Endoscopic Thoracic Sympathectomy (ETS) for Hyperhydrosis

ETS is a minimally invasive procedure i.e. surgery that use small instruments and cameras to allow entry into the body with miniscule incisions. This ensures minimal discomfort to the patients.
ETS is the only procedure available that provides permanent cure for hyperhydrosis. It is safe and effective and the hospitalization stay is short (12-24 hours). The patient will return to normal daily routine within a short period of time.

Details of ETS

The patient is put under general anaesthesia. An incision is made below both the armpits.

The endoscope equipment (tiny fiber optic camera) is inserted after the lung on the side of surgery is collapsed. This is to allow better visualization of the sympathectic chain.

The appropriate level is identified and cauterized. Once the surgery is completed, the instruments are removed and the collapsed lung on side of surgery is reinflated. Wound is sutured.

The scarring is minimal and return to regular activity is usually within a week.


Complications of ETS

There is no operation that is without complications. In any surgery, there is a small risk of bleeding and wound infection. For ETS, pneumothorax (air remaining in the chest cavity) may occur. This usually is minimal and does not require any treatment.

Horner’s syndrome may occur. This occurs when the nerve is inadvertently injured resulting in decreased facial sweating, drooping of the eyelid and small pupil on same side of the injury. This is rare i.e. <1% and is unlikely to happen when an experienced surgeon performs the surgery.


Side effect of ETS

Compensatory sweating is observed in patients following ETS. The patients may experience increased sweating of the back, thighs and the legs. Most are not troubled by this side effect. Only about 3% experience more severe compensatory sweating.

The patient may also experience gustatory sweating i.e. increased sweating while eating certain food e.g. hot and spicy food. This is also an uncommon phenomenon following ETS.

Keywords: sympathetic nervous system, hyperhydrosis, endoscopic thoracic sympathectomy (ETS)

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Treatment Options For Hyperhydrosis

The treatments available include:

1. Non-surgical options
a. topical and oral medications
b. iontophoresis
c. botulinum toxin injection

2. Surgery

The non surgical options are not permanent and must be done on a continual basis when the effect wears off. Surgery is the only permanent cure.

Medical Treatments

1. Topical medications

The physician may recommend over the counter antiperspirants. However, if this does not control the excessive sweating, prescription antiperspirants may be recommended. They may have to be applied several times a day. These include:

a. aluminium hexahydrate in alcohol
b. tannic acid solution
c. glutaraldehyde solution.

However, these are strong solutions and may cause redness, itchiness or even swelling of the skin and the effectiveness may wear off with repeated applications.

2. Oral Medications

Antianxiety medications and even antidepressant medications may help to reduce the stress induced sweating. The oral medications that may be useful include tranquilizers and anticholinergics. However, these medications may cause dry mouth, blurred vision or difficulty with urination.

3. Botulinum Toxin

It effectively blocks the nerves that trigger the sweat glands. However, it takes several injections to achieve the desired results and is painful, costly and the results will last for only several months only.


Surgery
The surgery is a minimally invasive procedure. It involves permanently cutting the nerves that carry the messages from the sympathectic system to the sweat glands with the patient under general anaesthesia. The success rate is 95-98 %.

Next: Surgical procedure - endoscopic thoracic sympathectomy (ETS) for hyperhydrosis

Keywords: sympathetic nervous system, hyperhydrosis, endoscopic thoracic sympathectomy (ETS)

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No Sweat - Help Is At Hand For Sweaty Palms

Sweating is a natural, physiological way of regulating our body heat particularly in response to the hot and humid weather for those living in the tropical regions.
Sweating is controlled albeit involuntarily by the sympathetic nervous system that innervates the sweat glands and this system maintains five million sweat glands throughout the body and two-thirds of these are located on both hands.

However, excessive sweating in the absence of such conditions can occur and be a problem. This disorder of excessive sweaty is called hyperhydrosis.

Hyperhydrosis tends to affect the palms, feet, armpits and even the face. Mildly stressful situations, consuming spicy foods or mere physical exertion can trigger excessive sweating causing discomfort and inconveniences. At its extreme it can be hazardous. The cause of hyperhydrosis is unknown but is believed to be secondary to hyper-excitability of the sympathetic nervous system.

Hyperhydrosis can pose severe occupational, social and even emotional distress. Patients suffering from hyperhydrosis may encounter it in different circumstances i.e. be it at their workplaces, homes or social occasions, and in activities e.g. executives requiring face-to-face interaction with their clients, individuals socialising with friends and acquaintances, students or secretaries smearing their work papers, assemblers handling electrical contacts, mechanics handling tool etc.

In some cases, the situation has gotten so bad that patients may even avoid contacts like shaking hands for fear of putting off their business acquaintances, friends or mates. A simple handshake can therefore be emotionally stressful and this may aggravate the sweatiness and may lead to a loss of self-esteem. Hyperhydrosis may also contribute to skin diseases such as athlete’s foot and contact dermatitis.

As this problem does not appear to pose serious health risks, people tend to seek home-brewed remedies which do not address the root of the problem. The good news is that help is at hand (pun-pun) and in the upcoming articles we will examine the options available, including treatments and surgery, to overcome this problem.

Keywords: sympathetic nervous system, hyperhydrosis

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What are the treatments for varicose veins?

This depends very much on the severity of the condition.With medication and stockings, the symptoms of cramps or pain can be controlled. Unfortunately, once diseased, varicose veins can only be cured with surgery.
The type of surgery depends on the distribution of the incompetent valves.

The most common method is to remove the varicose vein from the groin to the knee by passing a wire stripper and pulling the vein out through a small cut at the knee. An alternative is endovenous ablation of the varicose veins. A laser or radiofrequency fibre is passed up the vein from the knee to the groin and the vein is destroyed from within. The advantage of endovenous therapy is smaller wounds and less bruising after surgery. There is theoretical advantage of recurrence of varicose veins from vein regrowth at the groin. Varicose veins in the calf are then removed through small cuts. Surgery can be done under general or regional anaesthesia and there is an option of the patient returning home on the same day.

Injection sclerotherapy is a method of destroying unwanted veins by injecting them with a drug called a sclerosant. This method can be used for both fine as well as large veins. Inflammation of the injected veins, pigmentation and recurrence can be a problem. Another alternative to unsightly fine veins is laser treatment

Keywords: varicose veins, deep vein thrombosis

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High Pressure In The Veins Of The Leg

What are the long term effects of the high pressure in the veins of the leg?
This leads to leakage of fluid out of the blood vessels resulting in leg swelling, this is called lymphoedema. The veins in the skin also swell to become reticular veins, telangiectasia (spider-like veins). The red blood cells also leak out into the tissue around the blood vessels. Red blood cells contain the pigment haemoglobin which is rich in iron. The iron stains the surrounding skin black. This is called pigmentation.
A rash can also develop, it is called stasis eczema. This is a scaly rash that develops around the ankles. With time, the skin can become weepy and crack eventually becoming a venous ulcer. Such ulcers are at times difficult to treat. After healling, they tend to come back again.

What are the reasons for treating varicose veins?

Varicose veins have a functional as well as a cosmetic effect. They are located usually over the inner aspect of the calf. When they stand out like bunches of grapes, their unsightliness prompts sufferers to cover up with a long skirt or pants.
These can be easily removed with surgery. However, when pigmentation starts to occur, these skin changes persist even after surgery.
Cramps can occur at night after a long day of standing or walking. These cramps are usually experienced in the calves.
The ankles may swell and this gets better with raising the legs up or wearing a pressure stocking.
Sometimes, there is a length of varicose vein at the ankle or foot that has thinned out the overlying skin so much that the skin breaks and bleeding can occur from the vein itself. The bleeding can be frightening, but is not life-threatening.
If eczema occurs, surgical treatment of the varicose veins can prevent the rash from occurring.

Next: What are the treatments for varicose veins?


Related article

Keywords: varicose veins, deep vein thrombosis

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Varicose Veins And Spider Veins-Treatment For Every Type

Varicose veins are common and thought of as innocuous. However, it is a known cause of nocturnal calf cramp and heaviness of the legs. They are unsightly and a common cause of leg ulcers.People with varicose veins are usually unaware of their long term effects.

What are varicose veins?
These are dilated and tortuous veins found on the legs.

Who is at risk of developing varicose veins?
Both men and women can develop varicose veins, women more than men. The varicose veins are located on the inner aspect of the calf but can also be found on the thighs and the back of the knees. Women first notice the varicosities after the birth of their children, and they tend to worsen with each birth order.
There are instances where varicose veins appear in the teens. This occurs when a person is born without valves in the veins of the leg.
There are also people who have been afflicted with deep vein thrombosis in the past (deep vein thrombosis is a condition when blood clots in the deep veins of the leg), they can develop varicose veins in the superficial veins later on.

What are the veins in the legs called and what is their function?

Every person has two sets of veins in their legs, the superficial and deep veins. The latter can be found just under the skin. The former is deep within the muscles of the leg.
The superficial veins have two systems, the long or great saphenous vein and the other the short or lesser saphenous vein. Each can be affected in varicose veins.
Varicose veins in the lesser saphenous system can be found at the back of the calf or the outer aspect of the calf. The great saphenous system is more commonly affected than the lesser saphenous vein, causing varicose veins over the inner aspect of the calf or thigh.
The superficial and deep veins are there to carry blood from the legs back to the heart. However, it would appear that blood from the legs has to travel against gravity.
Hence, there are many valves in both the superficial and deep veins of the leg to assist in this function. These valves act by preventing blood from going back down to the feet as they allow only one way direction of flow, up towards the heart. This movement of blood occurs when we walk, since the muscles surrounding the deep veins will help to massage the blood upwards. When the muscles relax, the valves prevent blood from going back down to the feet.

What happens to blood flow in the leg veins when there are varicose veins?

Because the valves are not allowing one direct flow, these valves are described as incompetent. Each time the person stands up, the blood from the top flows back down towards the feet. Hence, the pressure in the veins of the feet builds up.

Next: What are the long term effects of the high pressure in the veins of the leg?

Keywords: varicose veins, deep vein thrombosis

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Celebrating Our 50th Through Healthy Aging

For those of us celebrating half-century of existence, doctors say we should consider early-detection screenings that might help us to reach the next milestone. When we were young and healthy, a general checkup once every four to five years sufficed. However when we reach 50, we need to plan for more regular checkups screening for things that are more likely to occur with age.

Because of concern for cardiovascular disease tests should include for signs of diabetes as well as high blood pressure and cholesterol. There are also screens for cancer e.g.
colon cancer - at age 45-50 most adults should consider an initial colonoscopy. For the "average risk" person, a stool occult blood sampling can be conducted annually.
prostate cancer - men over 50s are encouraged to have an examination through the back passage. Additionally, a prostate-specific antigen (PSA) blood test can detect the disease at an early stage.
breast cancer - women should consider commencing their annual mammography at age 40 or earlier when there is a family history and follow up by regular checkups thereafter.

Bones also requires attention particularly for postmenopausal women and bone density screening can help to detect for signs of osteoporosis.

Do check with your doctor about what lifestyle change is necessary to stay healthy. Maintain your weight, exercise and eat wisely are steps in the right direction.

The doctors have kindly extended their invitation for us to touch base with them through Ask A Consultant Forum.

Cheers


Keywords: high blood pressure, diabetes, cholesterol,impaired glucose tolerance, exercise and diet, osteoporosis

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