A Helping Hand

Teen was bullied for condition that causes excessive sweating

Teresa

Teresa Jose’s life and outlook changed when surgeons at Rady Children’s treated her hyperhidrosis condition.

Teresa Jose was at a church retreat a few years ago when she and other participants were asked to join hands. Reluctantly, she grasped the hand offered by the woman sitting next to her. But after a brief break, the woman did not return. Teresa was embarrassed but not surprised. She knew why the woman had left.

At the time, Teresa had a big problem with sweating – on her hands, under her arms, on her back and thighs, and on the soles of her feet. In class, she could barely hold a pencil because her hands would get so wet. It didn’t just happen when she was hot or nervous; it happened all the time, and nothing could stop it.

“My hands would sweat a lot,” says Teresa. “Taking notes during my government class, I couldn’t continue because the paper was soaking wet.”

Teresa had a condition called hyperhidrosis, and it had a dramatic impact on her life. She was bullied and had to change schools three times. Shaking hands was problematic; people would often wipe their hands afterwards. Nice clothes were out of the question—she would have permanent stains after wearing them two or three times.

The condition was forcing her to shrink away from the world.

“When I first met Teresa, she wouldn’t make eye contact,” says Tim Fairbanks, M.D., a pediatric surgeon at Rady Children’s Hospital-San Diego and an assistant clinical professor of pediatric surgery at UC San Diego. “This is common for children with hyperhidrosis. They don’t want to risk having to shake hands. Some even carry a rag in their hands to keep dry. It really affects their ability to interact with peers.”

Strategies to deal with hyperhidrosis include using antiperspirants in problem areas or even botulinum toxin (Botox) to temporarily block the nerves that cause the sweating. Teresa’s doctor prescribed medication, but it worked intermittently, then not very well. Teresa was looking for a more permanent solution.

“I wanted it to stop and have a normal life,” says Teresa.

A Surgical Answer

Needing a better option, Teresa began researching the condition on her own. She found a procedure called endoscopic thoracic sympathectomy and was soon talking to Michael Levy, M.D., Ph.D., chief of the Division of Neurosurgery at Rady Children’s and a clinical professor of surgery at UC San Diego, and Dr. Fairbanks, who specializes in minimally invasive surgeries.

“There’s been a revolution in surgery that has really changed how we treat this condition,” says Dr. Fairbanks. “Twenty years ago, we would have had to do an open surgery with big incisions, which was quite risky. It was basically the same surgery to replace a heart valve. But now we can do it using instruments smaller in diameter than a pen. We make small incisions in the chest, identify the nerve that is incorrectly sending messages to the sweat glands, then cut it.”

The nerve in question is part of the sympathetic nervous system, which controls such reactions as the hair standing up on the arms or the cheeks flushing. In most cases, severing it cures hyperhidrosis.

Being Dry

Though Teresa was nervous when she went in for surgery, she was also looking forward to the outcome. And she was not disappointed. For the first time in her life, her hands were dry.

It would be hard to overestimate the impact this change has had on Teresa’s quality of life. She no longer has to worry about what other people think when she shakes hands or try to cover up her sweating.

“This was the first time this surgery was performed on a child in San Diego and results were excellent,” says Dr. Levy. “This was a girl who had switched schools, who couldn’t hold a pencil, who had been bullied because of her condition. For her, this surgery was life-changing.”

This past June, Teresa graduated from San Dieguito Academy, and she is now taking a full load at Mira Costa College. Eventually, she wants to be a nurse. “I canwear the clothes I want to wear,” says Teresa. “I don’t have to wear heavy jackets anymore or wear black all the time.”

Most importantly, she doesn’t have to retreat from the world.

“She was a shy girl who didn’t want to interact,” Dr. Fairbanks says. “But when I saw her in the post-op appointment, she had a big smile on her face. She doesn’t have to hide anymore.”

Advanced research on nervous system conditions

Along with performing groundbreaking procedures, such as the one that helped Teresa, physician-scientists at Rady Children’s Hospital-San Diego are working with researchers at numerous institutions to better understand and treat conditions that afflict the brain and spinal cord.

Among these projects are testing stem cells to treat spinal cord injuries, developing new methods to measure concussion severity and seeking new ways to treat brain tumors. One of these tumors is medulloblastoma, the most common malignant brain tumor in children.

Michael Levy, M.D., Ph.D., chief of the Division of Neurosurgery at Rady Children’s and a clinical professor of surgery at UC San Diego, and John Crawford, M.D., M.S., director of Rady Children’s Neuro-Oncology Program and a UC San Diego assistant professor of neurosciences and pediatrics, are working with researchers at Sanford-Burnham Medical Research Institute and colleagues at UC San Diego to identify tumor mutations and find effective therapies that will treat them.

To determine which mutations are driving a patient’s cancer, the researchers are sequencing all of the DNA (genome) of a patient’s tumor cells.

They will then look at the patient’s healthy cells and compare the genetic sequences. “This way, if the cancer returns, we have a better idea of what we’re dealing with,” notes Dr. Levy.

The team is taking the research a step further, using high throughput drug screening to test thousands of potential treatments. Those treatments found to be effective could then be tested in clinical trials.
Originally published in U-T San Diego, 2013