Archive for Guest Posts
Plantar Hyperhidrosis
Posted by: · on April 2, 2011 | CommentsA reader– and blogger in his own right– was kind enough to send this great hyperhidrosis fact sheet to me so that I could in turn share it with you. Thanks, Wolf!
Plantar Hyperhidrosis Fact Sheet
Plantar Hyperhidrosis is the condition characterized by abnormally increased perspiration of the
feet, in excess of that required for regulation of body temperature.The cause of primary hyperhidrosis is unknown, although some doctors claim that it is caused by
sympathetic overactivity. Nervousness or excitement can exacerbate the situation for many
sufferers. Other factors can play a role; certain foods and drinks, nicotine, caffeine, and smells can
trigger a response.Symptoms:
Plantar Hyperhidrosis is characterized by excessive sweating of the feet. When enclosed in socks,
boots, or shoes generally four phases are encountered: sweating, swelling, peeling and blistering.
Each phase becomes progressively uncomfortable. If ignored suffers succumb to severe blisters as a
result of the feet softening and peeling. May suffers report symptoms even when wearing flip-flops
or sandals.Treatment:
There are several treatment options available for plantar hyperhidrosis sufferers. These include
topical solutions such as aluminium chloride, injections of botulinum toxin type A, Iontophoresis,
and endoscopic thoracic sympathectomy surgery. Each of these treatments has varying results and
all have severe potentially life-threatening side effects.The safest, and easiest treatment for all sufferers is to go without shoes or socks as much as
possible. Although this may not seem practical in all situations, plantar hyperhidrosis sufferers are
encouraged to go barefoot as a safe, non-medical alternative treatment. Most employers of nonindustrial
businesses are willing to accommodate the condition. Accommodations often include
signing personal injury waivers to protect employers from the perceived risks of going without
shoes.All plantar hyperhidrosis suffers report relief when not wearing shoes of any kind. This allows for
feet to breathe, and ambient air to remove excess moisture generated by the condition.Steve Bloor, DPodM, SRCh, HPC, a podiatrist in the United Kingdom has conducted research
which states that there is little to no risk for sufferers going barefoot. Bloors research has shown that
feet quickly toughen and become resistant to injury. Many hyperhidrosis sufferers show significant
improvement to overall health from not wearing shoes.Prognosis:
The Gale Encyclopedia Of Medicine (3rd ed.) states hyperhidrosis is not associated with increased
mortality. It primarily affects the patient’s quality of life rather than longevity. The condition cannot
be cured without significant personal risk. Research has shown it can be controlled effectively by
lifestyle changes.This document is published by the European Academy of Dermatology and Venereology ©2009 – All Rights Reserved
Guest Post: Dan’s Hyperhidrosis Story
Posted by: · on October 11, 2010 | CommentsRecently a reader and subscriber contacted me wanting to share his story. It is fascinating: having undergone ETS which resulted in severe Compensatory Sweating, he has been on a journey to find further treatment. He has had some success, as you will read, but he also has encountered many bumps along the way.
We all hope to find acceptance. When we find the courage to seek the advice and support of others who also suffer from hyperhidrosis, the hope is that we will be embraced. As you will see, Dan has (and I have!) encountered fear and anger amid some of the forums. We all have a story. Here is Dan’s:
I’ve had hyperhidrosis since early teens. Started under the arms, then moved to hands and feet– underarms went to normal (1980).
Like you I just thought I was a freak till age 31 (1991) when I saw my first Neurosurgeon. He injected a giant needle down through the front of my neck to my spine…don’t move he said..yeah right! Anyway he injected a Novocain-like substance onto the ganglia near T2 and T3. I stayed dry on my right hand for 1 hr, cost $900; insurance would not pay. I had just recovered from a motorcycle accident and had damaged those areas (T2 and T3) slightly with hairline fractures. My HH had worsened after the bike crash quite a bit and the doctor thought there may be a correlation.
My hands never dripped but my feet did during karate practice in college. He told me about a very invasive surgery that was done on some actors. I was in LA at the time, having moved from New England. I chose to live with my condition for now, but felt like there was hope.
Things got worse in my thirties and finally in my forties I found these procedures online being done, ETS, non invasive, great results, little risk of any side effects. I saw Dr Reisfeld in LA and he agreed to do the surgery. My insurance, Blue Cross, agreed to cover but suggested I chose a doctor in their network, so I did. Dr Baumgartner. Reisfeld did the clamp method, Dr Baumgartner only did the cutting as he assured me only 1 person in 700 so far ever wanted it reversed (2004). I believed him. As a matter of fact he still tells patient this.
Within a few days I started sweating at night profusely and a couple weeks later it started up during the day. Over the next 5 years it progressively got worse. I sought help.
I spoke with Dr Reisfeld about his new grafting technique (2008). Results were poor and my insurance would not pay (they still pay for cutting though). There is also the risk that you can end up with both CS and your old condition, as some have experienced from grafting.
I then found Dr Duarte in Brazil. We spoke for a couple years over the phone and by email about a procedure he had developed to alleviate sweating in the torso. I needed my records from the original surgery and had a very hard time getting that. I also had a hard time getting any of these doctors to speak to each other. These days it seems they’ve all gone on their own, and don’t share discoveries or ideas any longer… a common problem in modern for-profit medicine.
The procedure was a success (June 2010) and I’m awaiting Dr Duarte’s second procedure if necessary to alleviate the sweating below the waist; sometimes it’s less sometimes it’s more…. He wants to see how it evolves over time first, as he has varied results, and was honest with me about that. I also spoke with former patients who had different degrees of sweating remaining below the waist.
I’m also talking with Dr Thorpe in England about a technique he has that has had some positive results for CS, but results are varied.
I’m determined to fight this as my quality of life ticks away ever day. Having my upper body fixed really makes me want to get all the way back.
I sweat from the head and slightly under the arms. I’m very athletic and climb every morning. I believe my introduction of eating spice before exercising for a few years induced the head sweats. I also sweat all over in a sauna and have read that others do as well, leading me to believe in a secondary system in our bodies.
Like you, humidity is my enemy, as is my mind. I believe the sensation of wetness on the skin triggers more sweat with someone suffering from CS. If I splash water on my face in the sauna it starts to sweat, same with other body parts. Dryer air, a low dew point really makes a difference more than temperature.
I’m glad I found your site, you’re an honest and helpful person. I had been in a couple forums and as soon as I mentioned additional surgery a witch hunt ensued and I was digitally tarred feathered and labeled an “agent” of these doctors, or I was just plain censored. So much rage and other negative emotions comes from this plight of ours. I think it stems from years of hiding and feeling different…even from childhood discomfort of having “wet diapers” So much fear, you spoke of it so well in your handbook Miss Conaghan, thank you for that.
I’ve been thinking of starting my own forum and disallowing any crosstalk so people can express their stories without fear of criticism (something that make us sweat more!). Even the International Hyperhidrosis Society has sort of “disowned” us.
I also am trying to bring some of these doctors together like Duarte, Reisfeld, and Thorpe to share all their patient experiences in some sort of anonymous database. HH and CS are such an enigma one that can be solved by sharing information. Thank God for the Internet and for people like you.
I would like to thank Dan for his courage in telling his story. I do need to state that I am publishing Dan’s words and experiences and do not endorse or have an opinion, negative or otherwise, about any of the individuals his story names.
A Reader Shares His Own Hyperhidrosis Journey
Posted by: · on September 16, 2010 | CommentsThere are allegedly 178 million of us in the world who suffer from Hyperhidrosis. Due to the secrecy we often impose upon ourselves, I would venture a guess and say that number is significantly higher. Each one of us has a story.
I love love that some of you feel compelled to contact me in order to share your own story. It is therapeutic for you to unburden yourself, and it is so comforting to the rest of us to read about what you have gone through. It is a win-win!
I was contacted over last weekend by a gentleman who goes by the name of Wolfmaan. His may be one of the most unique stories about life with Hyperhidrosis there is. You may identify with some of what he describes having gone through, but I wonder if any of us would have the chutzpa to address his biggest problem in quite the way he has!
“My name is Wolfmaan. My entire life I have suffered from Hyperhidrosis.
When I was young, I dreaded winter because I had to wear shoes and gloves. This meant that I would go through three, uncomfortable and horrific stages.
Sweating: Covered or not, my hands and feet would sweat so badly it would literally drip off my hands and feet. Doctors prescribed dozens of treatments from electric shocks, to moisturisers – nothing worked.
Swelling: If I ignored the sweating, my body would strike back. Wearing shoes and socks, or gloves for an entire day would cause my hands and feet to swell. The swelling would get painful, itchy, and I would be unable to concentrate whatsoever on anything.
Peeling: If I ignored the sweating and swelling, my body had yet another trick. It would give me dozens of small painful blisters which felt like slivers and would then peel and leave sore, soft skin underneath.
I was constantly in trouble for not wearing shoes at school, and the often at work as I grew older the same thing would happen.
No one seemed to be able to understand I didn’t just like to go barefoot – I needed to go barefoot. Even wearing flip-flops my feet would sweat, peel, and swell very badly.
It was only after the advent of the internet I learned that the easiest thing to do was stay barefoot. There are dozens of barefoot support groups available and I read that many people were in the same situation. It was a relief to learn this. I was not alone.
After dozens of bizarre treatments which did not work, I had discovered a natural solution which suited me fine, cost me little money, and I could do long term.
Speaking with my doctor, he advised me that if I did not want the expensive botox injections, or risky surgery – then going barefoot may be a viable option. My doctor also assured me that this was a disability and nothing to be ashamed about.
I have been consistently barefoot for about four years now and have found a great improvement in how I feel. I no longer dread going to work, or school and having my feet literally rot while I am wearing shoes and socks.
My doctor was supportive and gave me a note for my employer or school to advise them I am required to go barefoot due to my disability.
It’s been a life changing choice which has brought many challenges, adventure and excitement.
I will sometimes get asked to leave a store, or get strange looks from people. I learned to understand that anyone who has a disability would get strange looks. Whether in a wheelchair, missing a limb, or in my case going barefoot. I learned to deal with the social implications and understand them.
You can certainly learn to deal with hyperhidrosis in creative ways.
The most important thing to remember is you are not alone and there are support groups out there to help you deal with it.”
If you visit Wolmaan’s website at www.Wolfmaan.com, you can see how he has embraced life barefoot. This is amazing to me– I believe it takes a great deal of courage to just do what you need to do regardless of the reaction of others.
We are different; most of us go to great lengths to conceal that and conform. Perhaps once in awhile the better option is to make your own path. Just don’t try to walk in Wolfmaan’s shoes. He hasn’t got any!
“A Patient’s Journey”: A First-Hand Look at Early Childhood Onset Hyperhidrosis and Iontophoresis
Posted by: · on June 29, 2010 | CommentsMany of you will find pieces of this story to be sadly familiar. Those of us who have Hyperhidrosis can relate similar heartbreaking childhood experiences. Laura’s journey and her description of her treatment of choice, Iontophoresis, allow us to see how this oft-ignored treatment really can make a difference for some.
Please note that the practice of using oral meds in the Iontophoresis solution is not a common one either in the United States or in England, which is where Laura lives.
This paper was sent to me by Hyperhidrosis UK (http://www.HyperhidrosisUK.org), and I am posting it here with their written permission. This paper was previously published in the British Medical Journal (BMJ).
Practice
A Patient’s Journey
Hyperhidrosis
By: Julie Halford, specialist nurse , adviser 1,2, Laura Hunt, patient3, George Millington, consultant dermatologist 4
At age 5 this patient was offered limited and unpleasant treatments for her hyperhidrosis. Now an adult, she describes how iontophoresis has greatly reduced the symptoms of her conditions.
Hyperhidrosis and its management have been a huge part of my life since I was 5 years old. As I nervously awaited being reprimanded for doing something typically naughty, I noticed the sweat on my hands. More than being clammy, they ran with sweat, and as I cupped them the sweat rested in pools in my palms. I remember feeling embarrassed, frightened, and fascinated by the sight. Ever since, my life has consisted of finding increasingly cunning ways of trying to hide my embarrassing secret.
Getting through the childhood and teenage years
In a world where many debilitating and life threatening conditions exist, it may seem ridiculous to consider hyperhidrosis as a condition that can affect self esteem and an individual’s social development and identity. But it can and does, and it has certainly had a huge impact on my life. As a tactile, friendly, confident person, I had to change all my natural inclinations to disguise my hyperhidrosis for fear of discovery and the inevitable reactions of disgust and ridicule. Simple childish games and other day to day tasks required careful “coping” methods—for example, sports; turning brass door knobs (which were the only kind in my primary school); writing essays in summer; gesticulating when talking (which I do very naturally); wearing sandals; going barefoot; and shaking hands. In short, things that most people do without a thought all routinely caused me great anxiety, and I developed elaborate stories to excuse myself as there was often no way of participating and disguising my condition. If you have ever experienced revulsion as someone touches your hand or notices how damp they are, you can begin to understand how mortifying it can be when it occurs.
As a teenager, when we all want to fit in and we develop our sense of self, my body image and self esteem were damaged by my loathing of my condition and therefore of my own body. My love of dance had to be sidelined; I couldn’t take part in classes barefoot as I would slide all over the floor and leave puddles. I carried on with my singing and acting but cultivated ways to hide my hands when on stage and be apologetic to fellow actors I had to touch. Relationships were very difficult. I couldn’t hold hands, couldn’t be as tactile as I naturally am, and was frightened to become close to someone for fear they would find me revolting.
How iontophoresis has changed my life
My family has always been very supportive and reassuring; my father, having had the condition as a child, grew out of it in adulthood. They encouraged me to see our general practitioner, who was mildly sympathetic and prescribed Anhydrol Forte and other aluminium chloride products to apply topically overnight. These were helpful and did bring me some normality and relief, but they were very unpleasant to use and by no means wholly effective. When I moved to London at 22 to study at university, I thought I would make one final attempt to seek medical help and saw my new general practitioner. He was extremely helpful and suggested a referral to the Dowling Day Centre at Guy’s and St Thomas’s Hospital for iontophoresis.
The only previous option that I had found during my internet research was sympathectomy surgery, which seemed rather horrific. Iontophoresis entails the patient’s hands or feet being placed on a metal plate and gauze in two trays containing glycopyrronium bromide solution and water, or just water if preferred. The plates are connected to a machine generating varying degrees of electrical current, which is passed through the plates, effectively facilitating a circuit through the body (for example, left hand to right hand). This process is then repeated with the current flowing in the opposite direction.
Tap water does not work for me, so I need the glycopyrronium bromide solution; but I understand that tap water works for about 85% of people who use iontophoresis, and that this is the normal practice throughout the UK in many dermatology departments. If people do not get a complete cessation of sweating with tap water alone, then they are switched over to the solution.
The treatment feels different depending on the sensitivity of the individual. I am very sensitive to the electric current and the solution, and I experience most of the known side effects, such as extremely dry and sore mouth and throat and dizziness, usually up to 24 hours after treatment. I also use Vaseline on my wrists and cuticles to prevent burning. The sensation is like placing your hands on an electric fence. It is often uncomfortable and sometimes painful, although I am particularly sensitive. It is not known precisely how iontophoresis works, but it seems to be extremely effective in blocking the sweating temporarily.
Although the glycopyrronium bromide solution provides total relief in localised areas as well as the entire body, it also prevents serious physical activity for 24 hours after a treatment as it blocks the body’s ability to control temperature fully. Iontophoresis gives me relief from hyperhidrosis for about five days, with a steady decline in effects thereafter. I usually have my treatment once a week to maintain the effects.
Through the guidance, warmth, and support of the dermatology nurses, iontophoresis changed my life. It gave me, for the first time ever, total temporary relief from my hyperhidrosis. In short, I felt normal, as though a black cloud had been lifted. For the first time, I could wear sandals, enjoy a summer’s day, hold hands, touch someone on the arm, sit with my hands in my lap, enjoy formal occasions, and shake people’s hands without dread. These examples may all sound inconsequential, but they revolutionised my life.
Professionally, the improvement in my confidence for auditions and performances as a singer and actress has been immeasurable. It has been difficult, given my sensitivity and the side effects, to plan my time around my iontophoresis and arrange treatment times around concerts, rehearsals, and anything involving physical activity. However, the treatment has such positive benefits, both to my life and to my self esteem, that it makes any difficulties worth the inconvenience. Thanks to it and to the support of groups such as Hyperhidrosis UK, I can begin to see my hyperhidrosis as a condition I manage, not as a condition that manages me.
The clinician’s perspective: Click to read
1 The Hampshire Clinic, Old Basing RG24 7AL , 2 Hyperhidrosis Support Group UK, 3 London, 4 Norfolk and Norwich University Hospital, Norwich NR4 7UY
Originally published: Published 7 April 2009, doi:10.1136/bmj.b1166
Cite this as: BMJ 2009;338:b1166
