Hyperhidrosis Answers

Can ETS (hands) and ELS (feet) be done at the same time?
The short answer is no however most of the patients that suffer from severe palmar hyperhidrosis (hand sweating) and plantar hyperhidrosis (foot sweating) are having thoracic sympathectomy first and then 3 to 4 months later endoscopic lumbar sympathectomy. The reason for the delay is to ensure physiological adjustment of the body to the initial procedure.

What are the most common side effects for the ELS procedure?
As in any operation side effects such as pain, discomfort and scar formation are common but on a very limited and mild basis. Compensatory sweating, which is the most frequent side effect after ETS, does not change after ELS. Various medical papers have been published on this matter however the research and study is ongoing.

Can ELS be done if I had previous abdominal operations?
Yes. ELS is done not through the abdominal cavity but through the abdominal wall muscles so there should be any entry into the abdominal cavity. Previous operations should not be a contra indication to perform ELS but always other factors such as obesity may have an impact.

Are there age restrictions for the hyperhidrosis procedure?
Basically yes there are. In the past young patients, as young as 10, were done but at present Dr. Reisfeld limits the age to 14. In exceptional cases when the youngster has mental maturity as well as physical maturity the procedure can be done at the age of 12. The reason for this age restriction is due to the fact that in the younger group the parents are more interested in solving the problem before the patient themselves are fully aware of the condition.

Is weight a factor in determining candidates for the hyperhidrosis surgeries?
Obesity as in many other surgical procedures can be a challenge. The same is true for endoscopic thoracic sympathectomy as well as endoscopic lumbar sympathectomy. A optimal height weight ratio is desired but each case should be discussed with an operating surgeon.

Why do people get excessive hand sweating?
The most likely reason is genetics. It has been shown in various medical papers that more than 50% do have a family history. This can be with immediate relatives (Father/Mother) or more remote family members (Aunt, Uncle). The specific gene location is believed to be known but the practical implications are still quite away from being translated into treatment.

What do the T levels mean in relation to the ETS surgery?
When a number is added to the T (i.e. T2) it is describing the location of where the sympathectomy is done. T2 correlates to the second rib level, T3 means third rib level T4 means fourth rib level and so on.

What about health insurance coverage and cost?
Most insurance companies do cover these types of procedures. Once you provide us with your insurance information we will check with the insurance company to see your level of coverage. There might be a request by the insurance companies to provide them with previous attempts to correct this problem with conservative measures and if so we will ask this information to be provided to us. The process of verification – authorization might take some time but we are familiar with this process and can help you through it.

What if I do not have health insurance coverage?
For those patients who do not have any health insurance coverage it is recommended to those candidates to call our office and discuss their financial options including a referral to a financing company.

What about scheduling the surgery?
Once a clinical evaluation is made by the operating surgeon and the insurance/financial issues are straightened out it is up to the patient to schedule the surgery. For those traveling from far away, they must be seen by the operating surgeon, one day before the operation.

How long does the procedure take and how soon can I return to work?
As a rule the operations are carried out on an outpatient basis which means the patient is able to go home or to their hotel the same day. The physical discomfort and pain are well controlled with oral medications. The exact time of returning to work or normal activity varies from one patient to another but overall patients can return to normal activity within 2-3 days. Patients can return to more rigorous physical activity within 2 to 3 weeks.