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Curing sweaty palms

Dr. Mark Krasna examines the palm of a patient at St. Joseph Medical Center.

Lauren Sarmiento’s hands sweated so profusely that the perspiration would pool in her palms and drip onto the floor.

The 17-year-old’s school papers became soggy and the ink smudged. When she drove, the steering wheel slipped in her wet palms.

Lauren’s were complaints that Dr. Mark Krasna at St. Joseph Medical Center said he has heard virtually hundreds of times.

A thoracic surgeon and medical director of the Towson hospital’s Cancer Institute, Krasna treats patients with hyperhidrosis, the excessive sweating disorder that Lauren, of Rocky Mount, N.C., developed in early adolescence.

Since the early 1990s, Krasna has been performing on such patients a surgery called thoracoscopic sympathectomy, a procedure Lauren underwent in July.

“She hasn’t had a drop on her fingers or hands from the minute we left there,” said Richard Sarmiento, Lauren’s father.

Krasna, who has been at St. Joseph for one year after 18 years at University of Maryland Medical Center, said the surgery can be a miracle for patients. He has operated on more than 400 people with excessive sweating.

But some hyperhidrosis advocates warn the procedure’s side effects can be a curse as well.

Hyperhidrosis affects an estimated 3 percent of the population, and is much more than a case of clammy hands, Krasna said. The condition can strike the palms and soles of the feet, the armpits, the face and hairline, and involves stained clothing and dripping and pooling of sweat.

“You will have people whose lifestyle has been completely put on hold,” Krasna said.

Many cases begin in adolescence, and in adulthood the symptoms can hurt careers, said Lisa Pieretti, executive director of the International Hyperhidrosis Society in Philadelphia.

Some can’t even shake hands. Krasna said that was his patients’ “most common complaint.”

Treatments include super-strong antiperspirants, Botox injections or electrical currents administered to the perspiring area.

Those treatments all must be repeated with relative frequency. The only permanent solution is thoracoscopic sympathectomy, a non-invasive procedure in which the surgeon makes an incision under each armpit to interrupt the sympathetic nerve chain. Overactivity in the chain, which runs along the spinal column, causes the excessive sweating.

Cutting to various levels in the nerve chain disables the sweating in various parts of the body, Krasna explained.

The effects are instant and permanent, but the surgery can be costly, Pieretti said. Sarmiento said he was quoted $29,000 for the surgery at one hospital. At St. Joseph, the surgery will cost the family about $5,000 after Lauren’s insurance agreed to cover it, Sarmiento said.

In about 40 percent to 50 percent of cases, patients develop a side effect called compensatory sweating, Krasna said. Basically, the excessive sweating reappears in another part of the body — the inner thighs, the back.

Compensatory sweating is serious enough to prompt the International Hyperhidrosis Society to advise against the surgery, said its executive director. The nonprofit is supported in part by grants from the companies that make treatments for the condition, including Allergan, which makes Botox, and the Secret antiperspirant brand.

The treatments “are not permanent, but at the same time, since the surgery is permanent, if you get these side effects, you have them for life,” Pieretti said.

“Not everyone is prepared mentally or otherwise to deal with that,” said Krasna.

Surgeons could be careful to discuss with patients the severity of the side effects, he added.

Lauren assured her father her situation could not be worse.

“She said, ‘Dad, my hands are always visible to the public. I have to touch people, I have to touch things. Any other form of sweating cannot be as bad,’” Richard Sarmiento said.

But Pieretti warned that some overeager surgeons may not properly advise their patients of the risks.

“Surgeons are very savvy marketers for this,” she said. “It’s a very profitable procedure for them.”

“A lot of people say they could do the operation, and some are very capable,” Krasna said. “You need to go to someone who’s experienced, who won’t do the operation when it’s not indicated.”

Krasna has published on the surgery in various journals, and he advised patients to look for other surgeons who have done the same.

Lauren Sarmiento has had no negative side effects since her surgery, said her father, who becomes emotional about the positive effects he’s seen.

“It’s helped her become the person she would not have been able to be,” Sarmiento said.