Solution for Excessive Sweating
Keith D. Mortman, MD, FACS, FCCP, discusses hyperhidrosis, a condition often referred to as excessive sweating. The impact it can have on someone's quality of life is often negative and can limit their social life or career. Dr. Mortman shares details about the minimally invasive surgical treatment that can immediately and permanently cure the condition for the majority of patients.
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Learn more about Dr. Keith D. Mortman
Keith D. Mortman, MD
Dr. Keith D. Mortman, he is an Associate Professor of Surgery at The George Washington University School of Medicine & Health Sciences and the Chief, Division of Thoracic Surgery at the George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates.Learn more about Dr. Keith D. Mortman
Transcription:
Solution for Excessive Sweating
Dr. Michael Smith (Host): Welcome to GW Healthcast. I'm Dr. Mike Smith. The topic today is solutions for excessive sweating. My guest is Dr. Keith Mortman. Dr. Mortman is an associate professor of surgery at the George Washington University School of Medicine and Health Sciences, and the chief for the Division of Thoracic Surgery at the George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates.. Dr. Mortman, welcome to the show.
Dr. Keith D. Mortman (Guest): Thank you for having me.
Dr. Smith: Excessive sweating. The official medical word for that is hyperhidrosis. Can you just tell us a little bit about that?
Dr. Mortman: Sure. Hyperhidrosis is a medical condition where people sweat more than is necessary to control their body’s temperature. We all have to sweat to some degree, otherwise our bodies would overheat. This is sweating more than you need to to control that temperature. This is actually affects approximately 1% of the population.
Dr. Smith: Talk a little bit about it because this does impact people. Sweating too much could affect social life and work life. Tell us a little bit about what somebody goes through who has hyperhidrosis.
Dr. Mortman: Absolutely. The patients I typically see have been dealing with this condition for many, many years. Most patients I see are either in their late teens up until their mid 30's. They tell me that they can remember the excessive sweating really as long as they can remember dating back to high school, to elementary school, and sometimes even before that. As you mentioned, it has profound effects on their social interactions, on their decisions in terms of which career path they choose – people who have sweating hands obviously don’t want to go into a business environment where they have to shake hands frequently – as well as an emotional impact on patients. The first thing that we typically have to determine is that there are two ways this gets broken down. One is called primary hyperhidrosis and the other is secondary. The patients that we treat, we typically see have this primary condition – where that is the underlying problem – and it’s happened since early in childhood. People can also have what's called secondary hyperhidrosis and these tend to be older patients where the sweating is actually secondary to something else – either an endocrine condition, typically thyroid, it could be a side effect of a medication, it could be a side effect of a malignant process. In other situations, it’s important of the physician to really figure out what that other underlying cause is.
Dr. Smith: How often is it primary versus secondary?
Dr. Mortman: The primary hyperhidrosis patients that I see, again, that’s the one where it can affect about 1% of the population, and those are the patients for whom I can offer a surgical treatment. The other thing to remember is that the primary hyperhidrosis patients, the areas where they sweat, tend to be much more focal. Most commonly, I see the sweating palms, it can also affect the soles of the feet, it can affect under their arms and it can affect their face. There's older patients that I mentioned that tend to have the secondary form of hyperhidrosis. They tend to have a more generalized form where they tend to sweat really all over their body.
Dr. Smith: For the patients you see with mostly the primary hyperhidrosis, you had mentioned that many of them say they’ve been dealing with this since early in their life, starting in their teenage years. Are we just not catching that in the primary practice in the community setting or maybe do the patients not bring it up with their physicians? What do you think?
Dr. Mortman: I think it’s a combination of those. I certainly think that’s an under-recognized medical condition. I think many patients that experience it themselves don’t realize that it’s a medical condition and they’ve come up with different ways that they’ve adapted into their daily lives. There's also really an underappreciation of the condition, even amongst medical professionals – many physicians in fact don’t necessarily recognize it as a discrete medical condition and know that there's a treatment for me.
Dr. Smith: Let’s talk about that because I know that you offer a treatment that can be very helpful. Tell us about what you do.
Dr. Mortman: I do a procedure called a thoracoscopic sympathectomy, and that is a minimally invasive outpatient surgical procedure. This addresses, again, the primary hyperhidrosis, and that’s caused by an over-excitation of something called the sympathetic nerve, and that sympathetic nerve lives in the chest. We do a minimally invasive procedure to pinpoint incisions in the armpit where we go in with a tiny scope, identify the nerve and then essentially divide the nerve. This has been found over many decades now to be highly effective at pretty much eliminating the sweating for their patients. The best results that we see are the patients that present with the hand sweating. The benefits of the procedure are that it’s highly effective – meaning about 99% of patients will have almost complete resolution of the hand sweating – and the effects are immediate and they're permanent. When patients wake up in the recovery room, they actually wake up with dry hands, and this is not something that needs to be repeated in a couple weeks, a couple months or a couple years – the effects are permanent.
Dr. Smith: If a patient has the focal sweating somewhere else – you mentioned the feet or certain other areas – is this procedure still offered, knowing that it may not be as effective as the hand sweating?
Dr. Mortman: It is. For many of these patients, I can still offer them the procedure, again, if they fall in that right category, so I do see patients who either have isolated foot sweating, many of them will have a combination of these different areas – meaning under the arms as well as the feet or they can present with hand and foot sweating – or sometimes even isolated facial sweating or facial blushing. The results for those other areas are also very good – somewhere in the 75% to 80% range – in terms of significant reduction or elimination of the sweating.
Dr. Smith: How long has this procedure been available?
Dr. Mortman: We’ve known about this relationship between cutting the nerve and sweating for probably over 100 years, but the procedure has become more popular in the last 20 to 25 years with the advent and the refinement of minimally invasive surgery. In the past, maybe 20 or 30 years ago, patients would require a much large incision on the chest to cut this very small nerve, so the risk benefit ratio there was really not in the favor of the patient, but now that we have minimally invasive chest surgery and it can be done through two small incisions and the patient goes home an hour later, suddenly that’s completely the reversed.
Dr. Smith: Optimizing the procedure, minimally invasive – that really now is opening the doorway for more patients with hyperhidrosis to get this procedure done.
Dr. Mortman: Absolutely.
Dr. Smith: Dr. Mortman, in summary, what would you like people to know about excessive sweating?
Dr. Mortman: I would urge patients if they feel that they have excessive sweating to discuss this with their primary care physician, to go online and they can see our website for the Division of Thoracic Surgery at GW, and certainly if they have any questions to call us and we’d be happy to see them in consultation.
Dr. Smith: Dr. Mortman, again, thank you for the work that you're doing and thank you for coming on the show.
You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Mortman or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment.
This is Dr. Michael Smith. Thanks for listening.
Solution for Excessive Sweating
Dr. Michael Smith (Host): Welcome to GW Healthcast. I'm Dr. Mike Smith. The topic today is solutions for excessive sweating. My guest is Dr. Keith Mortman. Dr. Mortman is an associate professor of surgery at the George Washington University School of Medicine and Health Sciences, and the chief for the Division of Thoracic Surgery at the George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates.. Dr. Mortman, welcome to the show.
Dr. Keith D. Mortman (Guest): Thank you for having me.
Dr. Smith: Excessive sweating. The official medical word for that is hyperhidrosis. Can you just tell us a little bit about that?
Dr. Mortman: Sure. Hyperhidrosis is a medical condition where people sweat more than is necessary to control their body’s temperature. We all have to sweat to some degree, otherwise our bodies would overheat. This is sweating more than you need to to control that temperature. This is actually affects approximately 1% of the population.
Dr. Smith: Talk a little bit about it because this does impact people. Sweating too much could affect social life and work life. Tell us a little bit about what somebody goes through who has hyperhidrosis.
Dr. Mortman: Absolutely. The patients I typically see have been dealing with this condition for many, many years. Most patients I see are either in their late teens up until their mid 30's. They tell me that they can remember the excessive sweating really as long as they can remember dating back to high school, to elementary school, and sometimes even before that. As you mentioned, it has profound effects on their social interactions, on their decisions in terms of which career path they choose – people who have sweating hands obviously don’t want to go into a business environment where they have to shake hands frequently – as well as an emotional impact on patients. The first thing that we typically have to determine is that there are two ways this gets broken down. One is called primary hyperhidrosis and the other is secondary. The patients that we treat, we typically see have this primary condition – where that is the underlying problem – and it’s happened since early in childhood. People can also have what's called secondary hyperhidrosis and these tend to be older patients where the sweating is actually secondary to something else – either an endocrine condition, typically thyroid, it could be a side effect of a medication, it could be a side effect of a malignant process. In other situations, it’s important of the physician to really figure out what that other underlying cause is.
Dr. Smith: How often is it primary versus secondary?
Dr. Mortman: The primary hyperhidrosis patients that I see, again, that’s the one where it can affect about 1% of the population, and those are the patients for whom I can offer a surgical treatment. The other thing to remember is that the primary hyperhidrosis patients, the areas where they sweat, tend to be much more focal. Most commonly, I see the sweating palms, it can also affect the soles of the feet, it can affect under their arms and it can affect their face. There's older patients that I mentioned that tend to have the secondary form of hyperhidrosis. They tend to have a more generalized form where they tend to sweat really all over their body.
Dr. Smith: For the patients you see with mostly the primary hyperhidrosis, you had mentioned that many of them say they’ve been dealing with this since early in their life, starting in their teenage years. Are we just not catching that in the primary practice in the community setting or maybe do the patients not bring it up with their physicians? What do you think?
Dr. Mortman: I think it’s a combination of those. I certainly think that’s an under-recognized medical condition. I think many patients that experience it themselves don’t realize that it’s a medical condition and they’ve come up with different ways that they’ve adapted into their daily lives. There's also really an underappreciation of the condition, even amongst medical professionals – many physicians in fact don’t necessarily recognize it as a discrete medical condition and know that there's a treatment for me.
Dr. Smith: Let’s talk about that because I know that you offer a treatment that can be very helpful. Tell us about what you do.
Dr. Mortman: I do a procedure called a thoracoscopic sympathectomy, and that is a minimally invasive outpatient surgical procedure. This addresses, again, the primary hyperhidrosis, and that’s caused by an over-excitation of something called the sympathetic nerve, and that sympathetic nerve lives in the chest. We do a minimally invasive procedure to pinpoint incisions in the armpit where we go in with a tiny scope, identify the nerve and then essentially divide the nerve. This has been found over many decades now to be highly effective at pretty much eliminating the sweating for their patients. The best results that we see are the patients that present with the hand sweating. The benefits of the procedure are that it’s highly effective – meaning about 99% of patients will have almost complete resolution of the hand sweating – and the effects are immediate and they're permanent. When patients wake up in the recovery room, they actually wake up with dry hands, and this is not something that needs to be repeated in a couple weeks, a couple months or a couple years – the effects are permanent.
Dr. Smith: If a patient has the focal sweating somewhere else – you mentioned the feet or certain other areas – is this procedure still offered, knowing that it may not be as effective as the hand sweating?
Dr. Mortman: It is. For many of these patients, I can still offer them the procedure, again, if they fall in that right category, so I do see patients who either have isolated foot sweating, many of them will have a combination of these different areas – meaning under the arms as well as the feet or they can present with hand and foot sweating – or sometimes even isolated facial sweating or facial blushing. The results for those other areas are also very good – somewhere in the 75% to 80% range – in terms of significant reduction or elimination of the sweating.
Dr. Smith: How long has this procedure been available?
Dr. Mortman: We’ve known about this relationship between cutting the nerve and sweating for probably over 100 years, but the procedure has become more popular in the last 20 to 25 years with the advent and the refinement of minimally invasive surgery. In the past, maybe 20 or 30 years ago, patients would require a much large incision on the chest to cut this very small nerve, so the risk benefit ratio there was really not in the favor of the patient, but now that we have minimally invasive chest surgery and it can be done through two small incisions and the patient goes home an hour later, suddenly that’s completely the reversed.
Dr. Smith: Optimizing the procedure, minimally invasive – that really now is opening the doorway for more patients with hyperhidrosis to get this procedure done.
Dr. Mortman: Absolutely.
Dr. Smith: Dr. Mortman, in summary, what would you like people to know about excessive sweating?
Dr. Mortman: I would urge patients if they feel that they have excessive sweating to discuss this with their primary care physician, to go online and they can see our website for the Division of Thoracic Surgery at GW, and certainly if they have any questions to call us and we’d be happy to see them in consultation.
Dr. Smith: Dr. Mortman, again, thank you for the work that you're doing and thank you for coming on the show.
You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Mortman or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment.
This is Dr. Michael Smith. Thanks for listening.