Personal Stories

Getting a Grip on Palmar Hyperhidrosis

Most people haven't heard of hyperhidrosis and, once they do, they'd probably never guess what the word means: excessive sweating. About 1% of adults suffer from hyperhidrosis, even though many of them don't even realize it. However, there is one dead give-away—sweat, and lots of it.

Perspiration is a normal and healthy bodily function, controlled by the autonomic nervous system. But in patients with hyperhidrosis, the autonomic stimulation of the sweat glands is hyperactive. Symptoms of hyperhidrosis usually appear in the hands and feet. Typically, hyperhidrosis begins in childhood or early adolescence and increases in severity through puberty and into adulthood. The sweat glands do not discriminate—men and women are equally affected by the condition.

A 27-year-old graphic designer, who asked that her name not be mentioned in this article, knows the symptoms of hyperhidrosis all too well. For all of her life she has suffered from palmar hyperhidrosis, or sweaty palms. The most common manifestation of the condition, palmar hyperhidrosis is also the most challenging for patients because it is extremely difficult to control. Like many people with palmar hyperhidrosis, the designer also suffered from plantar hyperhidrosis, or sweaty feet. In recent years, she had noticed that the condition had spread to her armpits (axillary hyperhidrosis) as well.

"As far back as I can remember, I've always had sweaty hands," she says. "They were always wet and cold, and just left me feeling uncomfortable. They would sweat from morning to tonight, for no reason at all; nothing would trigger it, not even temperature. Even in the freezing cold of winter, they were sweaty."

"The worst part about the condition is you can't hide it," adds the designer. "If I was in a situation where I didn't want my hands to be sweaty, without fail they would sweat. For example, if I was going to a job interview and had to shake someone's hand, they would start sweating more."

When asked to define 'sweating', the patient clarifies, saying, "my hands weren't moist; they were physically dripping."

Hyperhidrosis impacts one's ability to interact effectively in the work place, and can have devastating effects on one's social interaction with others. "Professionally, I would dread certain situations. I used to show my portfolio to get freelance work and I remember picking up the board of my artwork and there would be wet fingerprints on it. And then there were the keys on the keyboard of my computer—they would each have a little puddle. Socially things were just as bad. I remember sneaking out at weddings so I wouldn't have to shake anyone's hand at the end. I didn't even want to pick up the program at the wedding because it would be soaking wet after I touched it. My feet sweat so bad that if I was wearing shoes with leather at the bottom, the leather would turn into mud. The little things that were supposed to be fun were never fun," says the patient.

Before opting for surgery, the patient tried medical therapies, but to no avail. "I tried smaller, temporary solutions, but nothing worked. I was at the point where I wanted a permanent solution. None of the primary care physicians I went to in the past could comprehend my condition. They weren't even aware of hyperhidrosis. In fact, I brought the term up to them after doing some research on the web."

Lyall A. Gorenstein, MD

"After I found The Center for Hyperhidrosis at Columbia on the Internet, I talked to my primary care physician about it and she said I should give it a try," she continues. "That's when I met Dr. Gorenstein. He was the first doctor I met who had complete knowledge of the condition and understood how people feel when they have it. He asked all the right questions and knew exactly where I was coming from."

Lyall A. Gorenstein, MD, 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, thought that the designer would be an excellent candidate for Endoscopic Thoracic Sympathectomy (ETS), a surgical procedure to treat hyperhidrosis.

The goal of ETS is to eliminate the constant autonomic stimulation of the palmar sweat glands, while maintaining other sympathetic nerve function and minimizing trauma to the surrounding tissue. Using two microscopic incisions in the armpit, the surgeon clips or cuts the sympathetic nerve, the overactive nerve which stimulates excessive sweating.

"Dr. Gorenstein explained to me that the surgery would be non-invasive. He took special care to make very small incisions under my armpits so no one could see them. I had surgery Monday morning on July 19, 2004 and I was home by 1 or 2pm on the same day," explains the patient. "I remember going to a concert in the park that night. I was a little sore the first and second days, but by Wednesday I was back to work and fine."

In terms of the benefits of ETS, most patients notice a difference soon after surgery. "The results were immediate, and I feel amazing now. My whole cooling system is working correctly now. I can wear flip-flops in the summer and walk around and not be uncomfortable. I can actually touch people that I'm close to. I can tickle my niece's back and not gross her out that my hands are sweating. Human contact is something that I think you miss out on the most with hyperhidrosis."

The patient says she has only one regret—that she sweated it out for too long. "The surgery changed my life. I wish I would have done this 10 years ago. It feels so good to sweat like a normal person—finally."