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Nerve surgery that's no sweat

Doctors are refining procedures for treating excessive perspiration.

June 23, 2003|Benedict Carey | Times Staff Writer

It's not unusual for high school seniors to sweat the dreaded personal essays they often have to write as part of college applications. But Annie Grabarsky might have set a new standard. While literally mopping her hands to keep them dry, she poured out 1,000 words on the phenomenon itself -- sweating.

Since she can remember, Grabarsky, 19, now a sophomore at UC Berkeley, has perspired excessively from her palms and feet due to an overactive sympathetic nervous condition called hyperhidrosis, which affects 1% to 2% of the population. "My younger brother would always tease me about it," she said. "I can remember playing Nintendo and handing him the control, and he'd hold it up and say, 'Ewwww.' "

As if the social trials of one's teen years weren't enough, Grabarsky had to carry a supply of paper towels everywhere she went. Taking tests or notes involved a discreet, rhythmic toweling off that looked like some furtive sign language. She learned to drive a car with those paper towels; she carried them with her on dates. She went through piles of socks, as well, while running cross-country and playing soccer in high school.

She tried prescription deodorants and even an electric hand-drying machine -- neither of which worked. Then, in February, Grabarsky's parents saw an article on current treatments for hyperhidrosis.

The article described how dermatologists had begun injecting patients' hands and other problem areas with Botox -- the product best known as a wrinkle smoother -- because it can also block or blunt the sweat response.

In many people, the treatment keeps hands dry for several months before it wears off. Another method used to treat the condition is iontophoresis, in which an electrical current is used to slow the sweating, although the treatment requires more frequent repeating.

And vascular surgeons have refined a procedure called sympathectomy, in which they sever the sympathetic nerve network that signals the body to perspire. This procedure, which once took two hours and required several days' recovery in the hospital, now takes less than 30 minutes. Doctors use surgical endoscopes that allow them to operate without a major incision in the back. People can go home the same day. The operation costs about $7,000 and is usually covered by medical insurance.Grabarsky's mother called her at school in January and suggested that she undergo the sympathectomy procedure during spring break. "I thought, 'No way, not surgery,' " Grabarsky recalls.

After a brief consultation with Dr. Robert McKenna, a thoracic surgeon at Cedars-Sinai Medical Center in Los Angeles, Grabarsky changed her mind about surgery. The operation would only take about 15 minutes, McKenna said, and required just two small incisions, one beneath each arm. He explained that as a result of the surgery most patients experience some compensatory hyperhidrosis: Their hands, or underarms are dry, but the lower back, scalp or other regions begin perspiring profusely. In about 5% of cases, the new problem is as bad or worse than the old one, doctors estimate.

Other possible side effects of the procedure are damage to the tissue surrounding the nerve, painful scarring and Horner's syndrome, a drooping of the eyelid that sometimes occurs when surgeons treat facial sweating.

McKenna said studies show that about 95% of people are satisfied with the result; their output of sweat drops immediately, often to normal levels. Those were odds Grabarsky would take.

On the day of surgery, Grabarsky was put under general anesthesia, and McKenna threaded the surgical scopes around her chest cavity and behind her lungs, to locate the sympathetic network, which runs along the backbone, and cut it. By monitoring the veins and temperature in her hands, he could determine whether the overactive system had been turned off.

Grabarsky remembers little of the surgery but says she woke up with a sore throat (from the anesthesia tubes), an aching chest and stinging incisions. The pain persisted for two days, but over-the-counter painkillers were enough to help her cope with it. After two days, she was feeling normal again. "I'm young," she said. "It was no big deal for me."

Her condition hasn't gone away completely. Her hands are fine; her feet are "dramatically improved but still a little clammy," she said. For reasons doctors don't fully understand, the sympathectomy is more than 90% effective for hands but only about 75% for feet.

No matter; Grabarsky could now save her paper towels for kitchen spills and closet cleaning. A week after the surgery, she was due in Colorado to start an internship with the U.S. Olympic Committee. She brought with her all the promise of a new adventure -- and no embarrassing perspiration. "I knew I was going to be meeting all these new people at the job, and before the surgery I was a little worried about the sweating," she said. "Now, I'm sitting here at a computer, my hands are fine, they're dry....The problem is gone. It has absolutely changed my life."

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