Wet hands can be troublesome at best, but extreme idiopathic hyperhidrosis leads to depression. Patients who are not helped by any therapy look for their chance on the Internet. It may happen that a single accidental medical item saves a life.
Janet Ruddock felt devastated: she had long waited for the moment when she would be able to take her first grandson in her arms, but it turned out that this unrepeatable incident had worsened an ailment that had plagued a woman for nearly a decade. In June 2010, Ruddock, then 59, flew to Vancouver with her husband to welcome a new family member. However, when the couple arrived at the scene, Mrs. Ruddock began to sweat terribly. When she finally sat down in the armchair with her grandson in her arms, she only felt a wave of sweat flood her head and upper body, drenching her T-shirt and soaking her four-week-old baby in the process.
“I cried,” remembers Ruddock. – At that moment, I could only think that I was all wet, this poor child is also wet, and the event that should have been one of the most beautiful in my life was irretrievably destroyed. Nothing could fix it anymore.
This unpleasant incident only increased the woman’s suicidal thoughts. For eight years she had been undergoing various examinations in vain, taking medications, had to deal with the disbelief and surprise of the doctors to whom she reported in the case of unpredictable and exceptionally strong bouts of sweating. Once the whole family knew her embarrassing secret, Ruddock sought treatment from a psychiatrist. By coincidence, months later she found out about a woman whose dot-to-dot experiences resembled her own. Only then did she gain hope for effective help.
“The case of this patient was absolutely unique,” said Charles Abrams, a Washington internist who has been looking after Ruddock for several years. – We usually hate people who consult with the revelations they read on the internet. And yet it happens sporadically that information from the Internet leads us to the trail.
Ruddock, the wife of a Canadian diplomat, patiently endured the hot flashes that began to plague her around 2001. Once, while visiting a friend, a woman experienced a five-minute bout of sweating. – What happened? The friend looked at Ruddock with concern. It was summer, but the heat did not explain it enough: the Ruddocks spent many years in diplomatic missions in three African countries where sweating was not a problem for them. Now the disturbing symptoms could finally be treated as a result of the menopause … “But nothing like this is happening to us,” replied friend Ruddock. – What does your doctor say?
Ruddock hadn’t had time to talk to the doctor about it yet. She assumed that bouts of sweating of varying intensity, lasting from a few seconds to more than five minutes, would subside over time. However, a year passed, and the waves of sweat not only did not fade away, but with time became even more unpleasant for the patient, especially in public situations.
First, Ruddock visited her internist in her hometown of Ottawa. After a series of detailed examinations, she heard that she was fine. The best she could do was take hormone replacement therapy, which sometimes reduces the hot flashes. When the first drug did not work, the doctor prescribed another, but the treatment turned out to be ineffective. Ruddock began to keep a diary of disturbing symptoms, but saw no correlation: the wave of sweat was not caused by heat, or stress, increased activity levels, or the time of day. The woman had better weeks when sweating wasn’t bothersome, but there were days when, after a sudden attack, I looked like I’d just got out of the shower. Mysteriously, even with extreme sweating, the woman’s hands, armpits, and the soles of her feet remained dry.
In 2003, an attack struck her in the office of an endocrinologist who confirmed that such symptoms were an anomaly. The specialist then ordered the patient a series of analyzes for cancer, diabetes, infectious diseases such as tuberculosis, and also ordered the thyroid gland to be checked, suspecting it was overactive. Ruddock performed scintigraphy, magnetic resonance imaging and computed tomography.
But as early as 2004, three eminent specialists admitted their helplessness, says Ruddock. Meanwhile, even in the cold Canadian winters, the woman wandered around the house in a sleeveless T-shirt, and the art of calming friends who happened to see her sweating led to the championship. However, she herself felt terrible entering the restaurant in the summer dressing room in January and understanding what impression it made on the other guests. Especially since Ruddock didn’t feel like explaining her problems to further friends and strangers. “Why would I tell them all I’m sweating?” It’s so embarrassing, she notes.
By 2005, Ruddock developed anxiety related to his fear of another attack. She visited a psychiatrist who prescribed her a number of medications, including antidepressants: they helped with anxiety, but not the sweating itself. The endocrinologist again referred the patient for tests, and again, nothing was found. (…) Then the doctor suggested that maybe Ruddock was simply exaggerating. His suggestion was obvious: learn to live with it. – I felt like a hysterical woman during menopause who cannot cope with symptoms that are tolerable to the rest of women – recalls the patient. She stopped taking hormones and tried to face the unpleasant ailments on her own.
In 2009, just before moving to Washington, a woman was diagnosed with high blood pressure. She was then prescribed medications that mysteriously reduced the patient’s sweating. (…) Unfortunately, in 2010 the unpleasant symptoms worsened, forcing her to seek help. “Before I left, I put on makeup, which was running down my face before I even got to the door,” she says. In response, the Washington doctor increased her dose of the antihypertensive drug and recommended anti-depressants. Soon after, a nasty incident occurred while visiting her granddaughter in Vancouver that left Ruddock completely broke. “I came to the conclusion that I don’t want to live anymore and that it can’t go on like this,” she recalls.
The husband insisted that she seek help from a psychiatrist again. Ruddock first consulted her brother-in-law, also a doctor: she sent him a list of medications she was taking, wondering if any of the measures were responsible for her condition despite the reassuring reassurance of specialists. One of the antidepressants turned out to be suspicious: it might be responsible for the increased sweating. Ruddock put it down and felt a little better.
However, on one beautiful summer afternoon, the woman and her husband went for a walk with her husband. After two severe bouts of sweating, they had to rush home. “I just thought that others might enjoy the weather, but not me, and I will never be part of this joy,” she recalls. Out of regret, she went to bed, where her husband found her two hours later. He came with the printout in his hand: “Read, it’s about you,” he said.
Frank Ruddock had been searching the Internet for a long time, hoping that he would find information that might help his wife. He accidentally found an article from 2006 by doctors in Amsterdam. They reported the case of a 56-year-old woman suffering from idiopathic general hyperhidrosis – profuse sweating of many parts of the body without a medically established cause – who was helped only by oxybutynin prescribed for her urinary problems. A six-month treatment with this agent in a person who had not been able to leave the house before without a few sweat towels, brought excellent results: the unpleasant ailments disappeared.
Dutch doctors suspect that the effectiveness of oxybutynin was due to its ability to block acetylcholine, which is responsible, among others, for the increased work of the glands. Despite this, the measure has not yet been approved for the treatment of hyperhidrosis, neither in Europe nor in the USA. “The antiperspirant properties of oxybutynin were mentioned in the literature only by the way,” wrote the Dutch, encouraging clinical trials on the safety and efficacy of the drug in hyperhidrosis patients. In a situation where excessive sweating affects larger parts of the body, and not only its elements (such as hands, feet or armpits, where botox, antiperspirants or, in extreme cases, surgical methods can be used), until recently doctors and patients had only hormonal drugs.
Ruddock read the article and was speechless. On the advice of a psychiatrist, she changed her internist and decided to seek the care of Dr. Abrams. Upon reading her impressive medical history, the new doctor initially suspected the psychological basis of the disease. “She looked exhausted, but otherwise she wasn’t as bad as she said,” Abrams recalls. – I was convinced only by the husband of the sick, who confirmed her version and told me about how often my wife soaks her blouses. (…) It must have been extremely onerous, especially for the wife of a diplomat, who has to appear in public often.
In September 2010, the Ruddocks came to an appointment with an article by Dutch doctors and asked them to try their method. The internist wrote a prescription, although until now he recommended oxybutynin only for urinary problems. (…) “To tell you the truth, I saw no reason not to try,” Abrams says, adding that due to Ruddock’s excessive sweating she was unable to enjoy life. The patient had already been tested for many diseases, and she ingested hormones that increased the risk of cancer without even needing to be taken.
The effect of the new treatment surprised Abrams. As early as five days later, the troublesome sweating had completely stopped. Three years have passed since then, and Ruddock takes oxybutynin daily. There are no problems with sweating. She complains of dry mouth and knows she’s more at risk of overheating in the heat, but overall Ruddock feels as if she’s back to normal life years later. In 2011, she was able to play with her granddaughter without the unpleasantness she experienced the first time.
She is deeply grateful to the doctor for agreeing to the therapy found on the internet. “Many specialists do not want the patient to come to them with a ready-made proposal,” she notes. “Fortunately Mr. Abrams was not a routine and willing to take the risk.
The internist himself admits that he initially reckoned with the placebo effect: because Ruddock believed so strongly about the chance of recovery, she could feel better. “She handed me a ready-made solution,” he said. – And yet it is the good cooperation between the doctor and the patient that often determines the effectiveness of the therapy.
Tekst: Sandra G. Boodman