SCI and Sweating

SCI and Sweating

Posted by Jenn on Oct 3, 2018 10:23 am

Hi Nurse Linda,
Posted below is a question someone has for you, thank you so much for any feedback or help you can provide.
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Dear Linda, I am 47 years post injury C5 C6, and I am recently experiencing excessive sweating that is not from autonomic dysreflexia. I've had episodes in the last couple years and was checked out for a syrinx problem but my MRI showed nothing. My urine is to clean, my bowel movements are regular, and I have no skin problems and have been blessed not to have them throughout the years except for minor abrasions (thanks to a bold nurturing mattress).. When I go through the success of sweating my blood pressure is still my usual low 90/60.

After peristalsis though I have a lot of pain in my gut and it seems like I keep sweating all day and it is really interfering with my going to work again. A top neurologist who who directed the rehab unit at the Cleveland clinic is suggested a stellate ganglion block, a temporary anesthetic procedure that I will be attempting.

Linda I am wondering if you have heard of any other treatments for excessive sweating. I've done a lot of research on the subject and there have been studies done were significant percentage of quadriplegics have excessive sweating even when they are not having autonomic dysreflexia. Have you seen any good solutions for this? I have also heard about a patch that is supposed to help. Do you know of any surgeries for this? It really is interfering with my active life.

Thank you in advance Linda for any wisdom you can add on this topic.

Nancy Becker Kennedy

Re: SCI and Sweating

Posted by AskNurseLinda on Oct 3, 2018 9:06 pm

Hello, Nancy, you pose a great question. Sweating below the level of spinal cord injury is not supposed to happen, of course until it does. There are many individuals with spinal cord injury that have issues with excessive sweating. Sometimes, it is continuous and sometimes intermittent or off and on.

Excessive sweating can lead to loss of magnesium, a mineral in the body that can affect kidney function. Early signs of magnesium deficiency are nausea, vomiting, loss of appetite, fatigue and weakness. It can progress to serious health consequences.
Excessive sweating is profuse sweating, more that just the normal of people who sweat without activity. You know it when you have it. Typically, people will have to change clothes and bed coverings because they are actually soaking wet.

There are external and internal causes for sweating. Your equipment could be the culprit if it is not allowing ventilation to be circulating where you are laying or sitting. Most medical equipment accommodates for this but pillows and other home use devices for positioning or comfort do not.

Some medications can lead to excessive sweating. These include dopamines, antidepressants, antipsychotics, insulin and alcohol. Check your medication list with a healthcare professional or pharmacist. If you have any of these medications on your list, discuss alternatives. Withdraw from alcohol use or excessive sugar consumption to see if this helps. You do not want to stop alcohol suddenly but cut down slowly.
Some undiagnosed problems can lead to excessive sweating. These might be diabetes, hyperthyroidism, Parkinson’s Disease and some tumors. Unfortunately, individuals with spinal cord injury can also have these diseases which might appear with less obvious symptoms due to paralysis.

The autonomic nervous system is in control of sweating which is an automatic function of the body. The autonomic nervous system is typically given the credit for excessive sweating with or without spinal cord injury because it is the source of control. This is why Autonomic Dysrelexia (AD) is first though about with excessive sweating.

The most common symptom of AD is known by most as an elevated blood pressure and pounding headache. However, there are many other symptoms that can be indicative of AD without the elevated blood pressure and headache. These include fast or slow heart rate (pulse), stuffy nose, apprehension, changes in vision, flushed skin, goosebumps, tingling and sweating. Any of these other symptoms can appear in any combination or just by itself. So, you could have AD with the only symptom of sweating.

Check to see if you might have any of the causes of AD such as an undraining or overflowing bladder or irritated or constipated bowel. Pressure injury or pressure on the skin can also be a trigger. Wrinkled sheets or too tight of clothing, waist bands or shoes are culprits. Sometimes, orthotics can be too tight or not positioned carefully. Odd things have been known to set off AD such as computer or cell phone use from the effects of backlighting of the screen. Electrical currents can affect these much more even though we cannot physically see changes, the brain notices them. Air currents from heating or cooling units can trigger AD.

Check to see what is going on with your body when one of the sweating episodes occur. See if you notice any sort of pattern of being in a particular room, doing a particular activity, if it is just before catheterization time or a bowel program, something you eat, if the humidity is high. This is a challenge to look for something in the middle of everything, but you might find a trend that can be changed thereby reducing your sweating.

There are medications called anticholinergics that reduce sweating. These are both oral and topical (applied to the skin where the excessive sweating is happening). Some people find this will help, but the oral medication will travel through your system, so some people do not like those effects. You can try them for awhile and see if they work for you.

Botox, which seems to be used for everything these days, is an effective treatment for excessive sweating. It is injected in the area of concern. It has to be repeated periodically although some people find after a few treatments, it is no longer necessary. Others stay on the botox treatment for a long time.

The higher level of treatment is the injections you have had suggested. I don’t know what you have tried so far but these other treatments might be less invasive. It is important to talk with your healthcare professional to see what is right for you. If you have tried the lower level treatments, you might be at the point to move ahead with the injections.

If you think you have an idea about an AD trigger, long term treatment of AD can be tried as well. I know this will give you a lot to think about. A spinal cord injury specialist reviewing your case would be helpful. AD is a sneaky situation, especially when the symptoms are not the high blood pressure and headache. Many people think they do not have it without these symptoms, but the evidence is demonstrating more and more of the other symptoms in isolation especially when combined with technology. Let us know how this turns out. I think you are going to be a great source of information about this for others. Nurse Linda

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