MY ETS SURGERY IN 1998 TO TREAT SWEATY HANDS

Hyperhidrosis

Hyperhidrosis Forum

Background

Sometime in late 1997, I started using the Internet regularly, and one of the first things I did a lot of research on was hyperhidrosis, or more specifically, on excessive hand sweating. My hand sweating (which started around 1991 right around the advent of puberty) at the time was quite severe, probably about 75 percent as bad as what you see in this sweaty hands video. The following is a picture of someone else's palmar hyperhidrosis that seems to better convey the exact level of severity of my hand sweating in 1997. Although many experts suggest that such sweaty hands affect 1-2 percent of the population, I never met anyone in my life with such a problem until I had my ETS surgery and saw other patients in the same hospital.

The sweating could randomly start at any time of the day, independent of weather, stress, nervousness, anxiety and so on. I would guess that I had at least somewhat sweaty palms for half my waking hours. I messed up exam papers while writing, played racket sports with unease whenever the racket slipped, and hated shaking hands. During the course of my research, I was quite surprised to learn that there was a simple surgical solution to my problem of excessively sweaty hands in the form of endoscopic thoracic sympathectomy (ETS). At the time, not too may surgeons were offering ETS surgery. Nevertheless, the top few search results for "hyperhidrosis" on AltaVista in 1997 and 1998 were all related to ETS surgery.

Unlike today, there were no well known anti-ETS websites on the internet at that time, since ETS had only become a popular option to cure hyperhidrosis recently. There were as yet not a significant number of people who had adverse side effects from ETS and who also had an organized internet presence. The most popular hyperhidrosis related website in 1998 was USA-based surgicalteam.com, which promoted ETS surgery trips to Sweden with the renowned and pioneering team of Dr. Goran Claes and Dr. Christopher Drott. These two men invented the endoscopic approach to sympathectomy, which has since revolutionized hyperhidrosis treatment. If I was going to have this surgery, I wanted to go to the best. Surgicalteam has since expanded significantly and now offers ETS with surgeons around the world, while the Swedish team is now retired. The company also started offering weight reduction surgeries in the early years of the new century, and seems to have purchased the hyperhidrosis.com domain name. Hundreds of surgeons around the world now offer ETS surgery and I would recommend reading the ETS surgeon rankings page instead of just trusting the surgeons some company endorses at any particular moment in time. Surgicalteam has endorsed some crazies in the past.

Prior to 1998, I had only tried a cream and a lotion to treat my severely sweaty palms when in my mid-teens, to no avail. I wanted to get rid of this problem so that I could shake and hold hands and write without smudging everything. So in the spring of 1998, I booked my ETS surgery via surgicalteam.com after calling several of their happy ex-clients whose stories were displayed in a brochure they sent me. These clients all seemed very pleased with their results. The cost of the surgery was $6,000, and I paid out of pocket since my college health insurance refused to reimburse me and I didn't know that you could appeal that decision at the time. Today, most insurance companies will pay for virtually all hyperhidrosis treatments, including ETS surgery and iontophoresis. Ruth Matti was the main contact person at surgicalteam at the time, and neither she nor my soon to be surgeon Dr. Claes discussed iontophoresis treatments with me. In fact, I never talked to Dr. Claes till reaching Sweden for the surgery! At the age of 19, I was, perhaps not surprisingly, a bit rash in my decision making. Even today, some surgeons will not force you to try iontophoresis before contemplating surgery, but I hope you don't follow their advice to get on the surgery bandwagon asap.

Day before my ETS surgery

In July 1998, I flew to Gothenburg, Sweden for my ETS surgery with Dr. Goran Claes. I told my family and several friends close to the month of surgery about this trip because I felt the surgery was minor and I also didn't want to hear from people telling me that it was crazy to have surgery to stop sweaty hands.

Upon arriving in Gothenburg, I got picked up and dropped off at a hotel. In the evening, I had to find my way to the Carlanderska hospital in order to meet Dr. Claes. Carlanderska is quite a secluded hospital, and it took me some time to find the correct entrance with an intercom, via which I had to convince some Swedish speaking person why I should be let in. Not a great start. I still remember not really being bothered about all this, and was in fact eagerly anticipating exploring Gothenburg! I would take surgery planning far more seriously today. Below is an image of Carlanderska:

Carlanderska Hospital Hyperhidrosis ETS Surgery

At the hospital, I was examined by several serious nurses and also got to meet a number of patients. At least half the patients were from Scandinavian countries and were there to get rid of facial blushing. Several were there for a re-operation, since their first ETS did not remove their blushing permanently. Only one other patient (Joel) was from the US and could speak English really well, and he came with his mother. Joel and his mother bought me dinner and we prayed together before eating since they were devout Christians. Joel played some kind of instrument, but this task was made extremely difficult by him having dripping hands half the time.

At night, Dr. Claes came by and met each patient individually. He was a very genial man and put me at ease despite his English not being great. He asked me a few questions about what sweating I wanted to get rid of. I responded that I wanted to get rid of my hand sweating, while facial sweating did not bother me too much. He said that with the surgery, both hand and face sweating would definitely stop, and feet sweating might stop too, but no guarantees about that. Later I learned that he cauterized my second (T-2) thoracic ganglion during the surgery. Dr. Claes discussed the main side effect of compensatory sweating with me, and also mentioned the very small chance of other problems such as Horner's Syndrome and possible complications during surgery.

Day of my ETS surgery

The next day, I had my ETS surgery, probably some time in the morning. I was put under general anesthesia, so do not remember the exact timing of the event. It was the first time I was ever "knocked out" in my life. After waking up, I do remember a very significant pain under my chest area, along with dry hands! I was delighted to finally have dry hands all the time. Later the same day, we were allowed to go to a sauna in the hospital and I went with Joel, who also seemed to have had a successful surgery. I think I just stayed overnight at the hospital for one night, and I left Sweden on the next day. Dr. Claes did meet me once more after the surgery, and several years later, he sent me surgery documents I requested after becoming more interested in this subject. All in all, the surgery was relatively easy compared to what I had been expecting. The pain in the chest area must have been tolerable the next day in order for me to fly out of Sweden.

Short-term results from ETS surgery

In the days and months after surgery, my hands remained completely dry and I was very pleased with the surgery results. As an added benefit, my facial sweating also disappeared and my resting heart rate supposedly decreased slightly according to the surgery records. Several days after the surgery, I noticed that my feet sweating had returned. Months later, I was sure that the feet sweating had actually worsened. Prior to ETS, I could not wear shoes or sandals without wearing socks, but at least the socks never became soaking wet. After ETS, even my socks get soaking wet from time to time. It seems like instead of getting compensatory sweating in my trunk or other body areas, my feet sweating worsened. This was the worst side effect I got from surgery. I would have definitely preferred compensatory sweating in my chest or back or trunk area rather than in my feet. The main problems with feet sweating are smelly socks and things sticking to my feet if I do not wear socks.

EDIT: Both iontophoresis and Botox have recently helped me control my feet sweating, with the former via Idromed being especially effective.

In the short term, I would say that my satisfaction rate from the surgery was an 8 on a 1 to 10 scale (with 10 being the highest).

Long-term results from ETS surgery and current situation

About two years post surgery, I started getting some sweat return to my right hand. This was nowhere near as significant or frequent as it was prior to surgery. To this day, while my left hand is dryer than a normal hand and sometimes even has white areas on it due to excessive abnormal dryness, the right hand never gets this whiteness. Sweating on the right hand can be significant if I exert myself excessively, or sometimes when I am drinking coffee/caffeine and in stress. Most of the time, the right hand is completely dry. Interestingly, Joel also had his right hand start sweating again, but he went back to Sweden for a re-operation. He preferred having no sweat at all on his right hand while playing his instrument professionally. I kept in touch with Joel for a few years, but have since lost contact. The last time I got an e-mail from him, Joel mentioned being happy with the second surgery results, although he lived in Alaska and therefore didn't have a chance to experience significant compensatory sweating during the warmer months.

Another side effect I got that seemed to worsen several years' post ETS was gustatory sweating. This is excessive forehead sweating when eating spicy foods, and on rare occasions, even when smelling spicy foods. It is strange that by having my T-2 ganglion cauterized, I can no longer sweat from the face or forehead or scalp even when playing professional doubles badminton (which is quite a workout) in a 90 degree building. However, eating spicy foods (which I prefer) does cause my forehead to sweat. In some ways I like this side effect, because it makes me feel normal to be able to sweat from my forehead once in a while. I also don't get embarrassed when this happens, but some people are quite uncomfortable with gustatory sweating.

The last side effect that I noticed several years after ETS surgery was Raynaud's syndrome (excessively cold hands), although this problem has subsided in recent years. Some people see cold hands become warmer after ETS surgery, but I got the opposite reaction. According to an e-mail to me from Dr. Goran Claes, this severely cold hands side effect happened in two percent of their patients due to "increased sensitivity to surrounding catecholamines".

In the long-term, I would say that my satisfaction with ETS surgery is a 7 on a 1 to 10 scale (with 10 being the highest).