Dr. Fischel: I'm gonna give you a little presentation to sort of talk about it and describe what it is that we do.What I'm going to really do is tell you what we do how we do it why we do it that way what our results are and why that's different than what anybody else does and I think you'll enjoy this.
Dr. Fischel: Hyperhidrosis - the word itself really just means "too much sweating". It doesn't say where. It doesn't say why. It doesn't say who's going to have it. But I like to discuss it. We're talking a lot of times about people who have excessive or dripping sweating from their hands.
Alexander Baker: Right away, it's clear
that "hyperhidrosis" is not actually a disease. From a physiological perspective, there is nothing wrong with excessive sweating.
Dr. Fischel: I call this a non-physiologic type of sweat. This is not the body trying to cool down. That's normal sweating. You need to do that to regulate heat. This is sweating that's related to a little nerve inside the body. It occurs in about 1% of the population so it's much more common than people think.
Alexander Baker: This is blatant deception. Dr. Fischel is clearly suggesting that the "non-physiological type of sweat" is "related to a little nerve", while normal sweating is not related to that nerve. That is false. All sweating is regulated through the sympathetic nervous system. Moreover, Dr. Fischel doesn't remove “a nerve”, he removes six entire nerve ganglia, each comprised of millions of complete neurons, like little brains.
Dr. Fischel knows that normal sweating is vital for temperature regulation. That’s why he must deceive his patients into thinking that he can magically cure the “excessive” sweating, while leaving normal sweating alone. That’s exactly what he told me at the consultation. It’s a lie.
Dr. Fischel: A lot of people think they're the only person in the world who has it and then they meet other people when they come and see me and have other people in the waiting room they talk about it and realize they're not alone. And it often runs in families, okay?
Dr. Fischel: Essential Hyperhidrosis - it essentially describes excessive sweating of the hands and feet it may also include the face or the armpits the sweating occurs without any provocation whatsoever and it is usually worsened with any form of anxiety.
Dr. Fischel: One of the key factors that I find in this is that there's a definite mental connection thinking about the sweating, or thinking about your hand, or thinking about meeting somebody and having to give a presentation, or shake their hand in public, or something such as that will cause the problem to get worse. And the more you think about it to try and make it go away the worse it gets. That's essentially a definite diagnosis of essential hyperhidrosis.
Alexander Baker: Essentially, Dr. Fischel is saying some people sweat more easily than others, and are embarrassed about it. I know. That was me.
Dr. Fischel: Most of the people I meet say they've for as long as they can remember and it's not associated with hypertension or any of the other things that would make you think of an endocrine disorder.
Alexander Baker: “Essential” hyperhidrosis means “you don’t really have anything medically wrong with you.
Dr. Fischel: This is a slide that demonstrates a patient with moderately severe hyperhidrosis. You see the shiny white sweat all over the hands. This person's just sitting there resting. They're not exercising they're not doing anything, they're not even nervous. That's what this sort of thing is like, okay?
Dr. Fischel: Where does hyperhidrosis come from? Well, as I said it's not your body trying to cool down. It is related to a nerve. It's related to a nerve inside the body called the sympathetic nervous system. That's part of your fight-or-flight mechanism that goes back to the caveman days when you had to run to survive. And it makes your heart beat faster, your blood vessels clamp down, and then you sweat. Okay?
Alexander Baker: In case you missed it the first time, Dr. Fischel is repeating the deception – trying to falsely convince you that “hyperhidrosis” is “related to a nerve”, while normal sweating is something separate. It’s a lie.
Dr. Fischel: Because the blood vessels clamped down people may often also notice that their hands or feet are quite cold. And I've met several patients who've had a diagnosis of a problem called Raynaud's phenomenon or Raynaud's disease where they were told that they have bad blood vessels or tight blood vessels to their hands. And they're cold. And it's really not that it's just an overactive sympathetic nervous system with another manifestation of that problem okay.
Dr. Fischel: Everybody has a sympathetic nervous system. In hyperhidrosis the nerve is no different either to the human eye or under a microscope. But the problem that occurs is something that we have not really fully defined.
Alexander Baker: Translation – there is nothing medically wrong with a person who sweats excessively.
Dr. Fischel: I tell people it's...if you picture this being the nerve inside your body... it's as if this nerve has its own little thermostat and the thermostat is set wrong. It's set too high. So you sweat when you're not nervous. And if you are nervous you sweat even more, okay?
Alexander Baker: There is merit to the analogy that the hypothalamus is like a thermostat, and sends signals through the sympathetic nervous system which acts as a complex relay system, which can affect a myriad of body systems to either cool down or to heat up.
Unfortunately, we cannot “turn down” the “thermostat” as Dr. Fischel suggests. What he does is much more analogous to chopping out six of the “relay stations” completely and throwing them away.
Instead of “turning down” the sweating, ETS stops all sweating forever in the top part of the body, and makes it hyperactive in the lower part.
Dr. Fischel: Everybody has a sympathetic nervous system. Regular people when they're nervous will sweat from their hands, their feet, their armpits, their face. It's a sign of nervousness and it's one of the reasons that people who have hyperhidrosis... where they can't control it... it's one of the reasons they hate this problem so much. People think they're nervous, or dishonest, or something's wrong and that's why they like to get rid of it. It's embarrassing.
Just in case you didn’t already realize, Dr. Fischel is here to warn you that if you sweat to much, people think you’re dishonest. In fact, Dr. Fischel is dishonest, but for him it’s no sweat.
Dr. Fischel: The differential diagnosis - things you must rule out. Thyroid or adrenal disease. Again that's in someone who maybe comes to you in their mid-20s or thirty and says, "I never used to sweat, now I have sweating". You rule out that they have anything else wrong. If they tell you they think about it and it gets worse, or that they've had it since childhood, it's probably hyperhidrosis.
Yes, people with “essential hyperhidrosis” can rule out any medical diagnosis.
Dr. Fischel: The other things listed here. Many of the patients I've seen have been sent for psychiatric evaluation they've been treated for anxiety we look at we look for any evidence of diabetes or malignancies but the classic hyperhidrosis that I'm describing is very easily diagnosed just from the things that I told you about.
Dr. Fischel: Why does this sort of thing happen? Well, most often it's for no reason whatsoever. Anxiety certainly makes it worse. Sometimes when you have to concentrate on an activity. I do a lot of people who work with computers, and when they think about doing it their hands start sweating. Lotions can cause it. Drinking alcohol or certain foods can cause it. And some people notice when they eat certain foods they may sweat a lot from their face and we often call that "gustatory sweating".
Dr. Fischel: One of the other types of problems that someone can have from this sympathetic nerve over-activity is actually not sweating at all but facial blushing. And what I'm going to talk about helps to treat that problem as well.
Dr. Fischel: There are many non-surgical treatments that you can try for this but in the thousands of patients that I've interviewed most of the time these have not proven to be particularly effective. Drysol is the most common one given by dermatologists, but to use this you have to apply it at night, wrap the hand in cellophane, sleep with it, wash it off in the morning. Many of the patients describe that their hands become dried, crack, they even will bleed. But they still sweat so it doesn't really work all that well for people that have serious hyperhidrosis.
Dr. Fischel: The tap water iontophoresis - also known as the Drionix device is something you can soak your hands on, sends a little electric charge through. Same thing - sometimes it doesn't work. And even if it does, you have to use it over and over for the rest of your life.
Dr. Fischel: Something being touted in the literature and in the public eye right now is Botox injections. Most of the patients I know who have had anything to do with this said it was very painful very expensive didn't work that well and didn't last that long. So it's not something that I routinely recommend.
Dr. Fischel: There are other things you can take such as drugs like Robenall, anti-anxiety drugs, patients have been treated with psychiatric drugs, or alcohol soaps. All these different things most of the time they're either partially effective or you have to do them over and over and over and people get tired of it.
Dr. Fischel: What can we do with surgery. Well there's several different approaches to doing surgery to treat hyperhidrosis. We've known for years that taking out a little piece of that nerve inside the body can treat this problem. It was probably discovered initially... some guy had a tumor they took it out and said, "hey doctor, my hand no longer sweats, you know. That's very interesting!" So they figured it out.
Alexander Baker: “Little” is a relative concept. A “little” elephant is 6 feet tall. A “little” mountain is 2000 feet tall. There is nothing “little” about the “nerve” that Dr. Fischel destroys. As mentioned, it is not a “nerve” but rather six entire nerve ganglia, each like a little brain. And these ganglia modulate the function of heart, lungs, blood vessels, fat burning, temperature regulation, immune function, and many other things that we know about, plus much that remains unknown. Hint: the unknown is why “we” are allowing this form of involuntary human medical experimentation to go on. Much is learned.
Dr. Fischel: But to do this operation it used to require a big surgery, either opening up the chest (that's a thoracotomy), opening up your back (going through the neck), or doing what we do now which is a video thoracoscopy through tiny little holes. The video assisted procedure that we use is a number one here nerve and ganglia resection. We actually take the piece of nerve out. This copies an operation that's been performed for over 30 years with excellent results. There are other people who do different things, also through a small hole with a video camera, and they will either burn the nerve, cut the nerve, or clip the nerve. And I'll discuss how that results in different results for this operation.
Dr. Fischel: Well, in the modern era today what we find are that patients are very aware of minimally invasive surgery. I first got involved with this when a neurosurgeon at Cedars Sinai, Dr. Marty Cooper came to me and said, "Rick, I've been treating patients for 25 years for hyperhidrosis."But what he does is make a four-inch incision in the middle of your back, take all the muscles off of your spine, take out a piece of rib on both sides and then pluck out this little tiny piece of nerve.
Alexander Baker: What would Dr. Cooper actually have had to say to a person to persuade them to do a major surgery back surgery with 7 months of recovery, just to “cure” them of “hyperhidrosis”?
Dr. Fischel: The good news is it always worked to cure the sweaty hands.
Alexander Baker: The bad news is that sympathectomy doesn't “cure” anything.
It destroys sympathetic nerve function to a large portion of the body.
Dr. Fischel: The bad news is there was seven hours of surgery, seven days in the hospital and seven months to recover from the pain. So he came to me and he said my patients... I still have patients who come to me with this but they don't want to have that big operation because they've seen on radio TV the internet that somebody can do this through a tiny little hole. So patients want surgery with a little incision have refused to have this larger operation. So we then developed a new approach.
Alexander Baker: The really bad news is that, unlike other types of injuries, the nervous system cannot repair itself.
Dr. Fischel: So through two little holes the size of a straw we're able to do the same operation that has been successful for over 25 years. And I think that's a very important point in what we're doing. We're not making this up. We're not testing something on a nerve that we don't know what the results will be.
Alexander Baker: Dr. Fischel knows what the results will be, yet he is not telling us, is he? Does he ever tell you that it stops all sweating on the top 1/3 of the body forever? Does he ever tell you that it affects the heart and lungs and blood vessels and temperature regulation and exercise capacity?
Dr. Fischel: So, based on that 25-year experience with removing what's called the T 2 and the T 3 ganglia through the back that Dr. Cooper did, we noted his results, as I mentioned, seven-hour surgery, seven days in the hospital, that always worked. And over the course of 30 years he did.