Keywords

Today, it is well-known that the anguish patients with hyperhidrosis is part of a vicious cycle of sweat–suffering–more sweat–more suffering, only capable of ending at the hands of specialists in the correction of hyperhidrosis. The procedure is called bilateral cervicothoracic sympathectomy , and the specialists that are dedicated to understanding this issue and operating safely are thoracic and vascular surgeons. It was because I underwent sympathectomy with the correct professionals—a thoracic surgeon, Dr. José Ribas Milanez de Campos, and a vascular surgeon, Dr. Paulo Kauffman, both living and working in São Paulo—that I can live happily and without the permanent anguish that previously accompanied me. The following collection of testimonials was obtained from the hyperhidrosis communication project known as “Suando em Bicas ”, which is composed of a book and a website published in 2002 (www.suandoembicas.com.br). Receipt of the testimonials was centralized via the website and reports of patients who had or had not already submitted to surgical treatment or other palliative forms of cure were displayed. I find it impossible not to be moved by the intimate confessions that I still receive to this day, in 2017, via emails from the most diverse places in Brazil and abroad.

Excessive sweating leaves anyone affected by it with a terrible sense of impotence. Imagine with me: when you feel very hot, on those very stifling days, whether you sweat or not, the first ideas that come to your mind range from taking a shower to finding an air-conditioned spot, refreshing yourself with an ice cream, or sitting up in a fresh environment. They all seem simple. If this works for you, good news: consider yourself a non-hyperhidrosis sufferer. For those suffering from this disease—excessive sweating on certain parts of the body, especially at the extremities such as the hands, feet, armpits, and head—these outlets do not solve the problem.

Most sufferers of this disease are astonished when it begins. Primary hyperhidrosis usually manifests itself more strongly from adolescence, to the point of causing people to develop a kind of aversion to living with others (“social phobia”). It is estimated that 1% of the world population suffers from this disorder, for many years considered, erroneous and simply, a reflection of poorly resolved emotions. Until the end of the 1990s, excessive sweating was understood as an anomaly of the involuntary nervous system, the only possibility of permanent cure for which is the surgery that this book deals with.

In this chapter, I use the condition of “ex-suadinha” (ex-sweater) to share the anguish of those who, from birth, sweat in an incredible fashion from their hands and feet, wetting the sheets of the crib. I dreamed—or rather "pined"—for upper and lower extremities of the body (hands and feet) for nearly 30 long and wet years, during which I was diagnosed by doctors as a "nervous", "very dynamic" person. Their recommendation: to be calmer than goes by. The specialists used to be very foccused in their issues, and the different areas of Medicine didn’t communicate to each other. So, as an example, the Dermathologists didn’t know that a toracic surgeon was becoming able to correct hyperhidrosis by an specific treatment called sympatectomy. I consulted dermatologists, gynecologists, endocrinologists, neurologists, and a whole host of other "ists", but none helped, leaving me unhappy, which is why I lived in a state of distress.

There was, however, a trigger for the process of sweating too much for me. Incredibly, it has absolutely nothing to do with an emotional state, but rather with climatic conditions, such as high air humidity , and/or heat above 28 °C. Just as the summer begins to show its face in my hometown, Porto Alegre,Footnote 1 I once again experienced hyperhidrosis, mainly on the feet and hands. This also happened in the cold and humid days of the heavy winters that occur in the southern region of Brazil, where even house walls pour water. It was in environments with high relative humidity of the air that I sweated even more, freezing my feet and hands in such a way that I could barely walk or write.

The so-called "emotional factor", diagnosed as the cause of the medical disorder, became dominant only from the moment the hyperhidrosis appeared, but it was definitely not the source of the problem. That was, for me, a certainty, but no one believed me.

The fact is that no specialist had detected, at least until the year 2001 in Brazil, that what I had was a lack of control of the sympathetic nervous system chain. Because of the incredible sweating, soaking my hands and feet, I could not wear sandals or flip-flops (the famous Brazilian rubber shoes), besides being deprived of things as simple as playing games with friends in high school, playing the piano, knitting, and writing.

Before sympathectomy became known, as it is today, the medical recommendations for hyperhidrosis were psychological treatment , coupled with the purchase of some manipulated or soothing creams, which had no positive impact on the cause of the disease, and other aberrations such as the use of electric current appliances that were promised to "numb" the problem. This lack of knowledge on the part of the professionals has led thousands of "sweaters" to uselessly expose their ills, spending money and losing hope with specialists who, if on the one hand helped them to solve fundamental questions related to their psyche, on the other hand did not lead them to correct ways to cure the disease. Many professionals from the most varied branches of medicine simply did not know that there was already a specific surgery to correct this malady. The result of this "mismatch" between what was available and what was being recommended in all fields of medicine generated countless exhausted and frustrated patients, and also sucked away their hopes of living in peace.

The excessive sweating that we are discussing here is known as primary hyperhidrosis, which is caused by something that is not yet well-known, but which, because of a "birth defect", causes some people to have a hyperactive sympathetic system. For those who do not know much about the subject, there is an important clarification: sweating too much because of menopause, diabetes, or extra caloric intake during a dinner has nothing to do with the hyperhidrosis we are talking about.

Interviews

"I have been suffering from palmar and plantar sweat since I was a child. Whenever I went to the doctors, they told me this was psychological. I have taken many remedies, but never got results". (B.J., 22 years)

Ø "My name is Caio, I'm from Petrópolis/RJ and I discovered that I have hyperhidrosis. I cannot live this way anymore, I have suffered from this evil since I've known people. I'm 19 years old today. I need help urgently, because I cannot be among friends anymore, for always being the subject of jokes. I'm already saturated with all this. I need to know how and where to treat myself. And also if there is another definitive exit without […] thoracic surgery, since I have undergone another surgery in my life and I was traumatized". (C.)

"Only those who suffer from the problem of hyperhidrosis know what it is. Imagine how I suffer, living in a city where it is horrible heat where, in the winter, I also sweat exaggerated even in an air conditioned environment! I am 24 years old and since adolescence my hands and feet are a river of sweat [laughs]".(C.)

Ø "The city where I lived—Tapiraí—is very cold, and here where I am living—Sorocaba—is very hot, so I transpire even more. My hands and feet are filled with bubbles that burst and peel. This is horrible. Where I study, everyone asks what I have. I only wear closed shoes in this heat. I lost a job because I went to the interview wearing sandals—worse bullshit I could have done! It was a job in my area—Administration—and my salary was better than I was getting. As I sat down, it seemed to form a river around my feet resting on the ground. My foot was dripping, my hands were slipping, I was nervous because I saw that everyone was watching, which made me even more nervous. The manager said he called me—but he did not, of course! It was God who made me watch you giving that program interview! I'm sorry for sending you emails, but as long as you do not heal me you're going to have to put up with me [laughs]". (C.)

Ø "I sweat a lot in my armpits, sometimes it drips. Most of the time I'm not nervous, not exercising or it's not a very hot day. I simply begin to perspire without making the slightest effort. It seems that on cold days it is worse. I'm really upset about this because in my school shirt is a ‘pizza slice’ [laughs]. I'm ashamed to raise my arm to do anything, even to touch my hair. Clinging, colored and baby-look blouses I love, but I do not use it because it soaks everything under my arm. I feel very distressed and ashamed, thinking that someone can see and find it disgusting. I take two to three baths a day, but it seems that I never feel 100% clean because, I barely got out of the bath and I'm already perspiring (ahh … for me this is death!). It does not smell very strong, but just being perspiring bothers me too much. I wanted to know which doctor I could go to and what is the best treatment for this excessive sweating ? I was very happy and relieved when I saw that I'm not the only one having this problem". (G.P.C., 17 years).

Ø I have suffered from hyperhidrosis since my adolescence, and today I am 23 years old. Only I did not know it was a disease! I always thought the cause was nervous and emotional—in fact, that's what everyone told me. I have sweat on my hands, feet and armpits. I have been a religious for two years and I have to live with this suffering, under a habit that stretches down to my feet. After looking for a doctor and getting to know his history, I would like to know how his recovery was, especially with regard to the feet that, as I understand it, do not stop sweating with the surgery. I am very hopeful to be free of all this". (A nun from Divinópolis/MG)

Ø "Since I live in a very hot place, it's terrible because I barely finish brushing my hair and I'm all wet, like I just got out of the shower". (C., from Cuiabá/MT)

Ø "Whenever someone greets me, comes that remark: ‘you seem to be dead with these icy hands' or even those looks as if they were all disgusted with me". (K.M., 15 years)

Ø "I discovered your book when I worked in a bookstore, and a client bought a copy to send it to Japan. It was a find for me. Reading the testimonials I felt like a new person. I was never ashamed to say that my hands were sweating, until the funniest ones began to mock: 'Looks like you spit in the hand … hahahahah!' They laughed at me, unaware of how annoyed I was. This mainly upsets my affective life, because I do not know how to get close, to caress someone with those wet, icy hands, looking like the hands of a corpse! And I also suffer from facial flushing—I do not need to feel such embarrassment for my face to become a pepper'. Pure social phobia. It is simply dreadful to have to present expository works. Nobody deserves! I’m finishing [studying] history, and I decided to consult after I read your entire book. I'm crazy to use Havaianas [laughs], go hand in hand (ah, what a dream!), drive a car … I even have habilitation, but I do not drive. Here at home, they think it's incompetence, but it's because people do not understand the drama of driving with the wet steering wheel! If I marry one day, I wonder: I hope the groom does not have to dry my hands with a hair dryer when it's time to put the wedding ring on". (L.M.P., São José do Rio Preto)

Ø "I found your email looking for a solution to my problem and I saw that you had the same thing as me. Today, after the cure, you are another woman, a happier woman. I would love to heal myself. I'm sweating more every day—my problem is in my hands and feet. I'm about to lose my boyfriend because he complains that it's not safe in his hands". (R.S.S., Bahia)

Ø "My name is also Regina, I'm 23 years old, married and currently a housewife who lives in constant depression. I've been suffering a lot for a year now, always canceling myself out of shame for perspiring so much. I quit practically everything. I always wear black blouses to hide my sweating, but most of the time I just quit, especially when it's hot. I feel the greatest shame when I see my back all wet and my face sweating on spouts. I only have my husband as a friend and confidant, and I do not even have the courage to tell my family about my trauma". (R.A.B., Paraná)

Ø “I'm 19 years old and I've always been sweaty. To prove this story , I still keep with me sheets of drawings, which I did in college, completely wrinkled. I've tried all kinds of treatment, but none […] successfully. Today, I see that surgery is the only solution. My mother does not support me to do the surgery, thinking that all this is ‘freshness’. Today, I found your site, www.suandoembicas.com.br, and I decided to write. I found the initiative very important. When I read the content, I was more confident of persisting…”. (B.P.A. Amazonia)

Ø "I am a doctor specialized in dermatology and medicine and cosmetic surgery. Right now, I'm on my third postoperative day of axillary hyperhidrosis—an evil, an embarrassment, a burden that accompanied me right up to the age of thirty-one, just like your case, as you put it in your book, ‘Suando em Bicas’. Exactly at 7:30 AM on August 27, 2007, I was in the operating room, anesthetized and intubated—it was time for my surgery and everything was within the plan, and by that time I was no longer awake or knowing what was going on. It was all ready for me to experience, after the surgery, what it would be like to live and feel free of hyperhidrosis, without further embarrassment. I could finally open my arms and not feel ashamed of myself for being sweaty, and would no longer have to wear coats or use other subterfuges to hide an evil that bothered me greatly. Here I am, telling my story to you, about how I got where I am, and to say that your book was a very important help for me to resolve to be cured of hyperhidrosis. I thank you for this wonderful job and you can be sure that it is already and will continue to help more and more people like you and me to have a better and better quality of life . You were a fighter, did not give up an ideal that was to be cured and this is a great step to seek more and more happiness and the quality of life that we want and deserve. Today, at this very moment when I write to you, I can tell you one thing: I made the right decision in my life. I'm very happy, I feel some pain still, of course, but this is normal. I am recovering very well, already doing some activities that require little of me, and wanting, more than anything, to return to ‘work out’. But for that, I will still have to wait a little longer. I'm very happy with the result and, of course, I already bought colored shirts that I could not wear before and I think I even looked prettier [laughs]. I wanted to share with you, who did the same harm I did, my story summarized above, but with a great end in common that is success”. (R.L.R.)

Ø "It's been about three years since I saw you on her show at Cultura Network and today I've had surgery for 18 days. I am very happy, Regina, because I have completely dried up! I perspired both in my feet and hands, back, legs and even belly—literally, I also lived ‘sweating on spouts.’ But, finally, I did: I did the surgery for the medical insurance that I own (and that I did not want to authorize, but I went after my rights…). I'm very happy, and thanks to that show I was watching. I always watched all programs directed to hyperhidrosis, but this one touched me a lot, especially because I saw that I was not alone. I had gone through several professionals and they had me look for psychologists or even psychiatrists, while others said I was ‘weak’. Thank you so much for your words, it was they who encouraged me. Today I can say, too, that I was reborn 18 days ago". (M., 37 years old, two children, Franca/SP)

Ø "I did the surgery a year ago, the problem was solved, but I suffered for several months with the effects of compensatory sweating (I began to sweat in the feet, groin and back) that still persist, but reduced. Another very boring thing that happened is that my hands were completely dry and I had no perspiration problem on my hands. And now I depend on moisturizers to keep the hands minimally wet. With that, things get very easy out of my hands and I cannot open grocery bags, turning pages of books and magazines, for example, needing to moisten my fingers with water or saliva. This all bothers me a lot". (C., Santos/SP)

Ø "Two years ago, I underwent hyperhidrosis surgery because I was sweating a lot on my face. Today, I face a much bigger problem—I sweat exaggeratedly on the back and belly, compensating, I think … the part of the face today is totally dry, but I pour water from the breast down". (D.C.S.)

Ø "I need your help in resolving this drama that I am experiencing with compensatory hyperhidrosis. I did the surgery in 2003 and today I am desperate and I see no way out. When I operated I complained that the problem was palmar. In this region, I have no more embarrassment. But today I sweat heavily on the back and belly, wetting all my clothes, which makes me very frustrated and unhappy". (C.L.)

Ø "I live in Brasília, I'm 21 years old. For some time I have suffered from sweating under the armpits and hands. I did the bilateral thoracic sympathectomy surgery in March 2007; I read the testimonials published in his book, but what happened to me was the following:

Perspiration improved only on the right side. My hand and armpit on this side are really frosty, just the way I always wanted it. But the left side continues to present sweating, as before. The doctor said that maybe there was a very small nerve that he did not see at the time and scheduled a new surgery to correct that side. I am willing to do, therefore, despite what has happened, I still trust the doctor. I do not know whether by the desperation to improve the situation or by trusting him, in fact. But anyway. I am willing to be cured and he said that solves the problem with a new surgery. Have you seen something like that? What guidance do you give me, based on all your knowledge of the subject?"

Regina replies: I also have very uncomfortable compensatory sweating, especially since I returned to live in Porto Alegre, where summers are so hot and humid. I take a medicine based on oxybutynin hydrochloride (a recommendation from my surgeon, which greatly improves the picture). I also recommend physical exercise . I think I'm a lot better than if my hands were still dripping, something so restrictive for performing so many activities.

In addition to these statements that I selected with the intention of portraying the pre- and post-surgical life of some patients, I report here the recent experience of a friend from Porto Alegre. Surprisingly, for me, this hyperhidrosis patient had two surgeries performed on different occasions—one that corrected sweat in her hands (2005) and another in her feet (2010). Both were carried out with the authorization of her health plan, without any impediment, which is so different from my situation, in 2001, when everything was paid by me. In addition, she no longer has any symptoms, despite commenting that sometimes she still perspires a little on her legs, in the region below the knees, on really hot days. She considers the results a true success, having completely changed her life. Before the surgery, she lived with wet hands, in summer or winter, and faced dramas in her daily life such as typing on a computer keyboard, driving, and even in getting along with people because of the anguish and embarrassment brought about by sweating. Sheets of paper always got wet. Inside the house she was always in socks, just as she was in the street, in midsummer. The soaked feet in her closed shoes produced a characteristic noise that made her embarrassed, but at least she could walk more comfortably and safely. Just like me.

Seeking the Right Answer: The Importance of Correct Diagnosis

To help patients with hyperhidrosis quickly and surely rid themselves of the agony of constant sweating, there are now more than 500 doctors in Brazil—thoracic and vascular surgeons—who make use of the technique known worldwide: cervicothoracic bilateral sympathectomy for the correction of excessive hyperhidrosis of the feet, hands, armpits, and/or head. Through it, defective nerve endings are resected which, for unknown reasons, send excess stimuli to the sweat glands, producing an unbelievable downpour to the extremities that exceeds the capacity of gloves and shoes in more serious cases of the disease. It is the only definitive way to fix this disease that affects between 1% and 2.4% of the world’s population.

Surgery is very effective for hand sweating, and it also helps reduce foot symptoms by up to 70%. Specific foot surgery has been studied in more depth in recent years, as it is known that it can increase compensatory sweating in patients with this predisposition.

Worldwide, the technique correcting primary hyperhidrosis is most frequently performed in China, Israel, England, Spain, and France, as well as Brazil, which is among the most advanced in this area. In Italy and Germany there are a few centers dedicated to the subject.

Over the years, for the sake of those suffering from hyperhidrosis and with the growing interest of the media and patients seeking information about surgery, more professionals have specialized in the technique. The number of specialists in Brazil jumped from three or four pioneers in the 1990s to more than 500 today (2017). Nowadays, there is a great chance that a patient can be treated in his own city, or a nearby center, which is always recommended. After all, in larger centers, there is usually a waiting list in public hospitals. In one of the largest reference centers for surgery in Latin America—Hospital das Clínicas, in São Paulo—the number of patients awaiting this procedure increased by 200% in the first years of surgery, generating an agonizing waiting time of up to 3 years, a situation that has now normalized, with the time between the consultation, preoperative examinations, and surgery taking no more than 2 months. Health plans also now authorize the procedure without major problems.

To facilitate access to information, it should be noted that the complete list of Brazilian specialists in sympathectomy is on the website of the Brazilian Society of Thoracic Surgery (www.sbct.org.br) and the Brazilian Society of Angiology and Vascular Surgery (www.sbacv-nac.org.br). It is fundamental to seek the assistance of one of these two professionals so that the surgery takes place as successfully as possible, since these are the specialists in the diagnosis and surgical recommendations for the correction of hyperhidrosis.