DEAR DR. DONOHUE: My son has excessive perspiration, particularly in the head and torso. He literally drips water with the least exertion. Some time ago, while watching a science program, I saw two sisters who experienced the same symptoms my son has. The treating physician operated on the girls, and it stopped the phenomenon. Do you know the name of the procedure? -- W.C.
ANSWER: Excessive sweating is called hyperhydrosis (HI-purr-hi-DROWE-siss). When it occurs in a few places, like under the arms, on the palms or on the soles, it is localized hyperhydrosis. When, as in your son's case, it happens in a larger body area, it is generalized hyperhydrosis, and it's more difficult to treat.
Illness like an overactive thyroid gland, some neurological conditions and infections such as tuberculosis and an unusual tumor -- a pheochromocytoma -- can be responsible for generalized hyperhydrosis, but usually it's an idiosyncrasy in which the sweat glands are overly sensitive to acetylcholine. Acetylcholine is the chemical secreted by the nerve cells that control sweat glands. It activates the glands.
A 20 percent solution of aluminum chloride (a prescription item) applied to the skin where sweating is excessive can lessen it. It can be put on the face and back as well as the palms, soles and under the arms. The directions on its use have to be followed explicitly.
Medicines that block the action of acetylcholine can also work. A reader wrote to me that his life was changed by Robinul Forte (glycopyrrolate). Glycopyrrolate can be made into a 5 percent solution to be put on the skin, but a pharmacist has to make arrangements to prepare it. Clonidine and Ditropan are two other medicines that block the effects of acetylcholine.
The program you watched might have been on endoscopic thoracic sympathectomy. Through a viewing tube and with instruments inserted through a small incision, a doctor severs chest nerves that control sweating.
Your son can ask his family doctor for a referral to a specialist who does this kind of surgery -- if medicines don't work.
DEAR DR. DONOHUE: Seven years ago, I suffered a cardiac arrest (a stopping of all heart action). Since then I have had exams with my cardiologist and have had periodic stress tests. Last week I ran up the stairs and my chest began to feel funny. I saw my heart doctor, and the choices were a stress test or angiogram. I chose angiogram, and it revealed two blockages in my heart arteries. My message is: so much for stress tests. -- J.B.
ANSWER: We live in an imperfect world, and a world of imperfect medical tests. Stress tests are not infallible. They can give both falsely positive and falsely negative results. Women tend to have more falsely positive tests than men. You made a good decision. You are a special case. You lived through a harrowing heart catastrophe. You cannot take any chances. For others, stress tests are better than resting EKGs but not as good as having dye injected into heart arteries while X-ray pictures are taken -- angiograms.
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