Compensatory Sweating

[Amherst]

A lot of you have written posts about compensatory sweating after receiving treatments for focal sweating that included botox, iontophoresis and ETS. I had a long discussions with the dermatologists who have treated me about this, and these are two have published quite a number of clinical studies about various treatments.

As you all know, ETS will produce compensatory sweating in virtually every victim, (oops, patient) ranging from mild to severe. I've always wondered about those studies that show that 97% of patients have developed compensatory sweating and then conclude that "ETS is a safe and effective treatment for hand, foot and axillary sweating." There was a study done by some Israeli researchers - and this is the only one out there like this that I know of. They took a small number of patients before the surgery, put them in a sauna and measured how much weight they lost. They then repeated the process after the surgery and discovered to their chagrin that the total amount of weight lost had increased. In other words, there was not just compensatory sweating, where you would have the same approximate loss of weight. The total amount of sweating had increased significantly.

I asked about compensatory sweating after botox or iontophoresis. These two doctors believed it unlikely that they should increase sweating elsewhere, since the armpits or feet comprise only a small percentage (2 to 3 percent) of the total sweat glands over the entire body. What about the persons who say that they experience this, I asked? They thought that patients may simply be more aware of sweating elsewhere, since they are no longer focusing on the areas that had once been the worst. One alternative explanation - sometimes sweat levels increase over a period of years or in response to stress, and what seems to be compensatory sweating that is the result of a treatment might be the result of these changes. The problem is that there are no studies on this -and you would need good gravimetric studies looking at the amount of sweat secreted or studies like the one making use of the sauna.

I think that the jury is still out on this, except for ETS, where the results are clear: you will sweat more, and sometimes drastically so.

Amherst

 

[Linnros2]

Amherst - we get it...you're anti ETS it sounds like. Have you had the surgery?!

I have. I made the decision to get ETS T2 because from a quality of life perspective something had to give. Either be a hermit and completely anxious about how I would get in social situations or go for the surgery and see how my life can improve. My career is also one that deals with the public and its a career I plan on doing for a very long time. Sweating down my face and neck as if I just came out of the shower and having people see you is not my idea of fun.

Since my ETS T2 -- my face, scalp, neck is sweat free. I actually laugh that I sometimes use lotion on my face now...something I never would have done previously. I do have compensatory sweating, its controllable and its on parts of my body that can be concealed or currently with robinul if I know i'm going to have social interaction.

Going to a "good" ETS surgeon is not some light decision. The surgeon gives you time to think about it and talks about the pros and cons, or just cons in your case. But they also provide alternatives as well. I figure being here is a place to support each others decisions because we seem to all sweat so bad that we have social anxieties.

instead of being so negative....can you provide some positives? how have you been controlling your HH? Have you been sitting in freezing cold baths or showers? Or staying in? Or like myself, strapped ice packs to your back when going out?

 

[Amherst]

To Linros2 - No, I haven't had the surgery, but the doctors at the hyperhidrosis clinic where I go treat many patients who have had ETS elsewhere and are suffering from unbearable compensatory sweating, which they admitted that they had difficulties treating. They strongly advised me against having any surgery, though they told me that for some patients (and you would obviously be one of them) it can help. Everyone who gets the surgery will sweat more but not everyone will get severe compensatory sweating. I'm glad that it has worked for you, since I can only imagine what your work must have been like with severe cranio-facial hyperhidrosis.

Yes, I struggle with my generalized hyperhidrosis (and I wouldn't be here on this site if I didn't) - and particularly during the summer months from June through early September. For any of you who live here in the mid-Mississippi valley, you'll know that it is just like the tropics during the summer. This wonderful week, we have temps going up to about 98 Fahrenheit (37 Celsius) with unbelievable humidity. We'll have low temperatures around 76 degrees or 24 Celsius. Within minutes of going outside in the mid-afternoon, I'll be damp all over and will start dripping from my torso after about fifteen minutes or so. I went and ran four miles in about 28 minutes the other day late morning (it was 86 outside or 30 degrees with a humidity of about 80 percent), and was so soaked head to toe when I had finished that I had lost about two pounds. The worst is getting into your car which has been baking in the sun in a parking lot for hours and feels like a sauna.

You asked for positives. Generalized hyperhidrosis hasn't changed my social or professional life at all, even if I've become something of an amateur meteorologist and simply try not to go outside at certain times. Whenever I have to deliver large lectures or teach I wear sutran undershirts, which have never failed to work for me. I try to make sure that my rooms are cool enough, and this is actually hardest in the winter, since Americans tend to overheat their buildings. Iontophoresis has generally worked for my hands and feet. Botox works splendidly for the armpits. I cannot get robinul (avert) to do much; my body doesn't absorb it for some reason, and I don't even get side effects after taking up to 6 or 7 mg at one sitting. I seem to be in the minority here. One also becomes a lot more empathetic to those with serious illnesses.

My ultimate goal is to get more medical researchers to look at what causes hyperhidrosis and point out problems in the existing research. Most researchers are so overworked or have so many clinical hours that they don't always have time to go through journals outside of their immediate area. I also pass on to my physicians tips about has worked for me and for many on this forum. They, for instance, didn't know about sutran shirts and didn't have any experience with certain types of iontophoresis machines like the Hidrex. My biggest hope that is by the time my children hit adulthood, there will be a better understanding of what causes hyperhidrosis and far more effective treatments available.

 

[wannabedry]

interesting read, thanks for posting! (you're from sweaty betty right?) im suffering intensely right now from my post ets compensatory sweating. ill be looking into those sutran shirts you mention. im pretty tired of my same old dark blue or black poly blend wick away workout shirts. interesting what you said about not absorbing the avert, maybe i dont either? ive tried up to probably 12 mgs in a single day of avert with only minimul dryness followed by a burst of sweat afterwards which would pour out of me like a dam bursting after the avert wears off. has anyone you know from that clinic you mention had success slowing down compens. sweating from putting drysol or similar things on their torso or back or legs? ive tried that and it dried me up pretty good but it wasnt the heat of summer and it left me burning and red for days, so i gave up. ok take care and thanks.

 

[Sprawling]

I think Amherst presented themself well.

Linnros2, I glad ETS has worked for you. I'm curious as to how long ago you had your surgery?

 

[Amherst]

Just one follow-up for wannbedry. I don't mean to sound like a salesman for sutran shirts, but they do work incredibly well. I was wearing one of their shirts while doing heavy-duty yard work (mowing uphill) for almost ninety minutes early this evening in temperatures that were 93 degrees Fahrenheit and in high humidity. I was soaking wet on my torso but not a single drop went through the t-shirt. They apparently have regular polo shirts as well but I haven't tried them yet. Wearing these really puts your mind at ease, and not worrying about sweat showing, in turn, causes you to sweat less. I'm getting botox at the clinic next week and will ask again about compensatory sweating.

 

[Amherst]

One more follow-up for wannabedry. Check out this study on treatments for compensatory sweating. In the Search for the Treatment of Compensatory Sweating

Scroll down until you hit the section of regional abdomino-lumbar iontophoresis:

"Regional abdomino-lumbar iontophoresis (RALI) was performed with the use of commercially available device for iontophoresis (Idromed 5DC, Bindner Medizin technik, Teningen, Germany) and gel electrodes (RFA High-Power Patient Return Electrode, Covidien, Poland). The selection of electrodes has been supported by a set of experiments and presented in another study. RALI included 21 initiating sessions for every area affected by sweating. Every 5 sessions direction of the current has been changed to opposite. The maximum intensity was 8 to 10 mA and was determined by the presence of burning and pain during session. In every such situation the patients were advised to increase the intensity of pain, and if any actual burn occurred, the area of burn was avoided in further sessions and treated with sulfathiazolum argentum cream. After the initiating sessions, the patients were performing sustaining sessions every 2-3 days."

The group treated with the iontophoresis had, on average, about a 40 percent reduction in its sweating. Of the three approaches tried, it apparently was the only one that delivered results. Do note that the sample size was small.

I've been in touch with Marcus Binder in Germany: I should ask him about how to get the gel electrodes from Poland referred to in the study.

Pub meds are an invaluable resources -but you do have to look pretty critically at a lot of the findings. My own professional work studying researcher bias keeps coming in play here.

 

[Modam]

Amherst, have you tried taking the robinul in the early morning, before breakfast? Just asking because that's the only way it works for me, otherwise it's useless. And even then it takes several hours to fully kick in.

I also found it builds up in the system, so if I take a dose one day, I wake up dryer the next day.

 

[Amherst]

Modam- unfortunately, I've tried that. I'll get up and take five or six mg at 5 am and have breakfast at 8 am. And even that has only a limited effect - but limited, I suppose, is still better than none. What I've sometimes had to do is to use the 5 mg from 5 am as a "loader dose" and then add 3 to 4 mg more later in the morning.

Interesting point about it building up in the system: hadn't thought of that. I typically don't take it for two days in a row, since I only need it on days when I'm teaching in classrooms that are overheated. The rest of the time, I'll let myself sweat.

I've been told by a close friend who is an anesthesiologist that glyco has a rather interesting molecular structure that does make it hard for some persons to absorb it through the gut. She uses it regularly in her anesthesia cocktails- but she obviously injects it through an iv.

 

[Modam]

That's an interesting possibility that it's hard to absorb through the gut. I was just reading another post where someone (sorry, don't remember who) said they grind it to a powder and sniff it through their nose, and it actually works much better. So, maybe if you ever get really desperate that would be worth a shot

 

[wannabedry]

that study sounds promising, thanks so much for posting it! Id love to find out how to purchase the correct electrodes that would cover such a large area of the body. i guess Ill seek out the iontophoresis forums and start asking around. maybe this treatment combined with drysol and I could almost be normal??

 

[HHDisturbed]

Hey wannabedry...its only a matter of time before the ionto-tub. Maybe we ought to get to work on that, huh?

 

[Sprawling]

On a serious note... I bet ionto can work in a tub. The problem being what will happen to the compensatory sweating. I mean the sweat needs to go some where.

A high voltage Galvanic Stimulator should work in a tub. The unit I'm using would probably be safe given that it can be plugged in or to be on the safe and paranoid side, used with the 9 volt battery option. Now if only I had a tub. I only have a stand up shower.

 

[wannabedry]

hmmm I read about a tub actually being used at some physical therapy place in germany for people with HH. I cant remember where i read it but i remember it. now i do currently have a tub and id be willing to try the galvanic thing but only if i was really sure i wont electracute myself.

 

[HHDisturbed]

I agree! There had better be plenty of safeguards so nobody gets cooked! Better stick with batteries. But certainly might be worth a try. If you were to build a prototype maybe you can you can patent it. I could certainly see a market for this.