Endoscopic thoracic sympathectomy (ETS) is a surgical procedure that helps to reduce the production of sweat in individuals that have focal hyperhidrosis, particularly in the palm and sole regions of the body. 
A group of medical specialists decided to look at whether this procedure is associated with any emotional outcomes in those that underwent ETS
Results were collected from 86 patients using specific questionnaires before and three months after the procedure. The research* showed that women are likely to have more crying episodes after having undergone ETS. This tendency was not observed in men. Unfortunately, there is no rationale or theory provided that explains this observation. 
* Stefaniak T, et. al. Innov Clin Neurosci 2013
A recently published study* provides evidence that surgery or endoscopic transthoracic sympathectomy - E.T.S. (the usual procedure used to surgically arrest excessive sweating) is somewhat disappointing in treating plantar hyperhidrosis
An Italian group of researchers examined the results of 41 individuals undergoing this procedure for palmar and axillary hyperhidrosis. More than half (26 individuals or 63%) were also affected by excessive sweating of the soles. 
The condition affecting their feet improved in 14 individuals, that is, about half. This improvement was partial in 80% and resolved in 20% of these individuals. In other words, only about 1 in 5 people with plantar hyperhidrosis opting for surgery will have a successful result. Also keep in mind the significant possibility of developing compensatory sweating, secondary to surgery.  
* Paliogiannis P, et.al.  Ann Ital Chir. 2013 Jul 28;84. pii: S0003469X1302126X. [Epub ahead of print]

Next Month: the influence of thoracic sympathectomy on the tendency to cry. I don't make these things up, I just report them! 

A new surgical technique is using the umbilicus, better known as the belly button, as a port of entry for a procedure to help fight excessive sweating. While the surgery, known as thoracic sympathectomy is not new, the access to the nerves that control the excessive sweating certainly is. 
In a study published last month*, Chinese researchers describe their novel technique as well as the results from patients post-surgery. While general anesthesia was still required, only a small 5 mm incision was performed. 
The study involved a total of 35 individuals and results were determined one year after the surgical procedure. The success rate was higher for palmar (hand/palm) than axillary (underarm) hyperhidrosis (97% vs 72%).  

While quality of life improved and most were satisfied with the results, compensatory sweating remained a problem in close to 30% of individuals. Compensatory sweating is a condition often associated with thoracic sympathectomy. While the surgery is able to curb the sweating from a specific region (e.g. palms of the hands), it will develop in another area such as the groin. Feel free to visit our page on compensatory sweating for more information on this condition.
Zhu, LH et. al. J Thorac Cardiovasc Surg, 2014

Next month, we will have a closer look at a very interesting Austrian study. It follows sympathectomy individuals over the course of 5 years. 
This group of individuals actually developed recurrences of their condition....more on this in our next edition of Sweating Matters. 
Hard to believe, but localized excessive sweating or focal hyperhidrosis is a condition that is grossly undertreated. Despite its impact on lifestyle, individuals with excessive sweating are unlikely to seek treatment. In recent study in Japan confirms this. A survey was conducted in 20 schools and companies among a large number of people aged 5 to 64 years of age. 
Almost 6000 responses were analysed. A little over 5% reported palm hyperhidrosis, while 2.8%, 5.8% and 4.7% reported excessive sweating of the feet, underarms and head/scalp respectively. What is more alarming is the fact that only 6% had seeked some form of treatment. This was also corroborated in a large survey of 150,000 households in the US. Authors of this survey cited the fact that individuals were unaware that their condition was treatable. 
The truth is that many treatments are available. Like all medical treatments, pros and cons are associated with these. Some are more effective, some cause more adverse reactions, and some are more expensive. Don't let cost misguide you into thinking that a higher spend will result in a more effective treatment. For a quick comparison different treatments, feel free to visit our Pros and Cons page. 

Happy New Year to all our Readers!
Unless you're a healthcare professional, you probably are not aware of the serotonin syndrome. Pharmacists in particularly familiar with the syndrome and screen patient medication profiles for potential occurences. Serotonin is a naturally occuring substance responsible for signaling between neurons or generating impulses that travel throughout the nervous system. Serotonin is involved in processes such as gastrointestinal motility, uterine contractions, bronchoconstriction and thermoregulation to name a few. 

Many drugs such as antidepressants work by increasing the availability of serotonin within the brain and nervous system. This can become problematic when one or more drugs that cause increases in serotonin are taken together. Excessive increases in serotonin can lead to unwanted adverse reactions such as agitation, tremor, muscle rigidity, hyperthermia, flushed skin and excessive sweating

In rare or more severe cases, the syndrome can actually be life-threatening. Drug classes implicated in this syndrome include antidepressants (e.g. fluoxetine, paroxetine, venlafaxine), analgesics (e.g. meperidine, tramadol, fentanyl), lithium, cough preparations containing dextromethorphan (e.g. Benylin DM), and St John's wort. The elderly are particularly more prone to this syndrome if dosages are not adjusted accordingly. Fortunately, the condition and its symptoms are easily managed by discontinuing the involved medications. The syndrome can also be reversed with antidotes (e.g. cyproheptadine). 
Granulosis rubra nasi. The medical term for an excessive sweating condition limited to the central part of the face, particularly the tip of the nose. As such, it is also referred to as 'hyperhidrosis of the nose'. It is also characterized by skin redness over the nose, cheeks, chin and upper lip. It's an inherited condition that more frequently appears in children (as early as 10 months of age) but can also be seen in adults. There are no statistics related to its prevalence but we do know that it is a relatively rare sweating disorder. 

Thankfully the condition usually resolves at puberty, but is some cases, it can last into adulthood. In many individuals, hyperhidrosis of the palms and soles is also present. Granulosis rubra nasi can be confused with other conditions such a s lupus erythematosus and rosecea, so it is important to consult a healthcare professional to confirm the correct condition.
A typical case of granulosis rubra nasi. Its incidence peaks between the ages of 7 to12 and usually resolves at puberty
This Summer, my son and I travelled through some of the world's hottest areas including the Mojave Desert, Death Valley and Yosemite National Park. While the latter isn't necessarily known for heat, we did come across one of California's largest ever forest fires. The infamous Rim Fire is estimated to burn for about one month and has spread to about 250,000 acres (as of 6sep13)  of forest. While we did get close enough to take some video, we actually didn't feel the intensity of the fire. Nonetheless, you don't need much imagination to know fires of that magnitude have to be generating an awful lot of heat. While my son is in his teens, I couldn't help but think how children do not deal with heat in the same manner as adults do. And so, I thought this could certainly be a topic for the Sweating Matters blog upon my return back home. 

It appears that children (pre-puberty) are not as well equiped as adults to deal with heat. As such, they are more prone to 'overheating'. There are several reasons for this: 1) their sweat glands have not matured and are not as efficient as their adult counterparts 2) they have a higher surface area to body mass ratio ans as a result they tend to warm up faster when exposed to environmental heat and 3) under stress and/or activity, their hormone system is not fully developed and, as such, their sweat glands are not receiving as many signals to perspire. 
Actual video of the Rim Fire taken just outside Yosemite National Park (August 21, 2013)
To compensate, particularly during play, children will deflect more of their carciac output towards the surface of the skin. In other words, their skin surface blood vessels will dilate and allow greater blood circulation near the surface. Because heat energy always moves to cooler areas, heat from the blood will dissipate towards the skin which is in contact with the cooler outdoors. A study in the early 1980's demonstrated that skin temperature in children is higher than adults when subjected to activity under identical environmental conditions. And so, children cool off more by a process of convection than evaporation or sweating.

Interestingly enough, another study has demonstrated that kids need 30% more energy than adults to perform the same activities. This in turn increases their metabolic rate and results in higher heat gains from muscular activity.

The bottom line is that children are more prone to hyperthermia during activity. Their ability to maintain a normal core temperature in jeopardized due to immature sweat glands. It is therefore important to keep our kids well hydrated during activity, especially in sunny, hot and humid conditions. 

Finally, the chart at the right provides an indication of climatic zones and their relative safety with respect to activity and the risk of hyperthermia. Of course the higher the temperature and humidity, the greater the risk and need for precautions such as hydration and rest periods. 

Heat stress and children - AAP Recommendations
Climatic security zones as they relate to activity and heat stress in children. Regardless of humidity index, temperatures over 29C or 84F are considered to be relatively dangerous.
Temperatures over 27C (80F) are particularly troublesome as even low rates of humidity give rise to 'alert' or 'danger' zones. For more details on climate, heat stress in children and recommendations from the American Academy of Pediatrics click on sun icon.
Gomes LH et al Rev Paul Pediatr 2013
What does proteins have to do with excessive sweating? Good question, and as it turns out, they are at the heart of the sweating process. Let's start with a quick little lesson about how proteins are made. Keep in mind there are thousands of different types of proteins and enzymes in our body. All are different in structure and all have different and often vital and life sustaining roles. Insulin is a good example of an extremely important protein. 

Protein synthesis is a complicated process and a lot can go wrong (for example, DNA mutations can give rise to faulty proteins or enzymes - many diseases result from this). But let me simplify the process and keep referring to the diagram below as we go through the steps. The key player in the synthesis of proteins is DNA. A specific section (or gene) of the DNA molecule (keep in mind this is a huge molecule) is copied and gives rise to a smaller molecule called mRNA. This newly formed mRNA contains the specific code for the protein that is going to be synthesized. This code is recognized by units called tRNA. Each tRNA carries an amino acid (amino acids are the protein building blocks). The amino acid carrying tRNA units attach to specific areas of the mRNA (code subunits) and leave behind an amino acid as it detaches itself from the mRNA code subunits. In turn, the amino acids attach to one another to form a chain of amino acids (also called a polypeptide). This long chain eventually gives rise to a protein once the process is terminated. That's it! 

So back to proteins and their role in the sweating process. Research is on-going but a family of proteins called water channel proteins are thought to play a key role in sweating or excessive sweating. One of these proteins is called aquaporin 5. This protein was recently identified in a specific cell type called 'clear cells' found in the sweat producing part of sweat glands.
As the name implies, these proteins function as water pores or channels across cell membranes. This allows water to be shunted from the cells' interior to their exterior. As such, clear cells and the aquaporin proteins are thought to play a key role in the production of sweat. Proteins also play a role in the duct section of sweat glands by reabsorbing electrolytes such a sodium. These so called 'sodium pumps' are responsible for the desalinating of sweat as it travels to the surface of the gland. 
Having said this, individuals with hyperhidrosis may have overactive or a large number of aquaporin proteins in the clear cells of their sweat glands. Here is the really interesting part of this story: what if we were able to develop a drug that was able to block the aquaporin protein. In theory this would put the brakes on excessive sweating. Hyperhidrosis could be controlled using different doses of this drug, just like a lot of other medical conditions. And so, research into this area of science continues..... 
It's the month of August and we are on vacation...only from our Sweating Matters blog that is. Everything else is business as usual. Thanks for your continued support and we look forward to resuming our blog in September. See you then!
If you have never heard of the humidex or not sure what it is, you are probably not alone. If you think it's something that has to do with the weather, you're right. The humidex is a shorter term used to express the 'humidity index'. It's a Canadian innovation first introduced in 1965. The humidex gives a better sense of just how hot is really is or how unconfortable it might be. For example, the temperature might be 32°C (or almost 90°F) and the humidex is 40. In other words, because of the ambient humidity, the 32 feels like a dry 40 degrees celsius (104°F).
The index is based on a calculation of heat and humidity by using current air temperature and the dew point (the temperature and barometric pressure at which water vapour condenses into liquid). This is an important consideration, particularly for those of us with an excessive sweating condition. The skin has a significantly more difficult time ridding itself of sweat under moist or humid conditions. And so, when it's humid your skin will more likely remain wet, hence the discomfort. Given that the evaporation of sweat from our skin helps to cool off our body, it is particularly worrisome when humidity inhibits this process. As such, the core temperature of our body can remain high.
Humidity acts as a barrier to the evaporation of sweat from the surface of our skin. This in turn inhibits our body from cooling off. As such, our internal temperature can remain dangerously high.

When the humidex reaches 40 to 45, Environment Canada recommends avoiding exertion. Above 45 is considered dangerous and predisposes individuals to the risk of heatstroke. The winter time equvalent to the humidex is 'wind chill'. Ironically, this measurement was invented in the US, where winters tend to be milder than those above the 49th parallel. 

The Sweating Matters blog takes a break for the month of August but resumes in September. Thanks for your continued support and we welcome any comments.
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