Personal Stories

Never Let Them See You Sweat: A Patient Puts an End to Facial Sweating with ETS

Lyall A. Gorenstein, MD

A 31-year-old attorney from West Orange, New Jersey, who asked that his name not be mentioned in this article, thought he had an anxiety problem when he would sweat excessively in the courtroom. "I thought it was just me, that it was a simple case of suffering from lack of self-confidence or nerves," he says. But there was one problem with that assumption—he was not feeling nervous; he was feeling perfectly confident. So, why was sweat trickling down his forehead every time he had an audience? The attorney began a personal journey to get to the bottom of a case that had remained a mystery for years.

"As a lawyer, this became a real problem for me. It was holding me back from being assertive when I needed to be. I had first noticed the symptoms towards the end of college. I was a student representative on the board of trustees for my university and the position involved public speaking. That's when I noticed I would sweat for no reason and I just couldn't control it," he explains. "It continued on in law school as well. If I was singled out in class to answer a question, I would start to sweat. It would happen around my temples, my scalp, and the back of my head. Sometimes my face felt soaked through."

After doing some research on the Internet, the attorney discovered it wasn't nerves, but rather a medical condition called hyperhidrosis that causes excessive sweating. "I had been to counselors, psychologists, primary care physicians, and no one ever mentioned the word hyperhidrosis, not even once. I discovered it myself through my research," he says.

Hyperhidrosis strikes different areas of the body in different patients—typically affecting the hands, the arm pits, or the face. The attorney only experienced excessive sweating around the face, also known as facial blushing.

Much more than an embarrassment, hyperhidrosis had a serious impact on the attorney's professional life. He had tried to ignore the condition at first, but it would always resurface to remind him–and others–that it was there. "If I found myself in a situation where I was put on the spot, I would start to sweat. Even excitement would trigger it sometimes. First, I would feel my temperature getting warmer and there would be prespiration around my temples. If I didn't constantly wipe it, it would run down my face. Sometimes it would go away after 5 or 10 minutes. Other times it would stay until the situation I was in was over. My first couple trials as an attorney, I didn't think I was nervous because I was prepared, but despite being prepared it would still happen. I began to realize this was not normal," he adds.

The worst part for the attorney was that he felt the condition was preventing him from performing his best on the job. When a situation called for him to assert himself, he would withdraw for fear of one thing—sweating. "I used to duck out of situations when I should have asserted myself. Sometimes, when I was in the courtroom or couldn't duck out for another reason, people even brought it to my attention. I remember a superior asking me in a polite manner, 'Do you want to open a window?' or 'Is it hot in here?'. You know the old saying, 'Never Let Them See You Sweat?' Well, I did."

The attorney came to the point where he wanted a permanent solution to the problem. "I tried performance counseling, I even tried relaxation therapy, but they ultimately made no difference. In my research, I came across a handful of places that peformed a surgical procedure for hyperhidrosis—Endoscopic Thoracic Sympathectomy (ETS). The Center for Hyperhidrosis at Columbia seemed the most credible of all the options. With a name like Columbia, I didn't think I could go wrong," he explains.

The attorney met with Dr. Lyall Gorenstein, Assistant Clinical Professor of Surgery at Columbia University College of Physicians & Surgeons and Director of The Center for Hyperhidrosis at NewYork-Presbyterian Hospital/Columbia University Medical Center, to discuss the procedure. "Dr. Gorenstein was very professional and thorough. He was a comforting and reassuring presence because he was so confident of the results. He made the procedure sound rather simple and straight forward," says the attorney.

After his surgery on February 12, 2004, the attorney was back to work and feeling himself within a couple of days. "The first time I found myself in a situation that mattered after surgery, I didn't sweat. I noticed the difference immediately. The results are perfect. Dr. Gorenstein said one of the side-effects is that sometimes you tend to perspire more in other areas. I tend to sweat a bit more in my legs now, but it's not noticeable. Overall, I was extremely satisfied with the care I received at Columbia."

As for the attorney's performance in the courtroom, he says a difference has been noted there as well. "People tell me I'm more confident and direct now. I don't back away from confrontation anymore. If I were to give advice to others in my situation, I would say that you should realize it's not something you can control. It's not a personal or psychological issue; it's a real medical condition. If you want to get rid of it, you have to do something about it." The attorney finally did. He is happy to testify that the case is closed on his hyperhidrosis—once and for all.