wife has condition
Weiss grabbed a flier about the procedure and gave it to Dr. Gary Howell, president of the group where Weiss practices, Radiology Specialists of the Northwest. Weiss thought Howell should learn the technique. Howell said, "No, you need to do this," Weiss said. "And I know your first patient." That's when Howell said his wife has hyperhidrosis.
Weiss started corresponding with a Belgian doctor, learning the theory behind the treatment. The skills were familiar: using a CT scanner to guide needles to a specific point in the body. But Weiss had never tried this exact procedure before Tuesday.
Sedated but conscious, Howell lay face down in the CT machine. The scanner's series of X-rays helped Weiss pinpoint where to insert two long, thin needles. He worked the needles in bit by bit, checking his progress with repeated scans.
Twice, Weiss had to thread a needle between ribs, a shoulder blade, a vertebra and one of Howell's lungs, until the tip hit a spot along the spinal column where key nerves sit.
Quick injections
Placing both needles took more than a half-hour. But the procedure finished in a jiffy.
Weiss got the phenol solution and a big glass syringe, both hard-to-find items. Weiss said he never used a glass syringe before but was trying it in case the phenol solution reacts with plastic.
He drew the thick solution into the glass tube, then pushed hard to force it through the narrow needle. He injected about a half-tablespoon on each side, then quickly removed the needles and sat Howell up: Gravity helps the phenol drip down, not up, avoiding the nerves that could cause Horner's syndrome.
Howell spent a few hours in the hospital, feeling some pain in her back, as if she just played a lot of racquetball. Then she left the hospital and tested the procedure out: She rubbed lotion into her hands during the hot car ride home. She went outside in the sun.
Dry hands.
"I'm thinking that it works, because thus far I have not had any overly sweaty palms," Howell said Wednesday. Her back was still a bit sore, but Howell said she had no other side effects.
The ultimate test of the procedure will come in a few days, she said: She is going to visit relatives in Mississippi in August.
http://www.oregonlive.com/search/index.ssf?/base/news/1154021116267010.xml?oregonian?lcfp&coll=7
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