January 2012 posts

Everyone sweats – but what if you had a condition that caused uncontrollable sweating in your hands?

Palmar hyperhidrosis is a benign condition where individuals experience uncontrollable sweating of their hands, way beyond their physiological needs. Hand sweating in such a scenario is often described as being present 24/7, may be worsened in situations of stress but also occurs out of nowhere in times of total rest and serenity. From the constant dampness the hands are exposed to, ulcerations and other skin related changes may develop. Many patients with this condition adopt a line of work and a life style that minimizes public encounters and avoid hand contact such as having to shake hands.

It has been known since the 1920s that by dividing the sympathetic chain (nerve) high up inside the chest, a procedure called thoracic sympathectomy, we can make the hands stop sweating. To achieve this surgically was quite an undertaking back then. The surgical trauma was such that historically very few individuals with hyperhidrosis opted to have corrective surgery. With the development of videoscopic surgery, however, it has become possible to perform the sympathectomy with minimal trauma to the patients. In addition, the magnification provided by the optics of videoscopic surgery has made the surgery safer.

What is involved in an ETS (Endoscopic Thoracic Sympathectomy)?

Nowadays, we offer surgery under general anesthesia as a day surgical procedure (meaning most patients are expected to go home the day of surgery). Two small incisions are needed, and we preferentially place those on your sides. At Swedish, our preferred approach is to clamp the nerve by placing titanium clips on the nerve at appropriate levels. The advantage of clipping the nerve instead of removing a segment of the nerve (as we did prior to 2005) is for possible reversal of the sympathectomy in the rare instance where a patient may be unhappy with the side effects of the surgery (see below).

What results should I expect?

In our hands, ETS will render the hands dry in 99 to100% of cases ...

You may have decided to create family resolutions, or have a personal new year’s resolution. But, as parents our biggest resolution is to do our best to take the best possible care of our children.

One of the more nerve wracking moments is when a child develops a cough, rash, or earache. We don’t want to overreact and rush to the doctor, but what if it’s serious? How do you know? Unfortunately, a lot of parents turn to Google to find out. While searching online may result in some helpful information, it can also be uber-scary because you can find all these unique, rare, serious possibilities.

In my job in community education, I run into several people a week who have Google-diagnosed their health concerns. They might be right but they are often looking at some of the remotest of possible conditions. There are good resources online for searching for health information.

• Swedish Kids Symptom Checker (on the web, or on your phone) can help you stay on top of your child’s signs and symptoms

In September, I co-authored this cover article in the Journal of Neurosurgery on the results of a study using ultrasound for the treatment of brain hemorrhage. The study involved 33 patients with spontaneous intracerebral hemorrhage who were screened for inclusion in a SNI clinical study known as “SLEUTH” (Safety of Lysis with Ultrasound in the Treatment of Intracerebral and Intraventricular Hemorrhage). You can the abstract and full text of the article or see background information on the study, and watch a related video on WebMD.

 When you are ill or injured, where should you go to receive the right level of medical care?

What are the top four innovations in health care reform in 2012? 

1. Innovative changes in health benefit packages
2. Increased focus on primary and preventive care
3. Affiliations and data sharing between health networks
4. Personal health coaches

What exactly does this mean? Watch the video below to find out:

January 21-22

• All campuses and locations are expected to have normal operations.

Information for Friday, January 20

• Due to weather, the continuing medical education conference Advances in Neuromodulation 2012: Current State of the Art and Emerging Indications has been cancelled.

• As of 5:00 pm, main hospital campuses and emergency departments are operating and will operate as scheduled on Friday, January 20. Any known exceptions (a few late starts for some primary care and specialty clinics) are noted below. Ballard Primary Care plans to stay open late as the road conditions improve and it is safer to drive so we can accomodate any patients in the community who need  care prior to the weekend.
  

• The following classes are cancelled on Friday, January 20: First Hill Sibling Preparation at 2:00pm and Newborn Preparation at 3:00pm; and Ballard Birth Center Tours at 4:00pm, 5:30pm, and 7:00pm. All scheduled Edmonds classes are also cancelled.

• All Minor & James clinics open at 10am. Please call the clinics directly if you have any questions or need to reschedule your appointment. See a list of clinic phone numbers here.

• If you are experiencing a power outage, stay safe. Prevent poisoning from carbon monoxide: Only use generators outdoors and far from open windows and vents. Never use generators or portable propane heaters indoors, in garages or carports. Never cook or heat inside on charcoal or gas grills. More information.

If we get additional weather notices or operational updates, we'll keep you posted here in this blog post and on Facebook.

Updates from Thursday, January 19

• 11:45 - Somebody wrote a note (by hand!) and handed it to the security team at First Hill. It reads:
  "To whom it may concern, we arrived about 6am for surgery scheduled for 9am. A big thank you & great job to all of the workers out there in the freezing rain keeping the sidewalks clear. They have been going non-stop since we arrived."
  We agree  - a big thank you again to all of our staff, employees, physicians, and nurses - and others in the city and surrounding areas working to keep the streets and sidewalks safe and passable!