Hypersweaty
People like Lee, Darren Loh and Deric Cheong wipe their hands constantly. But the sweat pops right out again, making their palms wet, slippery and cold all the time. 'Millions of people throughout the world are suffering, facing an isolating, damaging and embarrassing struggle every day from excessive sweating,' says Cheong, 32, an investment consultant. 'I have had sweaty palms since I was a child, but it was not until last year that I found out that (my problem) has a name: hyperhidrosis,' he says.

'Sweating is a necessity in life. We lose heat by sweating,' says consultant cardiothoracic surgeon Dr David Khoo, explaining this basic autonomous body function that sets us apart from animals like dogs that lose heat by panting. 'If we stop sweating, we will die because our bodies will overheat.' Unfortunately, he adds, some people sweat excessively all over their body or from certain parts of their body. Sometimes, this is due to certain medical conditions like thyrotoxicosis, certain cancers or anxiety disorders.

In about 1% of young adults, unnecessary and excessive sweating occurs due to an overactive sympathetic nervous system, although what causes this is still a mystery. This kind of sweating is called hyperhidrosis (hyper = excessive: hidrosis = water). 'Unfortunately, the sweating happens in places that are most prone to scrutiny: your hands, feet, face or armpits. You experience continuous sweating, for no apparent reason. It is not provoked by exercise: you could be sitting and relaxing. It is provoked by stress, and stops during sleep,' Dr Khoo explains. 'Many people live with this condition. Majority of them suffer ... and have lost confidence in their lives,' he says, having seen people with hyperhidrosis, from age 10 to 50, walk through his doors with miserable tales of their own.

'Hyperhidrosis takes a heavy toll on a person's life. You have no control over it. You constantly worry about how much you are sweating. You spend hours each day freshening up, wiping, putting pads under your arms or in your pockets. You bathe three times a day. You hide under dark-coloured bulky clothes,' says Cheong. 'When I'm writing, I have to put a handkerchief under my palms or else the whole paper will be thoroughly wet. It makes no sound when you tear it,' he says in an attempt to make light of the problem. What Cheong goes through is no joke, though.

'When I meet new friends and shake hands, it doesn't leave a good impression. They give you one kind of look [sic] and they wipe their hands on their pants,' he says, often humiliated by such reactions. Little wonder, when people throw out callous comments like 'Wah, why your hands so sweaty one? Go toilet never wash your hands, is it?' 'We avoid shaking hands with other people,' Lee says candidly. 'Imagine if you meet a girl and shake her hand. When she sees that your hand is sweaty, she will think that you are not a good guy.' In the end, 'you make excuses to stay home and choose not to interact with other people,' says Cheong. Many people who suffer from hyperhidrosis never talk about it, but constantly worry about what other people think. Sometimes, the problem goes beyond mere impressions.

Several times while driving home, Lee has been stopped by police and suspected of taking drugs when they see his wet hands. Not only has he had to take urine tests, he’s even had to go to the police station. '(But) I'm the innocent one,' he says indignantly. When Lee was in university, his lecturer asked him, 'If you have wet hands, why do you want to be an electrical engineer? It's very dangerous.' But Lee doggedly pursued the course, because it was what he wanted to do. After he graduated, he lost out on numerous job opportunities because potential employers preferred to hire an electrical engineer who would not electrocute himself on the equipment. The sweaty hands were also held against them as evidence that they were ill-prepared to handle critical tasks. Before Cheong was aware that there was treatment for hyperhidrosis, he found it difficult to live with the fact that everything he touched became wet. 'It's...' he paused, 'it's very disgusting, not only to other people, but to yourself as well.' However, Dr Khoo urges people with hyperhidrosis not to be ashamed of their problem and to get themselves treated for it.

A surgical solution
Treatments for palmar hyperhidrosis range from home remedies (antiperspirants) to medications (sedatives) to non-surgical techniques (injections with botulinum toxin or iontophoresis). None of these treatments are especially effective or attractive. Taking sedatives to calm your nervous system will probably make you unnecessarily drowsy. Injecting your palms with botulinum toxin takes 50 to 60 injections, repeated every six months. Iontophoresis requires you to soak your hands in a small tub of water and pass direct current through it to shock the sweat glands in your hands. 'Unfortunately, this method is painful, time-consuming and you often need to repeat it,' Dr Khoo says. 'Fortunately, there is one treatment that is permanent,' he assures, 'a surgical procedure called sympathectomy to cut off the sympathetic nerves.' These sympathetic nerves lie throughout the whole backbone. Cutting specific nerves in the sympathetic nervous system will block the nervous supply to the sweat glands in the hands, face and armpits. Originally a procedure that required surgeons to make a four-inch cut through the skin and open the ribs, sympathectomy was deemed risky and painful until video-assisted surgery was introduced. Now, video-assisted thoracoscopic sympathectomy can be done by inserting a camera into a 5mm incision just under the armpit. 'This is a safe operation, the results are excellent, and the scarring is minimal,' says Dr Khoo.

After undergoing the surgery, the patient may experience compensatory sweating elsewhere, usually on the back, the trunk or in front of the thighs. Video-assisted thoracoscopic sympathectomy costs approximately RM9,000 at a private hospital in Kuala Lumpur. The question now is whether this procedure is a medical necessity or just cosmetic surgery. 'Disease is defined as something that affects a person psychologically, physically and socially. When (palmar hyperhidrosis) becomes a problem where you cannot meet people and cannot work, it is a disease,' Dr Khoo justifies. Cheong agrees: 'It's a serious medical condition. It's a daily struggle that negatively affects everything.' For Lee, undergoing the surgery has been nothing short of life changing. 'My hands are dry now,' he says simply, grateful for something that the rest of us take for granted. At the end of the interview, I hold my hand out to Lee. Without hesitating, he returns my handshake. Dry, warm and confident.