Draper, UT -- (SBWire) -- 07/22/2013 --Dr. David Nielson is a Texas based cardio-thoracic surgeon who specializes in micro-endoscopic chest surgery. Dr. Nielson is widely known as a hyperhydrosis expert and sweating specialist with his innovative, least invasive treatment for patients who suffer from (excessive sweating of the hands, face, and/or armpits, Raynaud’s Syndrome, and Facial Blushing. These conditions are all connected to an over-active sympathetic nerve chain.  Micro-endoscopic thoracic sympathectomy (Micro ETS), created by Dr. Nielson, is the least invasive, most advanced surgery for people suffering from these ailments.  One of the most experienced endoscopic thoracic surgeon performing ETS surgery, Dr. Nielson emphasizes that extensive ETS surgical experience is essential to eliminating excessive sweating of the hands, face, and/or armpits.

Dr. Nielson's Micro ETS procedure has the quickest recovery time and has a high success rate for those suffering from hyperhidrosis of the hands. During the procedure, Dr. Nielson makes a single incision, one-twelfth of an inch per side , under each arm and inserts a 2mm scope. Nielson compares the size of his instruments to angel hair pasta. Once Dr. Nielson identifies the sympathetic nerve, he precisely divides it to instantly lessen hyperhidrosis symptoms and bring warmth to cold hands. The procedure takes 30 minutes. The patient is able to leave two to four hours after the procedure.

Board Certified Cardiac & Thoracic Surgery Endoscopic Cardiothoracic Surgery

Board Certified General Surgery    

Micro ETS Surgery - Created Micro 1/12th Inch Single Incision Endoscopic Thoracic Sympathectomy for Hyperhidrosis, Blushing, and Raynaud's

SDLA® - Created Sub Dermal Laser Ablation for excessive sweating of the underarms, and other body regions.

The Offices of David H Nielson, MD
1202 E Sonterra Blvd, Suite 101
San Antonio, Texas 78258

(877) 837-9379 (Toll Free)
(210) 490-7464 (Phone)
(210) 490-2506 (FAX)

Dr. Dave H. Nielson Receives Reliability Award for Effectiveness in Dawson County Texas from G3 Development (UT) Yuku for his Treatment Results with Hyperhidrosis Sweaty Armpits Sub-Dermal Laser Ablation and 'ETSandReversals' in Clay County Texas

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Hyperhidrosis - Overview of hyperhidrosis symptoms and treatment options.   Sweating is necessary to control body temperature during times of exercise and warm/hot surroundings. Sweating is regulated by the sympathetic nervous system. In 0.6 to 1.0% of the population, this system is revved-up and works at a very high level causing sweating to occur at inappropriate times in specific areas of the body. This condition is known as hyperhidrosis.  Classification - Causes of hyperhidrosis can be primary or secondary.  Regions of the body affected - Scalp, facial (face), palmar (hands), axillary (armpits), truncal (trunk), plantar (feet

Primary or idiopathic hyperhidrosis - Hyperhidrosis without a known cause. A more frequent condition than secondary hyperhidrosis. Localized commonly in the hands, armpits, scalp, face, and/or feet. Starts during childhood or early adolescence, worsens during puberty, and then persists for the rest of one's life. Nervousness and psychiatric disorders are rarely the cause. The excessive sweating is very embarrassing and social, professional, and intimate relationships are often seriously affected.

Secondary hyperhidrosis - Caused by an underlying condition. Usually causes excess sweating of the entire body, however. Some of these conditions are;   endocrine disorders such as hyperthyroidism, endocrine treatment for malignant disease, menopause, obesity, psychiatric disorders, systemic malignant disease.

Hyperhidrosis Symptoms = Either sudden onset or continuous sweating. Sweating usually brought on by no apparent reason. Usually not aggravated by exercise. Emotional stress, high ambient temperatures, and/or gustatory stimuli are the most important aggravating factors. Hyperhidrosis usually improves during the cold/cool months and worsens during hot/warm months. Sweating usually stops during sleep. Hereditary (25% of individuals with hyperhidrosis tend to have a family member with symptoms as well).

Hyperhidrosis Treatment - Secondary hyperhidrosis is treated by first addressing the underlying disorder. If a patient is on hormonal therapy then administration of an anti-estrogen (ciproterone acetate) can give relief to sweat attacks. Primary hyperhidrosis patients and secondary hyperhidrosis patients experiencing moderate to severe sweating not relieved otherwise may benefit from the following alternative treatment modalities;  Antiperspirants (Drysol), Iontophoresis. Medications (anti-cholinergics), Surgery.

Hyperhidrosis Surgery - Known as endoscopic thoracic sympathectomy (ETS), is the treatment of choice for severe hyperhidrosis.  Interruption of nerve impulses to sweat glands of the palms, face, axillae (armpits) by cutting or electrocautery is called "Thoracic Sympathectomy". The ganglia (nerve junctions) which lead to the sweat glands of the palms, axillae, scalp and face are accessible through the chest (thoracic cavity) because they travel along the side of the spine of the back. Using a Micro Single Incision endoscopic technique, easy access to this area requires only a single 1/12th inch incision per side.

In the past, a rib was removed or a large painful incision was required between two ribs to provide access to this area. Some surgeons today make three to four small incisions when performing endoscopic thoracic sympathectomy. Dr. Nielson has applied state-of-the-art technology to his endoscopic technique and he only makes a single 1/12th inch incision per side.

Facial Blushing = Facial blushing is often misdiagnosed as rosacea. A red face is a typical manifestation of this condition. Fear of social situations can bring on blushing and is known as erythrophobia.  Blushing commonly originates at the upper chest or base of the neck and extends up to the forehead, ears and can even spread down to include the trunk and legs. Facial sweat often accompanies blushing and feelings of burning or tingling. Hyperpyrexia (feelings of burning or tingling) is commonly associated with blushing and is actually much more debilitating to the individual than the mere appearance of blushing on the skin. This condition of hyperpyrexia associated with facial blushing is little understood and not typically recognized by many physicians. Functional impairment arises from the intense "burning" sensation that becomes so uncomfortable that the individual has to actually stop what they are doing because of the severe inability to concentrate or follow through with the task at hand.

Many patients have described the feeling they experience from hyperpyrexia as "hot flash or burning." This sensation envelops their face/head/neck to such an extent that they seek seclusion to "cool off". Medications are seldom helpful for this intense "hot or burning" feeling. Beta blockers (i.e.: Propranolol are commonly used but to little avail).  Even when the individual is relaxed, blushing episodes may occur. Sometimes excess sweating of the scalp and face is associated with blushing / hyperpyrexia attacks. This condition often causes the individual to become self-conscious, nonproductive at work or school during the episodes, and to develop a low self-esteem. Some patients that Dr. Nielson has treated have actually become so severely dysfunctional that they quit work and would move from job to job.

Many physicians don't recognize that these blushing episodes are commonly associated with hyperpyrexia of the face which is actually what is so debilitating and causes the severe functional impairment. The combination of facial blushing with the warm/burning sensation of the head commonly makes the individual extremely anxious and quite uncomfortable. This uncomfortable feeling can be so intense that the individual can lose all ability to concentrate and function properly. Medications commonly used to prevent or control blushing include beta blockers (Inderal) and anxiolytics (sedatives). These medications are usually of limited benefit in reducing blushing intensity and frequency of episodes.

Raynaud's Disease = Episodic vasospasm (constriction of small arteries) of the fingers or toes. It is characterized by digital (fingers or toes) blanching or white color, cyanosis (blue), a feeling of numbness or dulled sensory response and rubor (red) after cold exposure and rewarming. It can also be induced by anxiety or stress. This condition is primarily confined to the fingers and toes but can affect areas of the body such as your nose, cheeks, ears and even tongue.

Primary Raynaud's phenomenon is also called Raynaud's disease. Criteria for Raynaud's disease include episodic digital ischemia (sequence of color changes in the skin in response to cold or stress), a numb, prickly feeling of the fingers, or stinging pain upon warming or relief of stress, absence of arterial occlusion, bilateral distribution, absence of symptoms or signs of other diseases that also cause Raynaud's phenomenon, and duration of symptoms for 2 years or longer. Most people with Raynaud's Disease develop symptoms before they reach 40 years of age. It can occur in young children. Raynaud's Disease affects women three to five times more frequently than men. The prevalence is lower in warm climates than in cold climates.

Etiology - The mechanisms postulated to cause Raynaud's phenomenon include increased sympathetic nervous system activity, heightened digital vascular reactivity to vasoconstrictive stimuli, circulating vasoactive hormones, and decreased intravascular pressure. The sympathetic nervous system mediates the digital vasoconstrictive response to cold exposure and emotional stress but has been discounted as a primary mechanism.  Some investigators have suggested that increased sensitivity, increased numbers of postsynaptic alpha2-adrenergic receptors, or both enhance the vasoconstrictive reactivity to sympathetic stimulation. 

Hyperhidrosis Surgery Side effects = Patients should be aware that compensatory sweating can and does occur. Compensatory sweating is experienced as excessive sweating on the back, thighs, stomach, axillae, groin and/or lower legs and may range from mild to severe. Reported incidence of developing compensatory sweating in world literature range between 50% to 90% of all patients undergoing the ETS procedure. Of this group, it has been reported that about 5% - 10% of these patients experience severe compensatory sweating. Severe compensatory sweating, or severe compensatory hyperhidrosis, can be very troublesome, especially when it soaks through clothing. This can be more problematic in hot humid climates and can become more of a problem than the original problem treated.

The tolerance of compensatory sweating is patient dependent. Some patients tolerate severe sweating while others do not tolerate even mild compensatory sweating. There are medications that may help lessen the severity of compensatory sweating post operatively. Overweight patients may experience more compensatory sweating and those who live in hot, humid climates may find it less tolerable. Compensatory sweating is the most common side effect reported by patients regardless of which surgeon is performing Micro ETS. Gustatory Sweating, which occurs while eating or smelling certain foods, can develop post operatively in about 10 to 20% of the patients. Phantom sweating occurs in some patients after ETS surgery (feeling the sensations of sweating but not actually sweating) and typically resolves in 1 to 3 weeks after surgery.

Treatments for Hyperhidrosis = Prescription Deodorant and Antiperspirant Products. A popular treatment available to hyperhidrosis patients is that of prescription deodorant and antiperspirant products. These are much stronger than those available over the counter, and may be a big benefit to the person who deals with excessive sweating. Drysol is one of the strongest prescription antiperspirants, while Xerac AC may work for milder cases.

Botox Treatment = Some individuals with hyperhidrosis have found some success with Botox treatments as well. A Botox injection is a relatively fast procedure which takes only about 10 minutes, yet can last for about six months. This will reduce sweating in some patients. Botox or Botulinum toxin has been used for 10 years in the United States of America for various cosmetic as well as medical procedures. The FDA approved Botox Cosmetic in 2002, but that was only after many years of research and development. In 1895 the bacteria “Bacillus botulinum” was identified by Professor Emile Pierre Van Ermengem of Belgium. Then in the 1920s Dr. Herman Sommer isolated Botulinum Toxin Type A as a stable acid precipitate. In the 1950s Botulinum Toxin Type A was discovered to reduce temporary muscle activity by blocking the motor nerve ending. During the 1960s and 1970s research and development continued as Botulinum Toxin Type A was used to treat crossed eyes called strabisum. Botox has been approved by the FDA for specific uses in the United States from 1989 through 2010. In 2004 Botox was approved by the FDA for Hyperhidrosis Treatment or Excessive Sweating Treatment.

Liposuction Treatment = Another procedure which is relatively new in treating excessive sweating is liposuction. This procedure disrupts the ability of the axilla to produce sweat. This procedure has also been shown to be successful in some patients.

MiraDry Treatment = Another new treatment for hyperhidrosis is known as the MiraDry Treatment. This procedure uses microwave frequencies to cook the sweat glands. This procedure is quite new, and because of this its effectiveness is unproven, and its side effects are unknown.

Lumbar Sympathectomy

One Hyperhidrosis treatment option has existed for a longer period of time is the Lumbar Sympathectomy. This surgery is done from the back, near the spine. The goal of this surgery is to stop feet sweating, but it may not be effective for some patients, depending on their anatomy. T3/4 is another option, although this can lead to increased head sweating and blushing. Some patients still experience persistent palmar sweating because the T2 neural pathway is still intact and carries nerve signals to the sweat glands in the palms.

Micro ETS = Some other treatments which are commonly used by hyperhidrosis specialists include Micro ETS and ETS-C. Micro ETS stands for Micro Endoscopic Thoracic Sympathectomy. This is done through a single incision that is only 1/12th of an inch. The lungs are not collapsed, and the pain is very minimal because there is only one tiny incision.

ETS-C = ETS-C is the essentially same procedure, but clamps are used to interrupt the sympathetic nerve. This procedure is supposed to be reversible, but is not for many people. The clamp crushes the nerve to the point that it is similar to cutting it.

SDLA = Sub-dermal Laser Ablation – SDLA – is a procedure that uses a 1 mm laser fiber under the skin which precisely targets the sweat glands.

Herb Treatment = One of the least intrusive treatments may be the new herb treatment. This is useful for minor to moderate cases of excessive sweating. Some like to try this option because it uses natural remedies. Some people are weary because this new herb treatment still has to prove itself. There are obviously a lot of different options for those who suffer with hyperhidrosis. The best option for one person may not work well for another person. The best way to make the decision is in consultation with a medical professional who is an expert in the field of excessive sweating.

ABOUT DR. DAVID NIELSON
Dr. David Nielson is a Texas based cardio-thoracic surgeon who specializes in micro-endoscopic chest surgery. Dr. Nielson is widely known as a hyperhydrosis expert and sweating specialist with his innovative, least invasive treatment for patients who suffer from (excessive sweating of the hands, face, and/or armpits, Raynaud’s Syndrome, and Facial Blushing. These conditions are all connected to an over-active sympathetic nerve chain.  Micro-endoscopic thoracic sympathectomy (Micro ETS), created by Dr. Nielson, is the least invasive, most advanced surgery for people suffering from these ailments.  One of the most experienced endoscopic thoracic surgeon performing ETS surgery, Dr. Nielson emphasizes that extensive ETS surgical experience is essential to eliminating excessive sweating of the hands, face, and/or armpits.