St. Joseph doc reveals treatment for people with sweaty palms

August 18, 2011

J. Edgar Hoover was known to distrust anyone whose hand was sweaty or clammy when he shook it. It is believed that many an FBI candidate was rejected as a result.

The late Hoover was unaware that a sweaty palm may not have been the consequence of nervousness or some character flaw, but rather of a little known and understood condition called hyperhidrosis.

It is not known exactly how many Americans may suffer from this socially debilitating disorder; some estimates put the number at one to two percent of the population.

“Many doctors don’t know about it, or don’t understand hyperhidrosis, or patients don’t tell them that they experience extremely sweaty palms so the condition goes undiagnosed,” said Dr. Ziv Gamliel, chief of thoracic surgery at St. Joseph Medical Center.

People who are so affected, both men and women, experience severely sweaty palms even when resting in cool, controlled temperatures.

“These are not just clammy hands. They drip with perspiration,” Gamliel explained. “Usually, it starts in childhood, so these kids become shy and withdrawn.”

The good news, although little known, is that there is an effective treatment, one that is usually a cure. It is a minimally non-invasive, out-patient procedure called thoracoscopic sympathectomy.

“We do the operation through one incision that is just under a half-inch, low in the armpit by the top of the rib cage,” Gamliel said. “This allows us to visualize the sympathetic nerve chain with a telescope and reach inside to divide the nerves.”

To treat sweaty hands, the second and third levels of the chain are cut, he said. Results are immediate, Gamliel said. Patients wake up with warm, dry hands.

The procedure takes less than half an hour and is almost always successful, said Gamliel, whose patients have included a police officer whose hands were too slippery to get handcuffs onto criminals and an orchestra conductor who couldn’t hold on to his baton.

For most people, though, the condition is socially inhibiting. It is something they have suffered from since childhood, and which makes their contacts with other people intimidating because they are so embarrassed by it. “Dating and job interviews are just a couple of examples,” Gamliel said.

For those in need of sympathectomy treatment, Gamliel noted that it is “extremely important” that the surgery be performed by a qualified thoracic (chest) surgeon.

“Patients need to find a surgeon with extensive experience doing minimally invasive surgery, who knows their way around the chest with a telescope. This is an elective operation on smaller structures that may be challenging to identify,” he explained.

Once patients have had a successful surgery, “they are suddenly not afraid to be with people,” said Gamliel, who has performed more than 100 of the procedures.

He said feedback from his patients has “almost exclusively been dramatic and very positive,” especially with patients in their late teens who have been socially reclusive.

“They feel liberated and empowered and then they become very outgoing and social,” Gamliel said.

While some patients are up and at it a day after the operation, Gamliel said full recovery normally takes about five days.

“People don’t have to suffer from hyperhidrosis,” he said. “The problem is that they don’t know they have a treatable condition and think it’s just something they have to live with. They don’t, and doctors need to be more aware of the condition and alert to what their patients may not be telling them.”