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Prakash Chandran (Host): We all get sweaty sometimes. But for some of us, excessive sweating can be so extremely embarrassing and can actually point to a more serious underlying condition called hyperhidrosis. Now, the good news is, there are new treatments available that can help. And we’re going to talk about it with Dr. Charles Klodell, a cardiothoracic surgeon at Florida Heart and Lung Institute.

This is Helmet of Health, the podcast from North Florida Regional Medical Center. I’m Prakash Chandran. So, first of all, Dr. Klodell, what exactly is hyperhidrosis?

Charles Klodell, MD (Guest): Well hyperhidrosis is excessive sweating is what that literally translates into and people sometimes get confused. It’s not when you are on the treadmill at the gym. This is when people are sweating inappropriately. So, this is when someone is sitting in a cool room, the air conditioner is running, they are watching the TV and all of the sudden they have just sweat dripping from their hands, their feet. Those are the two most common sites. Sometimes it’s the armpits, occasionally it can be the face. But the hands are really the one that people complain about the most. And it’s excessive sweating at inappropriate times.

Host: Okay and does this just come out of nowhere? Is it something that’s gradual? When do people start experiencing this?

Dr. Klodell: Yeah, that’s a great question. So, hyperhidrosis comes sort of in two forms. One is primary, meaning they have had it their whole life. Some people will talk about when they were a child, they had trouble learning to walk on tile floors and things like that because their feet were sweating. They talk about when they were in school and they were learning to write, and they were constantly in trouble for either smearing or saturating their papers. So, that would be primary. They remember it their whole life.

Secondary is a little bit different deal and that’s I was fine until I was 45 and then all of the sudden, I started sweating and that’s a little different deal. That’s almost always caused by medications, hormones, things like that. So, what we really treat the most effectively is people that have had primary hyperhidrosis. There is a genetic component to it. So, oftentimes, patients will have a family member that has experienced very similar symptoms and may or may not have sought treatment. Maybe they just tolerated it their whole life. But oftentimes, there is a family history of it as well.

Host: So, let’s say that I start experiencing some of this excessive sweating in very normal conditions; tell me a little bit about how it’s normally treated.

Dr. Klodell: Well so the first line treatment for many of these conditions is medical and this can be things as simple as prescription strength antiperspirants. There is some aluminum chloride based compounds  that will help dry the hands or the axilla or the armpit. But many of those, they lead to pretty severe irritation. Then when you escalate to the next level, people will talk about they found this gel iontophoresis thing on the internet that gets advertised and it’s basically a small electrical charge. It’s really not the panacea that people hope for. But basically, they put their hands in a gel and shoot a little electrical charge through there and it stuns the sweat glands.

The problem is, people become very tolerant of it, very quickly. So, it starts out that they say they do it once a week and then they are doing it every third day and then they’re – you get six months down the road and they say they come home on their lunch break because of what they did this morning isn’t holding anymore. And it becomes very cumbersome for them. There are some pills that people can take, anticholinergics which means it calms down the nerves of the body a little bit. The problem with those is if anybody is active and these are a lot of young patients, we see with this; it really makes it difficult for them to have any athletic activity. If they go to the gym and they try and exercise or anything; it feels like they have a mouth full of cotton balls. So, many of those patients because of dissatisfaction with many of those treatments end up coming to see us for the potential of a surgical cure of this, really which is endoscopic thoracic sympathectomy.

Host: Got it. Yeah, it sounds like all of the other options that you mentioned; there’s always a side effect or a downside with a lot of them. So, maybe talk a little bit about the surgical treatments and how effective they are.

Dr. Klodell: Well surgical treatment of hyperhidrosis is exceptionally effective, particularly for the palmar or hand variant. We do 95-97% cure rate with that. Less good for armpits, less good for feet down to maybe the 70% range when you get down there. But most patients that see me for this, I always tell them, you are doing this because of your hands. That’s what’s socially limiting. That’s what’s career wise limiting and that’s what you better hope you get fixed. The surgery itself is an outpatient procedure. The patient ends up coming in, in the morning. I often do them on a Friday just because then they have the weekend to kind of relax. We make two very, very small three millimeter holes. One, just below the armpit and then one a little further down on the chest, laterally. And through those, one we put a camera, three millimeters which is about the size of a ballpoint pen refill. If you take you pen apart, that little tiny cartridge inside is probably greater than three millimeters.

We look behind the lung. We find a nerve in there and we use a little bit of cautery to control some of the electrical impulses that are going out to the sweat glands. At the end, we don’t even need to put a suture in there because the hole is so small, we just put a little bit of sterile super glue on there. Patients go home. They can go back to full activities the next day. And in general, by Monday, they are back in work.

Now I have had people run literally a mini marathon 30-36 hours after I’ve done this operation. Some other people say they feel a little bit of discomfort in their ribs for a day or two. But they can really be as active as they feel up to starting that next morning.

Host: That is absolutely incredible. And something that you mentioned is you really want to kind of fix the hands and I have friends, I mean even for myself, that get really clammy especially when I’m nervous and I don’t want to shake someone’s hand. Like could someone like me that may not have excessive sweating issues come in and get this treatment?

Dr. Klodell: Well, I think there are a lot of people that kind of take it to that extreme and in reality, what we want to do is we want to treat the people that have the real honest to goodness disease process and these patients, they are easy to pick out. I mean they’re the patients that will tell you that when they drive, they keep a washcloth in their lap so that they can dry their hands so that they can hold on to the steering wheel. When they go to a party, the first thing they do is grab a cold drink full of ice and they hold it in their dominant hand so that when they have to shake people’s hands that’s their social excuse for why their hand is wet. They don’t like to wear a lot of sandals and things like that because of the constant sweating of their feet destroys their shoes. They have constant problems with fungus on their feet and their shoes. They are the people that should really have this operation.

For people that just get a little clammy and they don’t really drip the sweat and it’s not socially and occupationally restrictive; those people probably should not have a surgical procedure.

Host: All right Dr. Klodell, I really appreciate your time today. that’s Dr. Charles Klodell, a cardiothoracic surgeon at Florida Heart and Lung Institute. Thanks for checking out this episode of Helmet of Health. Head to FLHeartandLung.com to get connected with a provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.