I never thought much of the axillae – or armpits – before becoming a doctor. They were ticklish, they sweated, I sometimes got round to shaving them. During my first year as a medical student, however, I stood over a cadaver and learned about the eponymous lymph nodes, artery and vein, contained within, plus parts of the brachial nerve plexus.
A few years later, as a general surgery junior, I realised their importance. A man was rushed by ambulance into A&E, after having slipped while putting out his rubbish. He was carrying the bag under one arm when a bottle broke and a single shard stabbed him in the armpit. It took the vascular surgeons hours to find the piece of glass that had entered his axilllary vein and was making its way towards his heart.
Later while working in a dermatology clinic, I met a patient suffering from hidradenitis suppurativa. This disease affects the skin of areas of the body bearing sweat glands. It causes inflammation, discharge and chronic scarring. Although antibiotics and steroids can provide relief, for this young man the only treatment that proved successful was the removal of all hair-bearing areas of his axilla.
In the past month I have also learned how to administer Botox there, to treat excessive sweating. The patient lies back, hands behind their head as I clean each axilla with iodine. I mix the Botox with saline, drawing it up into two syringes, each tipped with a tiny, yellow needle, then inject it at multiple points across the armpit. This works by blocking the chemical responsible for sending signals from the sympathetic nervous system to the sweat glands. As most patients enjoy relief from their symptoms for six to 10 months, this is a very satisfying procedure to perform.