INTRODUCTION:
Perspiration is the body's natural method of cooling itself down during active periods or exposure to warm conditions. Severe hand sweating, underarm perspiration, facial sweating and uncontrollable rapid facial blushing with a feeling of embarrassment is usually caused by an increased activity in the sympathetic nervous system a system of nerves over which we have no control. Such excessive perspiration and/or blushing is not important for normal regulation and control of body temperature. These conditions can be cured by dividing or clamping the nerves which regulate sweating of the hands, armpit and face as well as facial blushing. The surgical cure for this affliction is known as ETS or Endoscopic Transthoracic Sympathectomy. An experienced surgeon will locate the specialized area of the nervous system inside the chest cavity. Using a miniature camera and instruments, the nerve supply to the sweat glands is cut or clamped, preventing excessive sweating and/or blushing. Excessive sweating involving the whole body or constant redness of the face is not suited for surgical treatment.

NONSURGICAL TREATMENT should be considered before deciding to undergo surgery since the ETS procedure is irreversible. Nonsurgical options for excessive sweating include:
*Topical Astringents (Drysol, Maxim - www.coradhealthcare.com) which shrink the sweat glands,
*Botox (Botulinum toxin A) injections into the affected areas of the skin,
*Biofeedback,
*Acupuncture,
*Anticholinergic medication such as Glycopyrrolate or Homocyamine can reduce sweating but can cause dryness over the entire body,
*Medication such as betablockers and serotonin uptake inhibitors may reduce facial blushing,
*Stellate Nerve Blocks temporarily work and
*Iontophoresis (electrical saltwater baths applied to the affected area) see www.Drionic.com

The decision to undergo surgery depends on the level of distress suffered by the patient, not the amount of sweating and blushing that occurs. The expected effects of the procedure must be weighed against the risks, complications and side effects. Previous surgery of the chest and obesity will reduce the chance for a successful operation and increase the risk for complications.

OPERATIVE TECHNIQUE:
ETS is performed with you completely asleep under a general, endotracheal anesthesia. The surgeon enters the chest cavity though a 1/4 inch incision located under the armpit. A small amount of carbon dioxide (CO2) gas, which is harmless, is pumped into the chest cavity in order to push the lung aside. This allows the surgeon to see the sympathetic nerve chain located along the side of the back bone or spine. The surgeon will cut or clamp the nerve that is responsible for the underarm, face or hand sweating or facial blushing. After the surgery is completed, all the carbon dioxide gas is removed, the lung is released and the skin hole is closed with an absorbable suture that does not need to be removed. The procedure is repeated on the other side. The operation takes about 30 minutes to perform and the patient is awoken with only minimal discomfort. A routine chest Xray is performed to insure the lungs have fully inflated after the operation and before you leave the hospital.

WHAT TO EXPECT AFTER THE OPERATION:
Most people go back to the hotel on the same afternoon as the surgery. You will feel somewhat tired and may have a slight pain the chest and upper part of the back at the level of the shoulder blades. Most patients resume work or light activity in 48 hours and return to active sports or vigorous activity in 7 days. A persistent, slight to moderate pain may be felt in the chest or upper back for the first few weeks. A few patients will experience a prolonged pain or numbness of the arm, but none have permanent paralysis or sensory losses of the hands. Since no stitches need to be removed, the scar is very small, resembling a mole.
The effect of the operation is immediately evident. Upon awakening from the anesthesia the hands are warm and dry. Stress will not induce the same embarrassing facial blushing. During the first weeks or months after surgery patients feel a tingling sensation much like preceding the sweating and blushing, but no sweat or blush appears. No surgical procedure is 100% successful, but long term follow up has found a greater than 98% relief of hand sweating, 95% relief of facial sweating, 85% for blushing and 70% relief of axillary sweating.

SIDE EFFECTS AND COMPLICATIONS:
While any surgical procedure has some degree of risk associated with it, ETS is a safe procedure with minimal side effects. Very few complications have occurred.

*COMPENSATORY SWEATING This is the most common side effect and occurs in ALL of patients. It is best described as periodic perspiration around the lower stomach, back or groin region. It is mild and is tolerated by most patients. In some patients, especially during physical exercise or stress, it is troubling. It usually, but not always, improves with time. Severe compensatory sweating occurs in 1-2% of patients and is the most common reason for regret of having the operation of those operated.

*Gustatory sweating is sweating in the head and neck area that is induced by certain smells and tastes. A runny nose may be the noticed side effect. Few regard this as a major problem.

*Horner's Syndrome is drooping of the eyelid, a small pupil and redness to the eye on the affected side of the face. It occurs in less than 1% of patients and in half of the patients corrects on its own. The eyesight is NOT affected. In rare cases of permanent Horner's syndrome, the drooping eyelid can be corrected with Plastic Surgery.

*Postsympathetic Neuralgia is pain in the shoulder or upper arm after surgery that persists for a few weeks after surgery. Fortunately, symptoms resolved in 3 to 6 weeks in most all patients.

*Recurrent Symptoms may return as soon as 3 months, even with an excellent operation. It is most often due to regeneration of the nerves.

*Dry hands, especially during the first few months can be treated my moisturizing creams.

*Increased temperature sensitivity with cold hands and feet is rarely reported.

*Heart rate is reduced by 10% and few patients actually notice impaired physical performance.

*Migraine headaches and trembling hands are improved in many patients.

The following are surgical consequences which occur in less than 1% of patients. These general complications are not common, but can be treated or corrected.
*You can have an adverse reaction to the anesthesia.
*Bleeding can occur in the area of surgery. Blood transfusion not usually necessary.
*Air leaks from the lung resulting in a collapsed lung that does not reexpand after surgery
*An infection in the operative site wound.
*Lung infection, pus in the chest cavity or pneumonia.
*Blood clots developing in the legs and spreading to the lungs known as Pulmonary Embolus.
*Chest tubes may have to be placed into the chest cavity to remove the trapped air or blood that has collected after surgery.
*Open the chest cavity and repair any injury or complication.

Your surgeon will make every effort to insure that you have a safe and successful surgery. If you have any questions, problems or confusion about the operation and the risks involved, you need to ask your surgeon or someone from the surgical office.

FOLK REMEDIES FOR THE TREATMENT OF SWEATY HANDS

Excessive Iodine my be the cause of excessive perspiration. Ask your physician to obtain a complete Thyroid profile. Try reducing your intake of Iodine. Iodine is found in kelp and iodine-rich foods such as beef liver, turkey, asparagus, white onions and broccoli. Iodinized salt is a common source of excessive Iodine.

Antiperspirants that you commonly use on your underarms will work for your palms. These contain Aluminum Chlorhydrate.

Astringents such as Witch Hazel or Alcohol help shrink pores and reduce sweating. You can apply either liquid using a cotton ball before a situation that sweating would be a problem.

Sage is good at reducing sweat. To make a tincture solution combine 1/2 cup of powdered Sage leaves with 1 1/4 cups of vodka in a well sealed bottle. Let this solution stand for 2 weeks, but shake it twice a day. After 2 weeks, strain the solution and store with the liquid in another bottle. Use 25 drops, 3 times a day. You may add it to tea or make a tea solution using the Sage leaves.

Tea Bags that are moistened can be held in your palm for 10-15 minutes each day. Any variety of Tea or Tea bag can be useful. The tannin in tea is an astringent which shrinks pores and decreases perspiration.

Zinc tablets are used to reduce perspiration. Do NOT take more that 15 mg a day for more than a week without consulting a doctor. Zinc may interfer with the absorption of Copper, another trace element.