Imagine losing your job for this

Nurses across North America have been following the case of an experienced operating room nurse in Quebec who was fired around Christmas of 2005 for sweating too much at work. Today, an arbitration tribunal ruled in favor of the hospital’s firing. The hospital’s case centered on concerns that her sweat created a potential risk for infection in the sterile environment and her scrubs were damp even when she changed them during surgery.

Given Canada’s severe nursing shortage, it is puzzling why the hospital wouldn’t have done everything to keep a trained nurse or at least let her work in another capacity at the hospital. According to the Canadian Institute for Health Information, poor working conditions and increased workloads have been a major reason nurses have been burning out and suffering from high levels of stress. A 2006 CIHI report on Canada’s nursing shortage found that an average of 7% of experienced nurses leave the profession every year, yet new nurses are not entering the profession in sufficient numbers to keep up with growing demands of an aging population.

The hospital’s sole reason cited for firing her, according to the hospital’s lawyer, was her sweating. No other cases of nurses being fired for sweating were found in an online search, though. Might there be something more to this story?

Details in the press have been sketchy, but one point has dominated the headlines and public commentary: not her sweating condition, but the fact that she was fat. Regardless of the details of this case, which we’ll only learn when she tells her story, the soul-searching issue of this case is how it’s being used to perpetuate stereotypes of fat people as disgusting, sweaty and smelly.

Would a tall, slender, and gorgeous nurse or a prestigious doctor have been fired for having this sweating condition? Or was the fact she weighed 300 pounds a major factor in her firing and why she was not given a chance to contribute her nursing skills in another area of the hospital? Was she completely mortified, humiliated and run off?

The nurses’ union filed a grievance on her behalf, claiming her obesity was a handicap and the hospital should have accommodated her by assigning her to different duties. Her union was reported by Employment Law Today as saying: “health problems such as obesity are common among nurses due to stress and staff shortages.” In doing so, they, too, perpetuated more myths of fat people as unhealthy and that this rare sweating condition is something else to blame on obesity.

Not a single reporter researched this sweating condition, called hyperhidrosis, to report its actual etiology and the fact that it is not caused by obesity. Nor did the nurses union or any of the hospital medical professionals step forward with the known medical information on this condition — information that could stop the proliferation of yet more prejudice and revulsion directed at fat people, and hurting countless numbers.

The fact that no one cared to, no one thought to, and no one bothered to, says more about the prejudices endured by fat people than even this nurse’s firing.

Hyperhidrosis

This medical condition, a dermatologic and neurologic disorder characterized by excessive sweating, causes great distress and can also be an occupational liability for its sufferers, said Dr. Robert A. Schwartz, M.D., MPH, professor and Head of Dermatology, professor of medicine, pediatrics, pathology, preventive medicine and community health at New Jersey Medical School University Hospital. It begins in childhood or adolescence, affecting up to 1%, men and women equally. It’s twenty times more common among Japanese than any other ethnic group.

No cause is ever found in the majority of cases of primary hyperhidrosis, according to the National Institutes of health, although it appears to run in families. Several years ago, research led by Dr. Samuel S. Ahn, professor of vascular surgery at the University of California, Los Angeles, found it appears to be inherited as a dominant gene. Sadly, not unlike obesity, the medical community has long assumed sweaty palms is self-induced and stress-related or emotional, so that it hasn’t been taken seriously, he said.

Secondary hyperhidrosis can be a complication of medical conditions, such as cancers, febrile illnesses, carcinoid syndrome, medications (such as propranolol, physostigmine, pilocarpine, tricyclic antidepressants, venlafaxine), hyperthyroidism, lung disease, tuberculosis, menopause, Parkinson’s or Hodgkin disease, pheochromocytoma, neurological diseases, spinal cord injury, stroke, metabolic and cardiac disorders, and hypoglycemia. Localized conditions affecting the palms, soles of the feel and underarms, can also be in response to various tumors, syndromes, and peripheral neuropathies.

Nowhere is obesity listed as a cause.

Nor is it something under a person’s control or prevented simply by using antiperspirants and good hygiene. Prescription medications haven’t proven much of an answer, either. Anticholinergic and other drugs haven’t been well studied, according to the NIH, and include a number of side effects, including dizziness and difficulty urinating. Botox has been approved for injecting under the arm in an attempt to control sweating — except the FDA issued a warning on February 8th of botox being increasingly linked to adverse reactions, including difficulty swallowing, respiratory failure and death. Hardly risks to wish on anyone. Invasive surgical procedures have been tried, which involve collapsing the lung under general anesthesia and cutting the nerve associated with the sweat gland; but the risks include artery damage, nerve damage, and increased sweating, which occurs in half of all patients.

As Dr. Schwartz has written, the evidence shows hyperhidrosis itself is not linked to increased risk for death. Identifying possible rare medical causes can help those cases, but education and understanding can most help people avoid being victimized by ineffective treatments and needless shame. While extreme cases can be physical limitations in some job capacities, the condition primarily causes needless social embarrassment and distress. In a culture that is quick to judge and condemn those not meeting cosmetic ideals, it has a lot in common with obesity.

© 2008 Sandy Szwarc