DEAR DR. DONOHUE: My son has excessive perspiration, particularly in the head and torso. He literally drips water with the least exertion. Some time ago, while watching a science program, I saw two sisters who experienced the same symptoms my son has. The treating physician operated on the girls, and it stopped the phenomenon. Do you know the name of the procedure? – W.C.

ANSWER: Excessive sweating is called hyperhydrosis (HI-purr-hi-DROWE-siss). When it occurs in a few places, like under the arms, on the palms or on the soles, it is localized hyperhydrosis. When, as in your son’s case, it happens in a larger body area, it is generalized hyperhydrosis, and it’s more difficult to treat.

Illness like an overactive thyroid gland, some neurological conditions and infections such as tuberculosis and an unusual tumor – a pheochromocytoma – can be responsible for generalized hyperhydrosis, but usually it’s an idiosyncrasy in which the sweat glands are overly sensitive to acetylcholine. Acetylcholine is the chemical secreted by the nerve cells that control sweat glands. It activates the glands.

A 20 percent solution of aluminum chloride (a prescription item) applied to the skin where sweating is excessive can lessen it. It can be put on the face and back as well as the palms, soles and under the arms. The directions on its use have to be followed explicitly.

Medicines that block the action of acetylcholine can also work. A reader wrote to me that his life was changed by Robinul Forte (glycopyrrolate). Glycopyrrolate can be made into a 5 percent solution to be put on the skin, but a pharmacist has to make arrangements to prepare it. Clonidine and Ditropan are two other medicines that block the effects of acetylcholine.

The program you watched might have been on endoscopic thoracic sympathectomy. Through a viewing tube and with instruments inserted through a small incision, a doctor severs chest nerves that control sweating.

Your son can ask his family doctor for a referral to a specialist who does this kind of surgery – if medicines don’t work.

DEAR DR. DONOHUE: Two years ago, I had blood in my urine. I was referred to a urologist, who performed kidney X-rays and a cystoscopy. Nothing was found. My doctor said we would just watch it. The next year I again had blood in my urine. No one has followed up on this. Should I ask for more tests? – M.T.

ANSWER: You should ask for a definite opinion. The causes of blood in the urine, either visible or seen only with a microscope, are many, including cancer. You had a kidney X-ray, so that pretty much rules out kidney cancer. You had a scope exam (cystoscope) of the bladder, and that rules out bladder cancer.

You might have an innocent condition, one where red blood cells are found in the urine when it’s examined microscopically. For a hefty percentage of people with microscopic blood in the urine, no cause is found. However, the doctor has to let you know that all the important causes, like tuberculosis of the urinary tract, have been investigated. If they all have, then you can let things ride and have periodic examinations to see if anything has changed. It would be reasonable to seek the opinion of another urologist to see if a second cystoscopy with a biopsy is necessary.

DEAR DR. DONOHUE: Seven years ago, I suffered a cardiac arrest (a stopping of all heart action). Since then I have had exams with my cardiologist and have had periodic stress tests. Last week I ran up the stairs and my chest began to feel funny. I saw my heart doctor, and the choices were a stress test or angiogram. I chose angiogram, and it revealed two blockages in my heart arteries. My message is: so much for stress tests. – J.B.

ANSWER: We live in an imperfect world, and a world of imperfect medical tests. Stress tests are not infallible. They can give both falsely positive and falsely negative results. Women tend to have more falsely positive tests than men. You made a good decision. You are a special case. You lived through a harrowing heart catastrophe. You cannot take any chances. For others, stress tests are better than resting EKGs but not as good as having dye injected into heart arteries while X-ray pictures are taken – angiograms.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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