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Thread: Question about sweating/temperature

  1. #1

    Question about sweating/temperature

    Every day in the afternoon I start sweating....I feel heat below my level and am sweating, and above my level I'm freezing. The more I try to warm up the more I sweat. My skin is intact, I dont have a UTI(I checked) and it doesnt correlate with bowel care at all, so I dont know if it's AD. It seems to not happen when I'm already warm enough. What's going on? Dr. Wise or SCI nurse I would really appreciate your input. What can I do?

  2. #2
    even though u may not have a UTI, your bladder maybe spasming casuing your sweating.

  3. #3
    Most reflex sweating occurs at or above the level of spinal cord injury. While it can intermmittently occur below the level, frequent sweating below the level of the injury could be a sign of a syrinx.

    On the other hand, your occurrence is related to getting cold in the afternoon. This sounds like it is related to altered temperature regulation. Since it so predictable, have you tried to "warm yourself up" in advance? It is just a thought.

    The other thing to consider is a hormonal cause (with perimenopause or menopause) if you are a female in this age range.

    Have you discussed this daily occurrence with your MD? PLG

  4. #4
    jdk,

    Your description suggests that the sympathetic system below your injury site is overactive and over-responding to temperature signals from your brain. This is unusual because spinal cord injury usually reduces sweating below the injury site (Yaggie, et al., 2002). The medical term for the excessive sweating that you describe is hyperhydrosis or hyperhidrosis (both spellings are used) below the injury site. The autonomic function of sweating is called sudomotor activity. After spinal cord injury, the sweating reflexes generally remain intact. Stimulation of peripheral nerves below the injury site can activate sudomotor responses (Reitz, et al., 2002) but these responses are often less active than normal. From your description, I think that you must have some sympathetic signals going from your brain to the spinal cord below the injury site.

    So, what can you do about it? First, you should look again and see if you have any reason for increased excitability of your sympathetic nervous system below the injury site. Since it occurs in the afternoon, could it be related to your sitting for a long period, bowel, or other possible sensory input? Could it be related to your dosing schedule of bladder spasticity drug such as oxybutynin (Ditropan)? A drug called propantheline bromide (Pro-Banthine) has been reported to relieve hyperhydrosis (Canaday & Stanford, 1995). This is an anti-cholinergic drug, is similar to oxybutynin, and is used to bladder spasticity. I was thinking that if you take oxybutinin in the morning, the oxybutinin levels might dip in the afternoon and this might be associated with increased bladder spasticity and hyperhydrosis in the afternoon.

    In addition to some of the possibilities suggested by PLG below, there are other causes of hyperhydrosis (see http://www.manbir-online.com/hyperhydro.htm). According to the Mayo Clinic web site, local antiperspirants might reduce sweating (aluminum hexahydrate in alcohol, tannic acid solution, formalin solution, glutaraldehyde solution). Some reports have suggested that some anti-cholinergics, anti-depressants, calcium channel blockers, may also help. As a last resort and only if the sweating is localized to a particular region, botulinum toxin injections into sympathetic nuclei have been reported to relieve regional hyperhydrosis (Dressler, et al., 2002). Surgical sympathectomy by endoscopy (http://www.neurosurgery.pitt.edu/spi...tions/rsd.html) will also eliminate regional thoracic hyperhydrosis (Doblas, et al., 2003). I would not consider these options unless the sweating is truly bothering you and it is localized to a limited area.

    Wise.

    References

    • Yaggie JA, Niemi TJ and Buono MJ (2002). Adaptive sweat gland response after spinal cord injury. Arch Phys Med Rehabil. 83: 802-5. Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182-7251, USA. OBJECTIVE: To compare the eccrine gland cholinergic sensitivity of upper (UE) and lower (LE) extremities in untrained able-bodied individuals (UAB), untrained individuals with spinal cord injury (U/SCI), and trained wheelchair athletes (E/SCI). DESIGN: Static group comparison. SETTING: SCI population. PARTICIPANTS: A total of 25 men (mean age, 27.8+/-5.0 y; mean height, 175.8+/-9.1cm; mean weight, 76.2+/-7.7 kg) were categorized into 3 groups UAB (n=10), U/SCI (n=10), and E/SCI (n=5). Individuals with SCI had injuries ranging from C4-8. INTERVENTIONS: Peripheral sweat production was induced by using pilocarpine iontophoresis at surface landmarks relative to the flexor carpi radialis and medial gastrocnemius muscles. MAIN OUTCOME MEASURES: Peripheral sweat rate (SR), sweat gland density (SGD), and sweat per gland (S/G) were calculated for both UE and LE. RESULTS: Peripheral SR for the UAB in both UE (7.58+/-1.99 g x m(-2) x min(-1)) and LE (4.42+/-1.23 g x m(-2) x min(-1)) were significantly greater than those for U/SCI (1.08+/-1.01 g x m(-2) x min(-1), .24+/-.35 g x m(-2) x min(-1), respectively) and E/SCI (3.61+/-2.1 g x m(-2) x min(-1),.71+/-.81 g x m(-2). min(-1), respectively). Furthermore, the UE versus LE SR ratio was calculated at 1.71:1 for UAB subjects, whereas U/SCI and E/SCI subjects showed a ratio of 4.50:1 and 5.07:1, respectively. UE SGD measures in U/SCI (83.20+/-39.84 glands/cm(2)) persons were significantly less than either the UAB (120.20+/-21.42 glands/cm(2)) or the E/SCI (120.80+/-21.56 glands/cm(2)). CONCLUSIONS: These results may indicate that sweat glands below the lesion are less sensitive to cholinergic activation, regardless of central or exogenous stimulation. However, glands above the level of the lesion may exhibit increased productivity when individuals are exposed to physical training and physiologic stress.

    • Yaggie JA, Niemi TJ and Buono MJ (2002). Adaptive sweat gland response after spinal cord injury. Arch Phys Med Rehabil. 83: 802-5. Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182-7251, USA. OBJECTIVE: To compare the eccrine gland cholinergic sensitivity of upper (UE) and lower (LE) extremities in untrained able-bodied individuals (UAB), untrained individuals with spinal cord injury (U/SCI), and trained wheelchair athletes (E/SCI). DESIGN: Static group comparison. SETTING: SCI population. PARTICIPANTS: A total of 25 men (mean age, 27.8+/-5.0 y; mean height, 175.8+/-9.1cm; mean weight, 76.2+/-7.7 kg) were categorized into 3 groups UAB (n=10), U/SCI (n=10), and E/SCI (n=5). Individuals with SCI had injuries ranging from C4-8. INTERVENTIONS: Peripheral sweat production was induced by using pilocarpine iontophoresis at surface landmarks relative to the flexor carpi radialis and medial gastrocnemius muscles. MAIN OUTCOME MEASURES: Peripheral sweat rate (SR), sweat gland density (SGD), and sweat per gland (S/G) were calculated for both UE and LE. RESULTS: Peripheral SR for the UAB in both UE (7.58+/-1.99 g x m(-2) x min(-1)) and LE (4.42+/-1.23 g x m(-2) x min(-1)) were significantly greater than those for U/SCI (1.08+/-1.01 g x m(-2) x min(-1), .24+/-.35 g x m(-2) x min(-1), respectively) and E/SCI (3.61+/-2.1 g x m(-2) x min(-1),.71+/-.81 g x m(-2). min(-1), respectively). Furthermore, the UE versus LE SR ratio was calculated at 1.71:1 for UAB subjects, whereas U/SCI and E/SCI subjects showed a ratio of 4.50:1 and 5.07:1, respectively. UE SGD measures in U/SCI (83.20+/-39.84 glands/cm(2)) persons were significantly less than either the UAB (120.20+/-21.42 glands/cm(2)) or the E/SCI (120.80+/-21.56 glands/cm(2)). CONCLUSIONS: These results may indicate that sweat glands below the lesion are less sensitive to cholinergic activation, regardless of central or exogenous stimulation. However, glands above the level of the lesion may exhibit increased productivity when individuals are exposed to physical training and physiologic stress.

    • Canaday BR and Stanford RH (1995). Propantheline bromide in the management of hyperhidrosis associated with spinal cord injury. Ann Pharmacother. 29: 489-92. Department of Pharmacy and Medicine, University of North Carolina AHEC Program, Wilmington 28402, USA. OBJECTIVE: To report 2 cases in which oral propantheline reduced the discomfort associated with sweating related to spinal cord injury (SCI), and to review the literature on the management of SCI-related sweating. CASE SUMMARIES: Case 1: A 27-year-old quadriplegic man with an American Spinal Injury Association (ASIA) Frankel class C injury to C5/C6 experienced profuse sweating and requested propantheline. He stated that he had received the medication previously and reported that propantheline 15 mg tid had controlled his sweating. Propantheline bromide was reinstituted, and within 24 hours, the patient's episodes of profuse sweating had decreased markedly in number and frequency. Case 2: A 35-year-old quadriplegic woman had an ASIA class D lesion at C3. Since her injury, she had experienced profuse sweating that worsened when she became cold and at night. She stated that her sweating was under control as long as she took propantheline. Propantheline therapy was continued and no further sweating episodes have occurred. DATA SOURCE: A MEDLINE search was used to identify pertinent literature including reviews. Standard texts and texts referenced in the pertinent literature also were examined. STUDY SELECTION: All available sources of information were reviewed. DATA SYNTHESIS: The earliest case reports of systemic therapy for hyperhidrosis described the use of the anticholinergic methantheline bromide. Methantheline in combination with ergoloid mesylates also was suggested for the treatment of congenital hyperhidrosis. Local topical therapy for hyperhidrosis, such as aluminum chlorohydrate and aluminum chloride, the active ingredients in some antiperspirants, have been tried with some success. Talc, starch, and other powders have been suggested to absorb excessive sweat. Formalin and glutaraldehyde also have been used. Topical propantheline bromide has been used successfully in treating palmar and plantar hidrosis. Clonazepam has been used successfully in a case of unilateral localized hyperhidrosis. Systemic phenoxybenzamine has been used with some success and there have been attempt at other systemic therapy using mecamylamine, atropine, propoxyphenel, and methenamine. Scopolamine patches also have been used successfully in a small number of patients. Other agents that have been used include dibenamine, piperoxan, and phentolamine. Systemic propantheline also has been listed as an agent with potential efficacy in treating the profuse sweating associated with SCI, but was not recommended primarily because of adverse effects and difficulty in titrating to the lowest effective dosage. However, studies or case reports specific to the use of propantheline in patients with SCI appear to be lacking, as are reports of direct comparison between propantheline and other agents. DISCUSSION: Concerning the mechanism of action of propantheline bromide for hyperhidrosis, it seems reasonable to attribute its effects to the drug's well-documented anticholinergic/antimuscarinic actions. At dosages used to effectively treat neurogenic bladder, propantheline bromide also should block the muscarinic receptors responsible for sweat gland stimulation. Central nervous system adverse effects should be minimal at usual clinical dosages, as propantheline does not cross the blood-brain barrier. CONCLUSIONS: It would appear that in some patients with SCI who are subject to incidental episodes of profuse sweating, oral propantheline may offer some relief and may, in fact, be well tolerated, as in the cases described. Additionally, propantheline would seem a good therapeutic choice in SCI patients with excessive sweating and neurogenic bladder dysfunction who may derive dual benefit from the agent.

    • Dressler D, Adib Saberi F and Benecke R (2002). Botulinum toxin type B for treatment of axillar hyperhidrosis. J Neurol. 249: 1729-32. Department of Neurology, Rostock University, Gehlsheimer Str 20, 18147 Rostock, Germany. dirk.dressler@med.uni-rostock.de. Recently, botulinum toxin type B (BT-B) became commercially available for treatment of cervical dystonia. It is the aim of this study to explore its use for treatment of bilateral axillar hyperhydrosis (HH).For this we directly compared the antihyperhydrotic effect of BT-B (NeuroBloc)/MyoBloc) with that of botulinum toxin type A (BT-A) (Botox). 9 patients (HD group) received BT-A 100MU unilaterally and BT-B 4000MU contralaterally. 10 patients (LD group) received BT-A 100MU and BT-B 2000MU. All patients were blinded as to which preparation was used in which side.All patients except one reported excellent HH improvement in both axillae. None of the patients had residual HH on clinical examination. The duration of HH improvement until first recurrence in the HD group was 16.0 +/-4.3 weeks in the BT-A treated axillar and 16.4 +/-4.5 weeks in the BT-B treated axillae (Wilcoxon rank-sum test, p = 0.336). In the LD group it was 16.4 +/-5.3 weeks in the BT-B treated axillae and 17.1 +/-5.7 weeks in the BT-A treated axillae (Wilcoxon rank-sum test, p = 0.059). There was also no difference in the duration of HH improvement between the axillae treated with BT-B 4000MU and BT-B 2000MU (Wilcoxon rank-sum test, p = 0.712). 5 out of 9 patients in the HD group (chi-square test, p = 0.025) and 7 out of 10 patients in the LD group (chi-square test, p = 0.008) reported more application discomfort in the BT-B treated axillae. In 6 out of 9 patients in the HD group (chi-square test, p = 0.014) and in 6 out of 10 patients in the LD group (chi-square test, p = 0.014) the onset of HH improvement appeared earlier in the BT-B treated axillae. One patient in the HD group reported dryness of the mouth and eyes and accomodation difficulties.BT-B is a safe and efficient treatment for axillar HH. Doses of BT-B 2000MU per axilla seem sufficient indicating a conversion factor between BT-A and BT-B in the order of 1:20. With a conversion factor for cervical dystonia in the order of 1:40 the autonomic nervous system seems to be relatively more sensitive to BT-B than to BT-A compared with the motor system.

    • Doblas M, Gutierrez R, Fontcuberta J, Orgaz A, Lopez P and Criado E (2003). Thoracodorsal sympathectomy for severe hyperhydrosis: posterior bilateral versus unilateral staged sympathectomy. Ann Vasc Surg. 17: 97-102. Vascular Surgery Unit, Complejo Hospitalario de Toledo, Toledo, Spain. mdoblas@cht.insalud.es. The aim of this study was to compare the results of simultaneous bilateral thoracodorsal sympathectomy in the prone position with those of anterolateral sympathectomy performed in two staged, separate procedures for the treatment of bilateral excessive sweating of the hands and axillae, and to describe our technique for bilateral, simultaneous thoracodorsal sympathectomy. From July 1995 to March 2001, 202 thoracodorsal sympathectomies were done in 101 patients for severe hyperhydrosis. There were 79 females (age range 20-46) and 22 males (age range 19-65). In 52 patients, anterolateral sympathectomies were performed in the supine position, using unilateral lung collapse, with both sides operated on in two separate, staged procedures. In 49 patients, bilateral sympathectomy was conducted during a single procedure, in the prone position, without using unilateral lung collapse. In comparing the results from these two methods, we concluded that simultaneous bilateral thoracodorsal posterior sympathectomy, has comparable safety, may improve outcome, decreases in half the number of hospital admissions, and produces a significant overall reduction in cost when compared with staged anterolateral sympathectomy for the treatment of severe hyperhydrosis.

  5. #5
    Wow Wise. We both answered at the same time! Hello from California! Thanks again for all of your wonderful wisdom! PLG

  6. #6
    PLG, you are great. Wise.

  7. #7
    Senior Member
    Join Date
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    Location
    California
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    Just wondering, my Dad (C3-C4) perspires under his arms and under his thighs... when it's hot (lots of blankets) or when 'exercising,' so in these areas, it seems 'normal.' (that is, prior to the injury).

    Should he not be able to sweat on a regular basis? Or is the sweating capability also a situation of "each SCI is different" so my Dad may have retained his ability to perspire in these areas? Should I check other areas?

  8. #8
    Sweating from local heating (such as from a too heavy blanket) can still occur in many people with SCI. Whether or not someone sweats below the level of their SCI in relationship to fever or environmental (ie, air) temperature depends upon both the level of injury and the severity of the cord injury.

    If the injury is below about T7, and if the sympathetic nervous system tracts in the cord are still working some, then the person may still sweat nearly normally. It is pretty individual to the person.

    (KLD)

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