# Odd injury -- can't sweat. This ever happen to anyone else?



## ecox (Apr 7, 2006)

Hi there. I've stumped my regular doc and a dermatologist, and I'm wondering if anyone in the cycling community has ever had a similar injury.

In short, I can't sweat anymore. 

The longer version is this:

Two weekends ago, my wife and I rode our bikes from our home in DC to Annapolis, MD. It's a 30ish mile ride. I didn't drink much, and got very dehydrated. In fact, for about 5 miles, roughly miles 20-25, I stopped sweating and had goosebumps all over my body. We came across a gas station at mile 25, and I downed about 3 liters of gatorade. For the entire ride, I was wearing a backpack with our locks and changes of clothes in it. 
I made it to Annapolis, and we made it home (slower than usual, though -- I was still weak). It took about 24 hours before I peed. 

Since that incident, most of my body can't sweat. From the top of my head to about my chin sweats like normal, but my back, chest, upper arms, legs, and to an extent my forearms (they get a very thin sheen of sweat on them now with exercise). 

I did a quick 20 mile ride from my home in DC to Bethesda, MD along a bike trail. Usually I'd have to peel my sweat-soaked shirt and bike shorts off me. But since the dehydration incident a couple weeks ago, my shirt and shorts stay bone dry. I drink about 2 liters of water or gatorade before, during, and after these type of rides. 

Instead of sweating, I feel pinpricks under my skin, which I understand is the sweat trying to get out of my body, but can't due to plugged sweat glands. They present a red rash and zit-like things for a few hours after exercise.

We're pretty sure I have something called "Prickly Heat Rash" or "Anhidrotic Heat Exhaustion." My docs can't figure out why my head sweats like normal, and why the rest of my body doesn't. What's even weirder is that we rode 101 miles this weekend, and I stayed hydrated, but I didn't sweat, nor did my core body temp go up like you'd think it would when you can't sweat to cool off. 

All my bloodwork, electrolytes, etc are 100% normal. Anyone ever have this happen to them, or have an idea what the heck's happening to me?

Thanks,

Erik


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## Flyer (Jan 25, 2004)

Call a specialist at a good Univ Research/Medical center. Try the University of Maryland, for example. Some rare situations like this are not encountered by most docs or specialists. These universities can even reach out to other specialists around the country.

I'd start making some calls soon. You could overheat, have a heatstroke, and do permanent damage to your brain. Keep us posted and I hope everything gets back to normal.


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## SmashFace (Aug 4, 2006)

I'm not a medical professional in any way shape or form, I'm just talking out of my arse here. So first off, take Flyer's advice and see a specialist as soon as you can.

If you're keeping an eye on your body temp and it is staying normal, then I wouldn't think your body would be at risk of heat exaustion, dehydration or brain damage. Our bodies are only supposed to sweat to manage our core temperature. It sounds like maybe your sweating head might be enough to keep your temp down for now? I wouldn't do any long distance or strenuous riding until you get this figured out, just in case.

I hope you find out what it is soon and get it taken care of. Be sure to let us know all about it


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## AlliKat (Apr 28, 2006)

Are you fully hydrated now? As in, are you drinking at least 64oz a day when not exercising; preferably a gallon? If you're not drinking like that, you're probably still dehydrated. And I would make sure you're getting sufficient electrolytes.


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## WhoUtink (Apr 16, 2006)

Is it possible that because of the trauma your body recieved form your recent dehydration, your body is remembering and trying to retain any water because of it? Just sit on your but and get lazy for a week and see if next week you sweat again. Me = not a doctor, or have any clue


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## Nat (Dec 30, 2003)

So you are not sweating on any skin that is covered by clothing, but you are on exposed areas? I wonder if the clothing is playing a part in blocking sweat ducts?

Does it sound like miliaria to you?
http://www.dermnet.org.nz/hair-nails-sweat/miliaria.html
http://en.wikipedia.org/wiki/Heat_rash
http://www.emedicine.com/derm/topic266.htm

Does your skin look like this?


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## ecox (Apr 7, 2006)

Me again, the guy who started this thread. I spent some time yesterday searching for possible causes. I think I found it. 
I was on a medicine called Topamax, which treats migraines. I think the medicine induced the miliaria, which the dermatologist was able to diagnose. 
What we can't find out now is how long this side effect will last. I discontinued the Topamax. 

Topamax has the following warning:

Oligohidrosis (decreased sweating), infrequently resulting in hospitalization, has been reported in association with TOPAMAX®use. Decreased sweating and an elevation in body temperature above normal characterized these cases. Some of the cases were reported after exposure to elevated environmental temperatures.

The majority of the reports have been in children. Patients, especially pediatric patients, treated with TOPAMAX® should bemonitored closely for evidence of decreased sweating and increased body temperature, especially in hot weather. Caution should be used when TOPAMAX® is prescribed with other drugs that predispose patients to heat-related disorders; these drugs include, but are not limited to, other carbonic anhydrase inhibitors and drugs with anticholinergic activity.


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## Nat (Dec 30, 2003)

ecox said:


> Me again, the guy who started this thread. I spent some time yesterday searching for possible causes. I think I found it.
> I was on a medicine called Topamax, which treats migraines. I think the medicine induced the miliaria, which the dermatologist was able to diagnose.
> What we can't find out now is how long this side effect will last. I discontinued the Topamax.
> 
> ...


Good detective work! Half-life is 21 hours, so maybe it won't be too long before you're back to normal. Hopefully.

Edit: I just saw that you d/c'd the medication. How long ago?


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## eggraid101 (Mar 13, 2006)

I need to try this Topamax stuff...I hate sweating!


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## ecox (Apr 7, 2006)

eggraid101 said:


> I need to try this Topamax stuff...I hate sweating!


Another side effect is that it's an appetite suppressant. My wife wants to use my leftover...


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## ecox (Apr 7, 2006)

Nat said:


> Good detective work! Half-life is 21 hours, so maybe it won't be too long before you're back to normal. Hopefully.
> 
> Edit: I just saw that you d/c'd the medication. How long ago?


I was on 100mg/day. d/c'd it going 100-75-50-25-0mg over a 4 day period. Been off it for about 10 days.


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## MRfire (Jan 12, 2004)

ecox said:


> I was on 100mg/day. d/c'd it going 100-75-50-25-0mg over a 4 day period. Been off it for about 10 days.


So you didn't read the label before you started taking it? Hmm


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## endurowanker (Mar 22, 2004)

ecox said:


> Another side effect is that it's an appetite suppressant. My wife wants to use my leftover...


hey, send some o' that stuff my way. i'm fat and sweaty. :madman:


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## TurboasT4 (Oct 2, 2004)

endurowanker said:


> i'm fat and sweaty. :madman:


The first step is always acceptance....


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## endurowanker (Mar 22, 2004)

TurboasT4 said:


> The first step is always acceptance....


maybe i could lose some weight if i wasn't always waiting for your ass to catch up.


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## tozovr (Jul 26, 2006)

I was on topomax and I sweat like a ******* trying to read.

Did it induce actual malaria or similar symptoms?


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## Nat (Dec 30, 2003)

tozovr said:


> I was on topomax and I sweat like a ******* trying to read.
> 
> Did it induce actual malaria or similar symptoms?


Miliaria, not malaria!


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## JKWITS (May 8, 2006)

wow.

this is/was a fascinating post. Thans for sharing. I would have totally freaked out. 

I reckon its wierd that some people sweat more than others. I sweat like a [email protected]


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## LyNx (Oct 26, 2004)

Love all these wondeful new medications that have a " few mild side effects"  Let's see get rid of the migranes but loose the ability to sweat. I always love listening to the commercials for most drugs these days "will help stop ***** but may include some side effects like headache, nasiau (sp?), cramping, bloating, itching, rashes, constipation etc etc". Glad I don't need to be taking any of that stuff and only on the very rare occasion take a panadol.


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## jlang002 (Jan 10, 2005)

double


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## jlang002 (Jan 10, 2005)

MRfire said:


> So you didn't read the label before you started taking it? Hmm


Rare side effects are not on the data sheet. Guess you didn't read it either.


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## MRfire (Jan 12, 2004)

jlang002 said:


> Rare side effects are not on the data sheet. Guess you didn't read it either.


Guess I wasn't taking it either.......and if I was - I certainly would have done some thorough research


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## jlang002 (Jan 10, 2005)

MRfire said:


> Guess I wasn't taking it either.......and if I was - I certainly would have done some thorough research


So I guess he shouldn't have taken a med to alleviate migraines because miliaria was a rare side effect in pediatric patients? Dude, get real. Virtually every prescribed med has side effects.


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## MuDPhuD (Sep 10, 2006)

I had some friends on Topamax....We call it Dumb-amax, for some reason in some people it makes them fumble for words....


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## MRfire (Jan 12, 2004)

jlang002 said:


> So I guess he shouldn't have taken a med to alleviate migraines because miliaria was a rare side effect in pediatric patients? Dude, get real. Virtually every prescribed med has side effects.


I would just go to my witch doctor in India.......


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## Fat Elvis (Jan 14, 2004)

ecox said:


> Me again, the guy who started this thread. I spent some time yesterday searching for possible causes. I think I found it.
> I was on a medicine called Topamax, which treats migraines. I think the medicine induced the miliaria, which the dermatologist was able to diagnose.
> What we can't find out now is how long this side effect will last. I discontinued the Topamax.
> .


Lord, migraines totally suck. I get them occasionally, unfortunately it happens from time to time when I'm riding. I'm pretty much screwed then.

A good buddy of mine was sitting at home watching tv one evening, when he realized he couldn't swallow. Imagine how scary that is. He spent about a week in the hospital, being fed through an IV and having to spit in a jar all of the time. Fortunately, after a week or so he was able to swallow again. They diagnosed him with having a minor stroke, which didn't have any serious lingering effects. He was lucky. The thought of not being able to sweat is unpleasant, but not being able to swallow really gives me the willies. Just thought that I'd pass that along. :eekster:


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## willis.4 (Apr 22, 2005)

Thought I may be able to ring in on the migranes (or however you spell it) while you ride.
My background, well I'm a current College Track and Field Athlete and avid mountian biker, I am in no way a Dr. or should you take my advice in that way.
Well first off Gatorade, isn't the greatest gift to earth, so if that is all that you are drinking before after or durring your ride, this could be your number one problem, stick to good old water. If you drink too much Gatorade, the sodium levels can actually cause you to dehydrate yourself even more (there is also the risk of overhydration, it is a real thing). Also a better sports drink and cheaper on is powerade, it contains way less sugar and a little less sodium so you will be better off sucking down on that than just plain old gatorade, but there is no substitue for water, dispite what anyone says. As far as the head aches, well you know those nights when you decide to kick back and drink a few, well when you drink beer you don't keep the water, and in the morning you have a killer head ache. Well If you don't drink enough water durring your exercise you are basically giving youself a hangover without even drinking since the hangover is casused by a lack of hydration to the brain. I know most of this not due to drinking but being a runner, I won't eat and barely drink on the day of a competition, so I end up well number one running out of energy(I only have to run 400m), and two getting one hell of a headache. So the best way to solve your problems with headaches, drink more water, and make sure you eat plenty of good food before you ride, this will keep you a happy rider.


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## dr.dirt (May 4, 2004)

*Bollocks*

Thought I would dispell a few points

"If you drink too much Gatorade, the sodium levels can actually cause you to dehydrate yourself even more (there is also the risk of overhydration, it is a real thing)."
-The sodium concentration is gatorade is less than that of serum. It will not cause an increase in your sodium concentration. Overhydration is also know as water intoxication, and as the name implies is due to free water load, not sodium. The most feared and deadly complication of sports and electrolytes is hyponatremia which has resulted in the deaths of a number of athletes, primarily novice marathon runners who diluted out their sodium by drinking too much water. There are volumes of research demonstrating the advantages of electrolytes in sports, and even more real time experience by athletes. Another huge problem in endurance athletics is muscle cramping which while related to a laundry list of issues, is predominanatly related to potassium and calcium. Repleting these both during and after training/racing is a pivotal aspect of proper training. There is also a bunch on glycogen and amino acids that I won't go into here.You're in college check out some chemistry and sports physiology while you're there.

"since the hangover is casused by a lack of hydration to the brain." 
Is caused by the accumulation of a alcohol metabolite, if memory serves it's acetyl aldehyde but could be wrong. While dehydration may play a role, the effects are much more due to metabolites than dehydration.

Very interesting on the topomax. Always a roll of the dice when you go on a new med. While not a migraineur myself, I have seen and treated enough to appreciate the lengths one would go to reduce the likelihood you would have more attacks. Good luck with finding the right therapy, guess Topomax wasn't it. Being a cyclist and staying active is prob doing you a world of help in and of itself.


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## kira (Jun 26, 2006)

Please correct me if I am wrong Dr. Dirt, (just a ditzy blonde here!) but I thought the reason you want to avoid those simple sugar sport drinks is because they must be diluted to a certain extent to be absorbed while you are excercising. If they are too concentrated, your stomach pulls fluid from other body tissues in an attempt to dilute them so they can be absorbed. Isn't that something to the effect as to why sugar based sports drinks can lead to dehydration whereas compex carbs are easier to absorb while riding?
Also, I used to have (and still get if not careful) migraines after rides. I started taking electrolytes when riding and I no longer have the problem. If I do feel the sensation after a ride, I take a few more, and it usually causes the headache to stop. I don't know when you get your migraines but it may be something to ask your doctor about. There are more electrolytes than sodium so be careful to get something that will replace them all.


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## dr.dirt (May 4, 2004)

*stuff cont.*

I thought I was the ditzy blond.
Water, sugar and electrolyte transport in the gut is really complex and I am hardly an expert on it. But there are some general concepts that can help here.
Most water doesn't get absorbed from your stomach. But the stuff that does follows osmolar gradients. Osmolarity is the total concentration of solute particles (sugars, electrolytes and protein mosty) in water. Your serum is around 290 mOsm/kg; sports drinks are often in the 300-330 range. If you drink straight water then it will get absorbed faster, no question about it. With sports drinks initially you will lose water into your stomach. Don't get freaked out here though, this is not the main place things are happening. The stomach is more a holding tank, the rest of the gut does the hard work. Most of the water gets brought in later on in the GI tract (typ your small intestine although a lot comes in your large intestine too) through a specialized transport protein. This transports sodium and sugar into the cells lining the GI tract, creating an osmolar gradient. water then follows this gradient into the body. You're right, if you drink a lower osmolarity fluid (protein drinks for example) you can hydrate faster in the gut as well. But you are not transporting salt and sugar into your body....which are the very things you are losing through metabolism and sweating. Don't just think of your water bottle as hydration; think of it as fuel. 
There are a lot of information and disinformation about nutrition and hydration. What is clear though when these things have been studied in cyclists specifically; sugar solutions around 6% result in improved performance. Adding protein to it never has shown a clear advantage (as far as I have read.) There are studies here and there but no consensus. The electrolyte issue is real though. You gotta get salt into your body when you are exercising. Small imbalances can result in headaches, nausea etc... Makes sense you have probs with your migraines when you don't replete them as judiciously.


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## narsol (Oct 21, 2006)

I read about a kid a few weeks ago who had a dissorder where his pain sensor neurons did not work. as a result his body had no way to monitor his body temperature and he did not sweat. It could be very dangerous to him because he got heat exhaustion easily. Maybe after your incident you had somehow damaged heat monitoring neurons, and your body is not as good at regulating your temperature.

how long ago did this happen? if it is something to do with neurons that monitor body temp they might not nessisarily be damaged. neurons have relative responses. If you overwhelm them they reset themselves so that they need a much bigger trigger than normal to fire. If that is the case they might return themselves to normal after a while so long as you dont dehydrate yourself badly again.

this is all just speculation though.


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## minnmirman (Nov 1, 2005)

HEAT RAAAAAAAAAAAAAAAAAAASH

Man I got heat rah reeeeal bad once in basic training. Here is what happenes from what I gather. I had a period of extreme heat and sweat, followed by a very fast cooldown when it rained. All of my pores than closed, trapping dirt? inside. After this whenever I moved I'd have terrible pain and prickliness with red dots and bumps. The way I made it go away was hot showers every day, like a lot hotter than usual. And long ones. This apparently makes your pores open up, and aftera few days it went away.

I also had to go to the emergency clinic in basic once for extreme dehydration which was accompanied by a migraine. All they did was stick a couple liters of IV fluid in me, and after a couple hours of that I was good to go!


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## fourtyounce (May 2, 2006)

I have a friend that's in the army as a medic. He says that whenever he dehydrates (prolonged exercise, hangover), he hooks himself up to an IV before sleeping and is ready to go in a few hours. Also, I add 32 oz. Gatorade before topping my camelback off with water before I ride and have never had any resulting headaches and never a problem sweating. 

Excellent thread.


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