An information resource on ETS surgery and its potential side effects

Serotonin syndrome can be the cause of excessive sweating - and this can be remedied WITHOUT ETS surgery

2011-11-03T23:14:00.003+13:00

New Zealand's weekly publication The Listener recently published an article on the use of antidepressant drugs in New Zealand. These drugs are also known as selective serotonin re-uptake inhibitors (SSRIs), Tricyclic antidepressants (TCAs), and Monoamine Oxidase Inhibitors (MAOIs).

The SSRI medicines available in New Zealand are:
Citalopram (brand names: Cipramil, Celapram) · Escitalopram (brand name: Lexapro, Cipralex) · Fluoxetine (brand names: Fluox, Prozac, Apo-fluoxetine, Lovan, Plinzene, Flexetor, Fluohexal) · Fluvoxamine (brand name: Luvox) - not marketed · Paroxetine (brand name: Aropax) · Sertraline (brand name: Zoloft) · Venlafaxine (brand name: Efexor)

Tricyclic antidepressants available in New Zealand are:
Amitriptyline (brand name: Amitrip) . Clomipramine (brand name: Anafranil, Apo-clomipramine, Clopress) . Desipramine (brand name: Pertofran) . Doxepin (brand name: Anten) . Dothiepin (brand name: Dopress) . Imipramine (brand name: Tofranil) . Maprotiline (brand name: Ludiomil) . Mianserin (brand name: Tolvon) . Noritriptyline (brand name: Norpress) . Trimipramine (brand name: Tripress, Surmontil)

Other antidepressants available in New Zealand are:
Mirtazapine (brand name: Remeron) . Moclobemide (brand name: Aurorix, Apo-moclobemide) . Reboxetine (brand name: Edronax) . Tranylcypromine (brand name: Parnate)

Please note, there may be other antidepressant drugs available in NZ that are not listed above.

According to the issue of The Listener published for the week of October 22 - 28, 2011, the prescribing of antidepressants has grown 40% here in the past five years. Pharmac estimates that 400,000 New Zealanders, or 10% of the population, are on antidepressants.

So how does this relate to hyperhidrosis (excessive sweating) and ETS surgery?

Last year, I became aware that the use of antidepressant drugs can cause serotonin syndrome in some individuals. Serotonin syndrome is a potentially life threatening drug reaction that causes the body to have too much serotonin, a chemical produced by nerve cells.

A common symptom of serotonin syndrome is excessive sweating not caused by physical activity.

Other symptoms of serotonin syndrome include:
agitation, diarrhea, fever, mental status changes such as confusion or hypomania, muscle spasms (myoclonus), overactive reflexes (hyperreflexia), shivering, tremor, unco-ordinated movements (ataxia)

If you have taken or are taking an antidepressant drug and have begun to experience excessive sweating, then suspect serotonin syndrome as the cause and seek help from a caring medical professional.

Do not let anyone diagnose you with hyperhidrosis and talk you into having ETS surgery without having investigated the possibility of serotonin syndrome being the cause of your excessive sweating.

The Kiwi ETS Group is aware of at least one New Zealander who had ETS with Dr Murray MacCormick for short-duration, excessive facial sweating that developed in middle-age. After having ETS, the patient went on to develop debilitating compensatory sweating that soaks through their clothes daily - a not uncommon side effect of ETS. An Auckland dermatologist who reviewed the patient's medical history post-ETS surgery concluded that they believed the patient had not been afflicted with hyperhidrosis but had in fact been suffering from serotonin syndrome as a result of the high dose of Aropax (an antidepressant) they had been taking over a two-year period before they had ETS surgery. Other typical symptoms of serotonin syndrome the patient had displayed were tremor and ongoing diarrhea.

A gradual adjustment in the dosage of Aropax this patient was taking, or a change in drug therapy, would likely have addressed the antidepressant side effects (serotonin syndrome) the patient was evidently experiencing. Instead, Dr Murray MacCormick, a private surgeon, diagnosed hyperhidrosis and performed ETS, irreversibly cauterising the patient's nervous system.

ETS is considered an absolute last resort option for someone with primary hyperhidrosis (not this patient) where all other alternative and less invasive treatments have been tried and failed (not this patient).

You can read more about the causes, symptoms, risks of, and treatments for serotonin syndrome here: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004531/

Information for Australian ETS patients wanting to investigate making a formal complaint

2011-09-29T16:15:00.000+13:00

Here are links for the various health complaint bodies in Australia.

www.hrc.act.gov.au
The Australian Capital Territory Human Rights Commission (established on 1 November 2006) has absorbed the functions of the former ACT Human Rights Office and the Community and Health Services Complaints Commissioner's Office, as well as having new functions in the area of disability services, and in relation to children and young people.

www.hccc.nsw.gov.au New South Wales Health Care Complaints Commission

www.hqcc.qld.gov.au Queensland Health Quality and Complaints Commission

www.healthcomplaints.tas.gov.au Tasmanian Health Complaints Commissioner

www.health.vic.gov.au/hsc/ Victorian Health Services Commissioner

www.healthreview.wa.gov.au West Australian Office of Health Review

www.hcscc.nt.gov.au/ Northern Territory Health and Community Services Complaints Commission

Plus this is a useful site:

http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/contact-us-1lp

A natural treatment option for those suffering from severe/disabling compensatory sweating after ETS

2011-09-23T14:24:00.001+12:00

Please follow the link below to the second ever post that was published on this blog, which is Briton Chris Carter's account of how he recovered, over a period of approximately one year, from ETS side effects - including severe compensatory sweating - by making long-term changes to his eating habits.

http://kiwietsgroup.blogspot.com/2010/01/in-case-anybody-reads-comments-on-above.html

"After one-and-a-half years of all these terrible side effects, I started to research the human body, starting with the ETS operation. Coming from an engineering background, I like to find solutions and answers to problems. After looking at all my side effects and what causes the same conditions in people who have not had ETS, I started to work things out from the results of all my tests and scans and I began looking at the op and the sympathetic nervous system in more detail.

"It took me about a year to fully come out of ETS side effects by changing my diet and lifestyle. For the last year and a half my body has been rebuilding. I was only going to get better as a result as coming out of the state of fight-and-flight...."

Thanks to Chris Carter for sharing this information.

A revealing published medical study on compensatory sweating after ETS (46 patients studied)

2011-09-23T14:11:00.002+12:00

Below you can read the abstract (summary) of a study done in the United Kingdom and published earlier this year in the International Journal of Surgery. The study was also presented previously to the Annual Scientific Meeting of the Association of Surgeons of Great Britain and Ireland, Glasgow, UK (13th–15th May 2009).

Here is the link to the study's online abstract:
http://www.sciencedirect.com/science/article/pii/S1743919111000720

An analysis of the natural course of compensatory sweating following thoracoscopic sympathectomy

A.C. Currieb, J.R. Evansa, P.R.S. Thomasa

Department of Surgery, Epsom and St Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton, Surrey SM5 1AA, United Kingdom

Department of Surgery, Division of Surgery and Cancer, Imperial College, London W2 1NY, United Kingdom

Received 28 March 2011; revised 12 April 2011; Accepted 13 April 2011. Available online 22 April 2011.

Abstract

Background
To evaluate the long-term results of thoracoscopic sympathectomy in the treatment of hyperhydrosis.

Methods
Theatre log books were used to identify all patients who underwent thoracoscopic sympathectomy between 2000 and 2006. Details of pre-operative symptoms, surgical procedure and post-operative complications were collected from the patient notes. Each patient was sent a questionnaire regarding success of the procedure, compensatory sweating and overall satisfaction.

Results
46 hyperhydrosis patients (34 females) age range 14–57 years. 20 patients suffered with hyperhydrosis in a combination of areas, 14 in the axillae alone, 9 palms alone and with 2 facial symptoms. There were 2 early post-operative complications, 1 haemothorax which required a chest drain and a chest infection. 3 patients required redo procedures. Of follow-up of 42 months (range 6–84), 32 (69·5%) patients reported complete dryness or a significant improvement in symptoms and 15 a substantial improvement in quality of life.

However, 43 patients (93%) suffered with compensatory sweating, of these 27 had to change clothes more than once daily. Compensatory sweating was graded as severe in 18 and incapacitating in 2.

Of note only 5 patients noticed an improvement in the compensatory sweating over time.

Only 26 (56%) would recommend thoracoscopic sympathectomy to others with hyperhydrosis.

Conclusion
Thoracoscopic sympathectomy is effective in the treatment of hyperhydrosis. However, compensatory sweating seems unavoidable and infrequently improves with time. Patients need to be carefully counselled before committing to surgery.

*****************

While this is but one study, it would be fair to say this is just one of many published studies on the side effects of ETS that shows ETS surgeons frequently do not reveal the true risks of the surgery to patients before they have the procedure.

Most ETS surgeons tell their prospective patients that the chance of developing compensatory sweating is around 1%, and that if compensatory sweating is experienced by the patient post-ETS, it will be 'mild' or 'just a little bit of sweating on your back or stomach'.

A reminder about the option of making a Treatment Injury Claim to ACC in New Zealand

2011-09-05T14:05:00.001+12:00

This is just a reminder for NZ ETS patients who have made an official complaint about their surgeon or who are considering doing so.

Here in New Zealand, the Health and Disability Commissioner (HDC) essentially deals with investigating complaints and 'educating' medical practitioners if they deem it necessary. The HDC does not pay any sort of compensation to patients, even if they find a medical practitioner has not provided a reasonable standard of care to the patient.

To seek financial compensation for injuries/health conditions caused by a medical treatment, a patient needs to make a Treatment Injury Claim to ACC.

See more info here:

http://www.acc.co.nz/PRD_EXT_CSMP/groups/external_claims_care/documents/form/wcm2_020603.pdf

The Kiwi ETS Group contacted ACC in early 2010, to ask them some basic questions about the Treatment Injury Claim process. At the time, ACC informed us that seven people in New Zealand had to date made treatment injury claims in relation to sympathectomy surgeries, and six of those seven claims were accepted.

Photos showing just how severe and disabling compensatory sweating can be post-ETS

2011-09-04T22:48:00.000+12:00

An anonymous Italian ETS patient created this web page to document the severity of their compensatory sweating (CS) post ETS.

http://www.ago972.altervista.org/index.html

These are not the kind of photos ETS surgeons show prospective patients - but they should. Regardless what the chances of developing this level of CS are, patients should be informed that the side effects of ETS can be much, much worse than the original condition.

Thank you to the patient who created this web page, for sharing your story.

Update on second complaint made against Auckland ETS surgeon Dr Murray MacCormick

2011-09-04T22:27:00.003+12:00

As discussed in this post from April this year, the second complaint in a 12-month period against Dr Murray MacCormick was made earlier this year by a patient who had ETS for facial blushing.

The patient's complaint focused on the lack of information they were given on the risks of ETS during their sole ten-minute consultation with Dr MacCormick, and the impact the side effects they developed post-ETS (such as severe CS, inability to sweat on the head and face, insomnia, and reduced exercise capacity) have on their daily life and quality of life.

During the Health and Disability Commissioner's (HDC) short investigation into the patient's complaint, Dr MacCormick refuted, via a letter, the patient's assertion that their consultation with Dr MacCormick lasted only ten minutes and that the only potential side effect of ETS mentioned by Dr MacCormick during this consultation was Horner's Syndrome. Dr MacCormick also stated in his letter to the HDC that of all the health issues the patient has experienced since having ETS, "only a few would be a likely result of sympathectomy."

Dr MacCormick also wrote in his letter to the HDC:
"As is clear from the files, I readily accept that this intervention was poorly advised, and patient selection on my part was inappropriate, something which I recognised in retrospect."

It is not clear what exactly in the patient's files Dr MacCormick might be referring to but he does appear to be freely admitting that he should never have performed ETS on the patient.

After hearing Dr MacCormick's version of events in relation to this patient's ETS consultation, surgery, and resulting side effects, the HDC decided to take no further action on the complaint.

From the HDC's final decision letter to the patient:
"It is clear you had an unfortuante outcome to ETS surgery and Dr MacCormick "accepts that this intervention was poorly advised".

"While I do not doubt that this outcome has caused you a great deal of anxiety, I must take into account the fact that your surgery took place over a decade ago. Given he amount of time that has elapsed I do not feel it would be practicable for me examine your complaint further. Further, ETS surgery techniques have changed considerably over the past decade and I do not feel it would be fair for me to assess the care Dr MacCormick provided to you based on current ETS knowledge."

The HDC's assertion in this paragraph would appear to expose bias or ignorance - the techniques used for ETS have not changed considerably or even moderately since 2001. There was a significant change in ETS surgery technique in the 1980s, when it went from being an open procedure involving a long hospital stay to an endoscopic procedure that can be done as day surgery, but there have not been any major changes in how the surgery has been performed since then. (Though there has been much internal debate among ETS surgeons on which levels of the thoracic chain should be operated on, such as T2 + T3, T2 only, or T4 only, but this debate does not involve changes in surgical technique.)

If any NZ ETS patients wish to make a complaint against Dr Murray MacCormick, you are welcome to reference this most recent complaint in support of your own, the HDC reference code for which is:

C11HDC00233

In addition, you are also welcome to reference the earlier complaint, made in 2010, in support of your own, the HDC reference code for which is:

C10HDC00679

Readers can refer to all posts on this blog labelled 'Dr Murray MacCormick' to read the background on the 2010 complaint made against him by a patient who had ETS for wrongly diagnosed hyperhidrosis.

Why should I listen to opinions on ETS from random people on the Internet who have no medical qualifications? (+ photo links at end of post)

2011-06-06T18:12:00.009+12:00

Following up from the previous post, the Kiwi ETS Group was also recently approached by another person considering ETS, who asked:

"Why should I take seriously opinions on ETS from random people on the Internet? The surgeon I have approached about ETS has performed the surgery hundreds of times. He is highly qualified and well respected and has put me in touch with a past patient of his, who said ETS changed their life for the better. Why should I listen to the opinions of unqualified people who angrily rant on the Internet about the dangers of ETS? I actually think some of these people are a bit nuts."

I decided to ask a young ETS patient, who is now suffering from numerous severe side effects of ETS, to answer this question. The side effects this patient lives with include CS that soaks through their clothing in winter and summer, anhidrosis, ongoing neuropathic pain, impaired thermoregulation, and heart problems. The name of this patient has not been used to protect their privacy.

*****

"I do realize the importance of your question, especially because I went through the same line of reasoning and justification when I encountered the Internet forum for ETS patients and the ravings of some the members who blame everything in their lives on this elective surgery.

"I thought to myself: why would I want medical advice from someone anonymous, who makes spelling mistakes in almost every word, and who sounds pretty deranged to start with? So I lingered just long enough to see that the Internet contains these communities of conspiracy theorists - in this case, medical conspiracy theorists - and decided I did not want to have anything to to with this kind of negative and clearly delusional worldview. I lived in a different world, where medical professionals base their 'art’ on science and not fiction, where the Hippocratic Oath and sense of duty overpowers any human shortcoming medical professionals might have - like greed. In this world, I also believed that the profession self-regulates and would, therefore, eject someone not worthy of the lofty ideals. In short, I was an ignorant snob who was well conditioned by society. Just where did these beliefs of mine come from? I could go on, but you can read about it somewhere else - for example, here: http://mythofmedicine.blogspot.com/.

"Do your own research, the information is all out there. It is sad that prospective patients have to do their own medical research, but you have to be skeptical - because you have to protect yourself. Unfortunately, the misinformation about ETS is so widespread, and it has been repeated so many times that it has become the ‘truth’.

"I previously thought the best source of information on ETS was the ETS surgeons themselves. So, I focused on reading their websites. In a rational, just world, this would have been all I needed to read. I also read many of the testimonials hand-picked by the surgeons from their patients, and did not realize how easily I got seduced by the sophisticated language of advertising. Soon, my brain was saturated with the carefully crafted sales pitch of the surgeons, and for some reason, the alarm did not kick in.

"My consultation was the same. I guess that’s because I was listening to a respected surgeon in a prestigious private hospital. He repeated the same pitch that I read on the 'net. Impressions count.

"Our belief in the authority counts and skews our perception.

"It is not true that the patient-doctor relationship is a relationship of equals. We always know less - mostly very little - about the subject, and we rely on the guidance and advice of the professional. We are always in awe of the knowledge and the science that allows them to save lives. With their air of authority and our conditioning, the balance of power is pretty uneven.

"But do not believe me, or those unhappy, ranting ETS patients on the Internet. Use your reason, and CLOSELY examine the texts that are published by the ETS surgeons for all to see. If you read enough and if you really pay attention, you will find all the tricks of the trade. All the contradictions and inconsistencies are there if you read enough or even if you read just one website or one 'study' really carefully. Apply your critical thinking and see what you come up with.

"Here are some examples of the lack of credibility and science, and of the pure contradiction, in the claims of ETS surgeons:

(1) ETS surgeons repeat, over and over, that ETS will arrest sweating in a limited, well-defined area, - usually the face or the palms, and that these areas can be easily targeted. They also mention that ETS only affects sweat gland function. If you read enough of these websites, you will find that some throw in a line about how ETS for palmar sweating or blushing will also arrest sweating of the feet - in some cases in 70% of patients. It is an additional selling point, and this is what the patient with the optimistic disposition will hear. However, to the medical professional it should sound a warning because it means that with ETS, the ‘targeting’ of an exact body area DOES NOT WORK, and that ETS - in the majority of cases - will have an overall (systemic) effect on the body, beyond what current science understands. A responsible medical professional already should be alarmed that they are venturing into territory they do not understand.

(2) Take the time to lay out a book of anatomy in front of you, and please spend some time pondering how cutting, burning or clamping the sympathetic chain, part of the information ‘highway’ between the body and the brain, is going to ONLY impact on sweating of the palms - as the ETS industry would want you to believe. It is an anatomical impossibility. Also, you might look up the illustration where it shows to which organs these nerve branches go and ponder what could happen once part of this chain is destroyed, in terms of heart function, lung function or overall complex autonomic reflexes. There have been published reports on patients needing a pacemaker after ETS, and the risk of bradycardia associated with ETS. It is not a coincidence.

(3) If you read enough, you will find surgeons who will describe their T2 surgery or T2 + T3 surgery as safe and effective and having a "nearly 100% cure rate of hyperhidrosis". Then you will find - a few years later - an article from the same surgeon, stating that ETS at T2 causes higher rates of CS. This surgeon is now performing ETS at T4, and with that he claims to have achieved 100% success and says hardly any of his patients get compensatory sweating. What do you think about the fact that this surgeon previously claimed T2/T2 + T3 ETS surgery was "effective" with a "nearly 100% cure rate"? Do you believe his new technique of T4 ETS surgery has a 100% success rate? Does it make you think about the credibility of the surgeon or the procedure? Maybe it should. After all, they are free to write in their articles whatever they please, and many use it as a platform for advertising and advancing their career/prestige.

(4) Have you read, over and over, that the ‘compensatory sweating’ is shifting of the sweating from one - targeted - area to another, so that the body can maintain thermoregulation? This, again, is a fallacy because the only study ever done on this topic showed that patients had a higher total sweat output after ETS than before. Yet, this fact will still not let you see the reality of how the ‘compensatory sweating’ impacts on patients lives. You would need photos for that. But you will not find a single photograph showing post-ETS compensatory sweating on any of the surgeons websites. Why do you think that is? (Please see some photos at the end of this blogpost, showing how severe CS can be.)

(5) You will find the internal (competitive) argument raging over which level(s) should be cut or clamped. The surgery has been done for decades. Perhaps there should have been some objective testing done by now to assess what happens to the patients in the short-term and long-term after ETS. But such an initiative would have to come from the surgeons who offer ETS in the first place. But that’s just it: the independent reviews that have been done all concluded that the ‘studies’ done by the ETS surgeons are prone to bias (self-serving lies or simple fiction to justify the procedure), and that there can be no conclusions made about the safety or effectiveness of ETS. These conclusions are not made by lunatic ETS patients on the Internet - these are reviews done by medical industry insiders (see link below).

"I think the problem is that when we read the surgeons websites, we are conned from the word go, and we do not read these texts as a skeptic, but rather as someone who fully BELIEVES what they are being told, and believes that they are being told the whole truth.

"We are not critical readers, we are consumers lapping up the sales pitch - because of where it’s coming from - and that makes us extremely vulnerable.

"And no, it is not true that the surgeons do not know about the adverse effects, or that these are so extremely rare that they do not bother to mention them, because the literature does not support any of these excuses. Instead, to justify the continued practice of destructive ETS, the surgeons make up a pseudoscience around it, and nobody seems to want to challenge this - at least not in the professional circles. It is not part of their culture. All the unhappy patient can do is to take the surgeon to court, and that is another story - a difficult and expensive story. And partly because of this, there is very little accountability on the side of medical professionals. Ignore this at your own peril."

"Sympathectomy is a technique about which we have limited knowledge, applied to disorders about which we have little understanding." - Robert Boaz, The Journal of Pain, 2000. (http://www.pfizer.no/templates/page____886.aspx (In Norwegian, but you can use Google's translate function.)

"A lack of high quality randomized trial evidence on ETS means that it is difficult to make a judgment on the safety and effectiveness of this technique. There is potentially a number of safety issues associated with this procedure." (ASERNIP-s Report No. 71, August 2009)

Some PHOTOS provided by the author of this blogpost, showing:

-Compensatory sweating that has soaked through clothing. Please note that the CS was not aggravated by playing sport or by increased physical activity - see photo 1, photo 2 and photo 3;

-Thermal image scans (scan 1, scan 2) showing the distinct temperature difference between the upper and lower body, with the line of demarcation at the level of the ETS surgery (please note, this scan was taken after a long cooling down period of 2 hours, during which time the patient engaged in no brisk physical activity and did not consume any hot or cold food or drinks);

-And a thermal image scan showing distinct neuropathy in the lower limbs.

"I had a couple of consultations with two different ETS surgeon and they said that that the patients who have T3 and T4 cut (instead of T2 or T2 and T3), have less side effects and less compensatory sweating. Is this true?"

2011-05-25T13:26:00.008+12:00

I was recently asked the above question by someone who is considering having ETS. Here is a copy of the reply I sent them.

*****

*Please note, I am not a medical professional but I feel that I have read and researched enough about ETS, its impacts on those who have had the surgery, and medical research in general, to state the following.

For such a statement to be scientifically correct - that patients cut at T3 and T4 have less ETS side effects and compensatory sweating - it would need to be based on numerous published studies with the following features.

-the studies would need to be independent/not have a conflict of interest (i.e., the studies could not have been done by ETS surgeons themselves)
-the studies would need to have been long-term follow-up studies (i.e., ideally done ten years after the subjects had had ETS)
-the studies would need to have used robust methodology (e.g., double-blind methodology, where the researchers do not know who the control group is in order to, for example, avoid influencing the study's subjects)
-the studies would need to have been done on thousands of ETS patients operated on at different levels
-the ETS patients would need to have been questioned/studied in depth in relation to the many potential adverse side effects of ETS, such as effects on heart rate and function, lung function, sexual function, etc. - not just the side effects of compensatory sweating (CS), gustatory sweating (GS), and Horners syndrome
-the ETS patients would need to have been questioned/studied in depth in relation to how CS affects them in their daily lives and the factors that apply here (such as the climate where patients live, their professions, whether or not they are active people, etc).

No such studies have ever been done. 99% of published studies on ETS that I have ever looked at (and I have read many):
-are done by the ETS surgeons themselves, so there is bias/a conflict of interest
-invariably involve only small study samples (i.e., around 200 patients or less)
-do not use standard methodologies that are considered the benchmarks of robust research
-are typically done soon after ETS (usually only a few months or a year after, when many side effects may still be yet to manifest)
-typically do not discuss or even mention any side effects bar CS, GS, and Horners
-no study on ETS to date, as far as I am aware, has developed and used a method of actually measuring the amount of CS that can occur after ETS - so conclusions on this are subjective.

In addition, even when studies on ETS do mention negative outcomes, the authors (ETS surgeons) invariably write a positive conclusion to their study along the lines of "20% of patients were happy with the results of their ETS, and a further 25% of patients were somewhat happy, which means that ETS is a very safe and effective procedure." Um, what about the other 55% of patients......?????

Some findings from studies that should be noted, in my view, are:

-An Israeli study (Steiner, Kleiner et al, 2007) found 41% of ETS patients felt their quality of life decreased as a result of CS;

-A French study (Gossot et al, 2001) found 8% of ETS patients (or nearly 2 in every 20 patients) felt "disabled" by their CS, with a further 25% saying they felt "disturbed" by their CS;

-And a long-term follow-up study from Germany (Walles et al, 2009) found that 10-14 years after having had ETS, only 40% of patients would have the surgery again. That means 60% either said they would not have the surgery again or they were unsure about whether they would have the surgery again, if it were possible to turn back the clock.

These are possibilities that ETS surgeons should warn patients about. But they do not, because if they did, it seems likely that only a very, very few people would still want to have the surgery. I also think ETS surgeons bank on (literally) the fact that many hyperhidrosis and facial blushing patients are desperate for a solution.

Yes, the results of my ETS have been good, and I have no regrets. But I remain deeply disturbed at how dishonest my surgeon was when informing me (or rather, not informing me) about the risks of this surgery, and I remain deeply disturbed that many who have had ETS - many young people like myself - have been left with devastating, adverse side effects from this surgery that are far worse than their original condition.

I cannot tell you what decision to make regarding having ETS. I can only say that there are two sides to the ETS story, and that the ETS surgeons only ever seem to tell prospective patients one side of that story. I am sure if you spend some time reading online, you will come across ETS patients who were cut/burnt at T3 and T4 who are happy with the results of their ETS, just as you will come across ETS patients who were cut/burnt at T3 and T4 who are NOT happy with the results of their ETS. Just as I am happy with the results of my T2 surgery, yet others have been left with dreadful side effects from being operated on at T2.

ETS is very unpredictable and no one knows why all patients get such different results from it.

Australian and Finnish medical authorities have reviewed the "evidence" (e.g., the studies done on ETS) on the safety and effectiveness of ETS in the past decade (in 2004 and 2009 respectively, I believe). Both authorities concluded that the surgery is associated with a high risk of side effects and there is little evidence for its effectiveness.

The Australian 2009 review concluded:
"A lack of high-quality randomised trial evidence on ETS (this means there is a lack of studies using scientifically robust methodology) means that it is difficult to make a judgement on the safety and effectiveness of this technique. There is potentially a number of safety issues associated with this procedure. The Australian Safety and Efficacy Register of New Interventional Procedures (surgical) (ASERNIP-s) concludes that a full systematic review including all available comparative and case series information, together with clinical input, should be undertaken to provide an up-to-date and comprehensive assessment of the safety and effectiveness of ETS."

Did you read the snippets on the Kiwi ETS Group blog from the interview conducted by me with an ETS surgeon here in New Zealand? He basically admitted that no one - including the ETS surgeons - knows how ETS works. Why would you cut an otherwise healthy person open and destroy parts of their body if you didn't fully understand what you were doing?

I have a few questions for you....

Have you sought a neurologist's opinion on ETS?

Have you spoken to a qualified natural doctor (ND) about your condition (I assume it is hyperhidrosis?) and asked if they can recommend any natural treatments or refer you to an ND who might know more about treating hyperhidrosis?

Have you tried making any changes to your diet and lifestyle to see if this has any affect on your hyperhidrosis?

Do you eat fish? There is one theory that excessive sweating can be a symptom of mercury poisoning, and most fish has mercury in it these days.

I hope this gives you some more information - and facts - to think about.

I know that hyperhidrosis can be hell - mine was a severe case and I would go so far as to say it was disabling, and I had tried and failed other treatments before I sought ETS (though it should be mentioned that I did not try all other non-surgical treatments). But there is no doubt that the side effects can actually be worse than the original condition, so I would advise you to really take your time with this decision.

A NEW complaint against Auckland ETS surgeon Murray MacCormick

2011-04-18T20:34:00.000+12:00

The Kiwi ETS Group recently learned that a NEW complaint has been made against Auckland ETS surgeon Murray MacCormick, by a patient who has been living with numerous distressing health problems since Dr MacCormick performed ETS on them for facial blushing.

The HDC reference code for this latest complaint is:
C11HDC00233

And the HDC for the complaint that was made about Dr MacCormick last year is: C10HDC00679

Anyone who has had a bad outcome after having ETS surgery with Dr MacCormick, and who is considering making a formal complaint, is welcome to, and encouraged to, reference these two other complaints in support of their own complaint.

Two complaints against Dr MacCormick by two New Zealand ETS patients, in less than a year, is a positive step. Little by little, we can all play our part to raise awareness of the risks of ETS among prospective patients, and to protest the failings in the medical system.

Reply to the HDC's decision on our complaint against Murray MacCormick

2011-03-14T19:12:00.002+13:00

We felt that the Health and Disability Commissioner's December 2010 decision on our complaint against Auckland ETS surgeon Murray MacCormick warranted a reply. Below is the reply sent to the HDC, Anthony Hill, in early February this year. The Kiwi ETS Group would like to extend heartfelt thanks to those who shared their expertise and assisted with writing this letter.

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“Practices may develop in professions, particularly as to disclosure, not because they serve the interests of the clients, but because they protect the interests or convenience of members of the profession.” (King CJ, in F v. R, 1983. 33 SASR 189 (medical malpractice case))

“Sympathectomy is a last resort.” (Australian Doctor, 15 December, 2006)

Dear Mr Hill,

Your response (dated December 7, 2010) to my complaint on behalf of (name deleted for privacy; hereafter referred to as 'the/this patient') is problematic for a variety of reasons and fails to address key elements of the complaint. I wish to point out material facts and failings in your decision.

First, I protest your choice of ‘expert’.

Second, you have – crucially – failed to note that Dr MacCormick contradicts himself while defending himself: Dr MacCormick defended his diagnosis of primary/idiopathic (lifelong, of unknown cause) hyperhidrosis to your expert, Professor Justin Roake, yet admitted in writing to you that he knows AROPAX (the antidepressant medication the patient was taking at the time of her first consultation with Dr MacCormick) is well known for causing sweating in some patients. That Dr MacCormick is still contradicting himself at this stage is evidence of his incompetence and/or his desire to invent justifications with hindsight.

In a complaint process such as this, your role is to ensure that the public are safe and not exposed to predatory or incompetent practices and practitioners. Your duty of care is to the patient and it should have been within your duty of care to ascertain whether the medical conditions and symptoms of the complainant are related to the elective surgical procedure she was offered as a “treatment of choice”. You failed your duty of care and in your role to ensure that the rights of this patient were upheld, and that her complaint was taken care of fairly.

You have a social responsibility to ensure that others are not exposed to harm, either by Dr MacCormick or other surgeons who offer a seemingly safe procedure that turns out to be something else.

By considering it unfair to call on an expert with background in neurology, you give away the fact that you are not interested in either finding out the truth of this case or protecting the public, as indeed such an expert would have found that the effect of sympathectomy does go well beyond arresting sweating (especially in a patient such as this patient, who already has an autoimmune disease (diabetes) and is, therefore, more vulnerable when it comes to injury to/surgery on the Autonomic Nervous System (ANS)).

By this refusal to face the facts, you betray your role.

Here are my observations and comments on the findings of both you and your expert, Professor Roake.

Diagnosis
Dr MacCormick is not qualified to diagnose hyperhidrosis or depression. He is a vascular surgeon.

Because Dr MacCormick also made a mistake by prescribing a drug post-surgery that could interact with AROPAX (a mistake you and Professor Roake do not consider to be a further sign of his incompetence), it is clear that he had or has very little understanding of drug management of disorders not within his area.

Dr MacCormick was not qualified to make a decision on whether the antidepressant drug that caused this patient's facial sweating could not have been changed for another drug, which she might have tolerated better. This should have been discussed with the patient General Practitioner (who prescribed the antidepressants), or Dr MacCormick could have referred the patient to a psychiatrist with experience of treating depression. This would have been a responsible move by a caring medical professional.

Instead, Dr MacCormick offered an irreversible, destructive surgical procedure on the ANS, causing permanent nerve injury and countless side effects for an already depressed patient, even though Dr MacCormick is aware that even one side effect – compensatory sweating – that is absolutely unpredictable, can cause depression even in previously unaffected individuals.

Neurology and specifically the science of the ANS are not something within the qualifications of Dr MacCormick or Professor Roake, yet they feel authoritative enough to make decisions on who this procedure is safe for and who is a good candidate for the procedure.

“Opinion must be more than “distinguished”. Epistemically warrantable rather that reputationally based.” (Journal of Law and Medicine, 2006. Feb. Vol. 13, No. 3)

I strongly disagree with your expert, Professor Roake, who also is a vascular surgeon with no qualifications in neurology or the function of the ANS, that this patient was a good candidate for sympathectomy. An expert's opinion in the ANS and neurology should have been sought – not only for him/her to establish causation in this case, but to consider what the likely outcome of such intervention would be, and thus, what the patient disclosure should contain in order to qualify as informed consent.

No responsible surgeon – and you can spend many nights going through the scientific literature – will agree with Professor Roake that this patient was a good candidate for this surgery.

ETS is considered an absolute last resort option for someone with primary hyperhidrosis (not this patient) where all other alternative and less invasive treatments have been tried and failed (not this patient).

Primary hyperhidrosis is present from birth or adolescence (not this patient), and is not dependent on triggers such as medication.

No knowledgeable medical professional will agree with you that this patient had primary/idiopathic (of unknown origin) hyperhidrosis – this was Dr MacCormick’s diagnosis, as stated in paragraphs 1and 4 on page 3 of your decision letter dated December 7, 2010 – and the conclusions and credibility of Professor Roake are questionable. Dr MacCormick is not qualified to diagnose primary hyperhidrosis, and he could not have diagnosed primary/idiopathic hyperhidrosis when he freely admits that this patient's facial sweating was likely caused by the antidepressant drugs she was taking. The fact that ETS arrested the facial sweating does not prove Professor Roake’s conclusions; rather it illustrates his incompetence, bias or both. Professor Roake should know that Endoscopic Thoracic Sympathectomy (ETS) will disrupt nerve signals to the sweat glands (among many other structures and organs) and arrest sweating, no matter what the cause. The so-called ‘success’ in this case does not indicate that the patient had primary hyperhidrosis.

In his letter to you, dated 20 August, 2010, Dr MacCormick freely and of his own will admits to having been aware during his first consultation with the patient that she was taking the antidepressant AROPAX, and that he is aware this drug is “well known to cause sweats in susceptible individuals”. In this letter, under the subheading ‘Diagnosis and choice of treatment’, Dr MacCormick listed non-surgical treatment options for facial sweating as a side effect of AROPAX, concluding that these options were “not advisable” and “not .... safe or practical” and ETS could be considered a “treatment of choice”. Dr MacCormick failed his duty of care by offering an irreversible procedure that placed the patient in danger and had a significant chance of severe side effects, even though he knew the patient's facial sweating could be eliminated by a change in medical therapy. This indicates that Dr MacCormick placed his own (financial) interests above the safety and well-being of the patient in his care.

In addition, Dr MacCormick is not qualified to make decisions on various drugs that are on the market to treat sweating. If he feels such drugs are unsafe, harmful to patients, and ineffective, he should have contacted Medsafe to make sure such drugs are removed from the market so that patients are not harmed by using them.

Informed consent

“Known risks should be disclosed when an adverse event is common, even though the detriment is slight, or when an adverse outcome is severe, even though its occurrence is rare.” (National Health and Medical Research Council of Australia, Guidelines, 2004. Para. 1, p. 11)

“The standard for informed consent is that which a reasonable patient might expect rather than what a reasonable doctor might think (Rogers v. Whitaker 1992), and failure to fulfil requirements may be considered as medical misconduct.” (Coles Medical practice in New Zealand, 2011. Chapter 9, p. 88)

Informed consent is at the heart of patient’s right for self-determination, and a violation of this right (by deliberately withholding information that would have been necessary for the patient to form a balanced view of the procedure) is a violation of the patient’s rights, integrity, and the code of the profession.

I have little doubt that Dr MacCormick would have exaggerated the positives of ETS surgery; conclusions can be drawn from comments he made at a 1999 Royal Australasian College of Surgeons conference, which were later published in a major daily Australian newspaper. Please find a copy of the article attached to this letter. In addition, please also see this online article written by Dr MacCormick for the website Family Doctor, where he states that hyperhidrosis is classically a life-long affliction of no known cause (see paragraphs 3 and 6).

“With no underlying clinical need for surgery, and the somewhat entrepreneurial nature of ‘cosmetic/elective’ surgery, there is arguably a greater degree of inherent tension between the wish of the surgeon to sell his or her services, and the more rigorous patient selection required to protect the patient seeking such procedures from misconceived notions as to what may be their benefit.” (Bill Madden: Competence and Irrationality: Locating the Law, Australian Civil Liability, 2006. Vol. 3, No. 5 & 6)

When it comes to elective surgical procedures, it seems likely that disclosure will sometimes fall short of accepted standards. Most ETS surgeons describe their procedure as ‘safe, easy to perform, minimally invasive’, and ‘transforming lives for the better’, with either 100% or 99% effectiveness. This myth is maintained by constant repetition of the fiction. There is no independent scientific evidence in support of these claims. While ETS surgeons describe it as a brilliant ‘cure’, other medical professionals refer to it as having ‘adverse effects that are understated’, and a significant number of ETS patients describe the procedure as ‘the worst mistake of my life’.

You have not provided any evidence that the patient had the information necessary to make an informed choice. Crucially, you have not provided any evidence of the existence of the said “written material” provided to the patient, as stated by Dr MacCormick and Professor Roake, nor have you provided any evidence that the patient was given such a document. Perhaps I should have been provided with Dr MacCormick’s “written material” on ETS so that I could determine if it covers the subject well. I am afraid that if your office received this information, you failed to forward it to me.

In addition, there is no evidence that Dr MacCormick had a lengthy consultation with the patient, taking her medical history, giving a diagnosis, explaining alternative treatments and the pros and cons of each, and then explaining the surgical procedure, possible complications, frequent side effects and less frequent and severe side effects.

“Rogers v Whitaker (1992) 175 CLR 479 High Court Australia decision affirms that a doctor has a duty to warn a patient of any material risk involved in a proposed treatment. A risk is considered material if a reasonable person in similar circumstances would attach significance to the risk, or if the doctor is, or should be, cognizant that the particular patient would express concerns about the risk.” (Coles Medical practice in New Zealand, 2011. Chapter 9, p. 91)

While both Dr MacCormick and your expert are happy to refer to ‘compensatory sweating’ (and no other side effects), you should realise that this name is largely misleading. It is far from ‘compensatory’ and is in fact a symptom of dysautonomia, or deranged function of the ANS.

The question arises: why would Dr MacCormick offer an irreversible surgical procedure to a depressed and vulnerable patient who is stressed over her facial sweating, when he knows all too well that the resultant so-called compensatory sweating can be just as bad, if not worse, for the patient?

“Patients who have a complaint about the care or treatment they have received have a right to a prompt, constructive and honest response, including an explanation and, if appropriate, an apology.” (Good Medical Practice: A guide for doctors, Medical Council of New Zealand, Dealing with adverse outcomes, June 2008. Point 34, p.13 (http://www.mcnz.org.nz/portals/0/guidance/goodmedpractice.pdf))

Dr MacCormick refused to see the patient when she wrote to him in April 2010. I have little doubt that he treats his other unhappy patients who are dissatisfied with the outcome of their procedure in a similar fashion, and refuses to acknowledge some of the severe consequences ETS can have.

It is not in the interest of the patient's emotional wellbeing to meet with Dr MacCormick and his offer to meet in his letter dated August 20, 2010 is 5 years late, and would cause further trauma and have no resolution. There is no doubt that Dr McCormick continues to believe that he behaved and acted in an impeccable professional manner, and your finding just confirms this.

No doubt the offer to meet with the patient (for what purpose?) came only to make him look like a caring doctor. Sadly, the facts do not support this image he so wishes to portray.

Summary
I refuse your finding that the patient was provided “appropriate information”. Appropriate information would have included quotes such as these (or a layman’s version of), and more:

“T(2)–T(3) ganglionectomy significantly decreases pulse rate and systolic blood pressure, reduces myocardial oxygen demand, increases left ventricular ejection fraction and prolongs Q-T interval. A certain loss of lung volume and decrease of pulmonary diffusion capacity for CO result from sympathectomy. Histomorphological muscle changes and neuro-histochemical and biochemical effects have also been observed.” (Clin Auton Res. 2003, Dec; 13 Suppl 1:I40–4)

“Forty-one percent of the participants claimed that their quality of life decreased moderately or severely as a result of Compensatory Sweating.” (J Pediatr Surg. 2007, Jul; 42 7:1238–42)

With no awareness of such information and, therefore, no opportunity to discuss the wide-ranging effects and consequences with Dr MacCormick, the patient was not provided with sufficient information to make an informed choice.

Furthermore, your ruling that it would be “unfair” to consult a neurologist on this case to ascertain causation is unacceptable, irrational and contrary to your duty of care. Indeed, this is the most important point of the case, but your wilful refusal to even consider the implications this surgery might have – and not just for this patient but for many other unsuspecting patients who volunteer to undergo an elective procedure – allows the continuation of this practice to go unchallenged. By refusing to acknowledge the facts and turning away from the problem, you have become part of the problem. Not quite the role the commissioner should play.

For some unexplainable reason, you suggest that the patient should see Dr MacCormick and consult with him on the disabling side effects she now has. The patient approached you to protect her (and others) from medical professionals like Dr MacCormick, and you failed to act on her behalf.

The CONTRA PROFERENTUM rule may be invoked by the patient in interpreting the consent form. According to this rule, if there is any ambiguity in a written document, it should be interpreted against the interest of the person seeking to rely on it – that is, the doctor.

“His Lordship referred to American authorities, such as the decision of the United States Court of Appeals, District of Columbia Circuit, in Canterbury v. Spence ((18) (1972) 464 F 2d 772), and to the decision of the Supreme Court of Canada in Reibl v. Hughes ((19) (1980) 114 DLR (3d) 1), which held that the “duty to warn” arises from the patient’s right to know of material risks, a right which in turn arises from the patient’s right to decide for himself or herself whether or not to submit to the medical treatment proposed.” [ROGERS v. WHITAKER [1992] HCA 58; (1992) 175 CLR 479 F.C. 92/045]

“Given that it is a rarely performed procedure, the number of claims we have experienced appears to be disproportionate. It is a highly elective procedure, so in the event of an adverse outcome, any claim can be difficult to defend. There is also concern that some medical practitioners may be performing Endoscopic Thoracic or Cervical Sympathectomies with little or no specific training in this procedure.” Lyndall Hillbrich, The Medical Defence Association of Victoria Ltd.

The numbers tell a story....

2011-02-01T20:12:00.001+13:00

These are the pageviews for this blog, by country, from May 2010 up to today:

New Zealand 696

United States 168

United Kingdom 141

Australia 121

Canada 34

Russia 34

Ukraine 26

Netherlands 25

Peru 23

Spain 18

This blog received 200 pageviews in January 2011 alone, from the following countries (in order of highest to lowest number of pageviews): New Zealand, Australia, United States, India, United Kingdom, Singapore, Canada, Germany, Malaysia, Netherlands.

Common key words used in Google searches that lead to this blog are:
endoscopic thoracic sympathectomy disability

HDC decision on complaint against Auckland ETS surgeon Dr Murray MacCormick

2011-01-31T17:45:00.009+13:00

In December 2010, we were informed by letter that New Zealand's Health and Disability Commissioner, Anthony Hill, had found in favour of Dr Murray MacCormick.

Here are links to the HDC's decision letter (one link leads to one scanned page, so five pages/links in total):
page 1
page 2
page 3
page 4
page 5

Note the commissioner's comment on page 4 about how it would be "unfair" for him to request advice from a neurologist!

And here are links to the earlier letter that Dr MacCormick sent to the HDC when they approached him to hear his side (two links to two scanned pages):
page 1
page 2

The expert chosen to aid the HDC's investigation in the case, Professor Justin Roake, is a vascular surgeon who works at a private practice in Christchurch, New Zealand, that offers Endoscopic Thoracic Sympathectomy (ETS).

ETS is, in best practice, supposed to be a last resort treatment for those with primary (lifelong, of unknown cause) hyperhidrosis, when all other treatments have been tried and failed. Even then, it is a surgery that comes with a significant risk of adverse side effects.

The New Zealand ETS patient who this complaint was made on behalf of never actually had primary hyperhidrosis. She was simply suffering short-term (duration two years approx. in middle age) excessive facial sweating, and other problems such as tremors, as side effects of the high dose of the antidepressant AROPAX she was taking in 2004/2005. The failure to realise this on the part of her prescribing GP, Dr Paul Fur, who referred her to Dr MacCormick, is disturbing. And Dr MacCormick's behaviour - in offering this patient ETS and describing it as a "treatment of choice" while acknowledging in his letter to the HDC that AROPAX is "well known to cause sweats in susceptible individuals" - speaks for itself.

The patient feels that her already severe Compensatory Sweating (CS) - a common adverse side effect of ETS - is getting worse: she gets soaked in sweat from her chest to knees daily in warm and hot weather. In addition, she has been experiencing other health issues that may be related to ETS. She has spoken several times of how she has contemplated ending her life because of how the CS has affected everything - her professional life, her social life, her quality of life.

Any New Zealand ETS patients contemplating making a formal complaint about your ETS surgeon, please feel free to reference this complaint in support of your own. The reference number is: C10HDC00679

The outcome of this complaint has been disappointing, to say the least. But it has created a paper trail that other New Zealand ETS patients can reference and use as a resource when making their own complaints.

It is vitally important that ETS patients suffering from the devastating side effects of this elective surgery make formal complaints about their surgeons who did not disclose during pre-surgery consultations the many frequent and less frequent adverse side effects of ETS. Eventually, the number of complaints will add up, and the authorities will be forced to act.

In the mean time, we have the power of the Internet. In the case of this recent complaint, the HDC did not even come close to 1) ensuring that the rights of the patient were upheld, and 2) investigating the complaint fairly - as is the Commissioner's role. However, this does not mean the Kiwi ETS Group has failed. We are still here and we are still one of several voices on the Internet warning those considering ETS surgery that the outcome of ETS surgery is often nothing like what your surgeon will promise you. This irreversible surgery does leave a significant number of patients with serious health issues that have devastating, life-changing effects, such as bradycardia, severe compensatory sweating, ongoing neuropathic pain, erectile dysfunction, and anhidrosis and the associated impaired thermoregulation, to name but a few severe and not uncommon side effects.

The wealth of published medical research on sympathectomies supports this truth, as do the testimonies of the many suffering patients. While those in power might currently choose to look the other way, they cannot silence either these testimonies or the medical research documenting the risks of ETS.

Another update on the complaint against ETS surgeon Dr Murray MacCormick

2010-12-06T22:57:00.004+13:00

The Kiwi ETS Group received an update from the Health and Disability Commissioner (HDC) on November 22. The HDC stated that they received our email in October, and that they went ahead with their request for 'expert' advice from a vascular surgeon "to assist the Commissioner in deciding what action to take on this complaint".

The HDC stated that they have now received the vascular surgeon's report and that they will "carefully review this information". They concluded by saying they will be in touch again once the Commissioner has decided what further action to take.

Quick update on complaint against ETS surgeon Dr Murray MacCormick

2010-11-01T11:05:00.003+13:00

This is a just a quick note to say that the complaint made to the Health and Disability Commissioner (HDC) is still in progress.

-The HDC contacted Dr MacCormick and gave him a chance to respond to the complaint.

-After hearing Dr MacCormick's response, the HDC decided to seek 'expert' opinion from an 'independent' vascular surgeon, and notified the Kiwi ETS Group of this by letter.

-The Kiwi ETS Group emailed the HDC after receiving the letter, asking them to bear in mind several key aspects of our complaint that we do not believe should or can be affected or changed by a second 'expert' opinion (e.g., the lack of informed consent and strongly suspected misdiagnosis, the surgeon's lack of care and professionalism).

We also re-highlighted that the side effects the ETS patient is suffering from are documented and well known - not rare - and that a vascular surgeon is NOT an expert in the Autonomic Nervous System. We asked the HDC to consider consulting a neurologist, and to review the medical literature we sent them copies of.

Why prospective ETS patients so often don't hear the full story, and the ongoing effort to change this

2010-08-27T12:25:00.009+12:00

'CSmess' is an American professional and family man who moderates and regularly contributes to the Internet forum ETS and Reversals Discussion. He has had both an ETS and a reversal surgery. The reversal only made his side effects worse.

ETS and Reversals Discussion was set up in the early to mid-2000s by American Carole Edward, who lives with hyperhidrosis, so that ETS patients around the world who have had bad outcomes from the surgery can come together online, tell their stories, learn more about their side effects, support each other, discuss possible treatments for side effects, name their surgeons, discuss their legal options, and more. A key mission of the forum is also to WARN prospective ETS patients about the other side of the ETS story - the one the ETS surgeons don't acknowledge and don't want prospective ETS patients to hear.

The forum has members from the following countries:
Australia, New Zealand, the US, the UK, Canada, Ireland, Spain, Sweden, Norway, Poland, Chile, Peru, Thailand, Taiwan, Malaysia...and probably more countries. Users of the forum don't always reveal their nationality.

In response to a happy ETS patient who expressed the view that the forum overwhelmingly contains the stories and experiences of those who have had devastating results from their ETS surgeries, 'CSmess' wrote the following on ETS and Reversals Discussion.

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"There is a huge amount of published research showing that a very substantial percentage of ETS patients experience disabling side effects that dramatically lower their quality of life and diminish their health. Yet, you will not find a single testimonial from any of these thousands of souls published in any surgeon's brochure or on their websites. Furthermore, while many surgeons provide telephone numbers of past patients to prospective patients, they only hand out the numbers of the happy patients. The unhappy stories are swept under the carpet. Prospective patients get to hear only one side of the story.

"The only place where the voices of the many disabled patients can be heard is on forums like this one.

"In other words, lucky/happy ETS patients have a number of formal avenues to "spread the joy", but those who did not have good outcomes have only a self-funded Internet message board. Do a Google search on hyperidrosis or blushing cures and you'll get page after page of lavishly funded websites littered with glowing testimonials. Our puny little forum is but a whisper drowned out by thousands of bull horns that paint a one-sided and dishonest picture of the effects and risks of this surgery.

"Beyond providing a place for the testimonials that the surgeons won't publish, the ETS Reversals and Discussion forum provides links to the mountain of medical research findings that contradict the claims most of the surgeons make regarding the number, frequency and severity of adverse side effects of this surgery.

"Most people considering ETS surgery only hear from patients with happy outcomes. The surgeons make a concerted effort to make sure that remains the norm. And that ain't right. It ain't honest. So, the members of the ETS Reversals and Discussion forum seek to right this wrong, and provide to folks who are considering the surgery the information they won't get from their surgeons."

Please speak up!

2010-08-26T12:22:00.003+12:00

This is another call for dissatisfied ETS patients of Dr Murray MacCormick to write to the Health and Disability Commissioner (HDC). The more complaints about this ETS surgeon, the harder it will be for the HDC to simply write Dr MacCormick an educational letter as a way of 'resolving' the one complaint against Dr MacCormick that they are currently investigating.

To add some perspective....Richard Stubbs, a liver cancer and obesity specialist here in NZ, who had been the subject of numerous complaints in relation to not obtaining informed consent, was recently fined NZ$100,000 by the NZ Health Practitioners Disciplinary Tribunal. He was also censured, and ordered to undertake a mentoring programme for 18 months and have a practice audit.

Was this a fair result? Consider this doctor's history of harming patients:

-He appeared before the Tribunal in 1999 and was found guilty of conduct unbecoming a medical practitioner.
-Five complaints were made to the HDC about this doctor between 2002 and 2004, mostly in relation to consent.
-Another two complaints had been made to the HDC by 2007.
-The case that brought him before the Tribunal most recently was one that found him guilty of of professional misconduct, failing to obtain informed consent, and failure to adequately document post-operative care. In this case, the male patient, 'Mr N', died in 2006, after an operation with Dr Stubbs.

So...this doctor contributed directly to a man losing his life, and has had at least eight other formal complaints made about him in less than 10 years.

And he is still practising.

He also tried, unsuccessfully, to get name suppression for himself and the hospital he works at (Wakefield Hospital, in Wellington), and tried to get out of paying the NZ$100,000 fine by claiming that most of his earnings went toward research and he kept only a small portion for himself. The Tribunal looked into this and stated they were "not impressed" with his evidence, and upheld the fine.

Disheartening and disturbing? Without a doubt. And it also highlights the fact that it takes a lot of noise before these medical professionals who harm patients again and again and again finally come to the attention of those who pull the strings.

I hope Dr Stubbs never treats another patient again. His name has been all over the media here.

Could the Kiwi ETS Group achieve the same with Dr MacCormick???

The latest on the HDC complaint.....

2010-08-15T18:52:00.004+12:00

The Health and Disability Commission (HDC) have written to say they are now giving Auckland ETS surgeon Murray MacCormick the chance to respond to the issues raised in our complaint.

The HDC also said in their letter that they do not have the authority to make a doctor financially compensate a patient, or to stop a doctor from practising* (*I think only the Medical Council of NZ has this authority). However, the HDC also wrote in their letter that they will consider the other 'desired outcomes' we stated in our complaint letter.

Another update on complaint against NZ ETS surgeon Murray MacCormick

2010-08-03T16:18:00.004+12:00

The Kiwi ETS Group heard from the Health and Disability Commission (HDC) today. It turns out that, for the last two months, the complaint submitted by our group on behalf of a Kiwi ETS patient has been with the HDC's legal team.

It's not as exciting as it sounds....the HDC's legal team were simply determining whether or not to consider the complaint as separate to an earlier complaint made by the same patient against the same surgeon.

Now that the HDC's legal team have concluded that this most recent complaint is a new, separate complaint (this had already been specifically pointed out when the Kiwi ETS Group contacted the HDC in writing in June....), the complaint has been returned to the HDC and Auckland ETS surgeon Murray MacCormick should be contacted by the HDC any day now regarding the complaint, if he hasn't already.

So, the process of investigating the complaint has finally begun.

We are a bit disappointed that it has taken this long - 2 months - for the complaint investigation process to get started, and more so that the HDC did not contact us at all during the last 2 months to simply let us know what was happening. Still, at least the ball is now rolling.

(Please refer to older posts to read more about the story beind this complaint.)

Quick update on complaint about NZ ETS surgeon Dr Murray MacCormick

2010-07-12T20:42:00.005+12:00

The Kiwi ETS Group's complaint has been received by the Health and Disability Commissioner (HDC) and the Kiwi ETS Group is now waiting to hear back from the HDC.

It has been a few weeks since we last heard from the HDC. We see this as a positive sign that the HDC is taking the time to thoroughly investigate the complaint.

Second update on complaint against NZ ETS surgeon Murray MacCormick

2010-06-14T17:08:00.004+12:00

The Kiwi ETS group has made a complaint, on behalf of a New Zealand ETS patient, to the Health and Disability Commissioner about prolific Auckland ETS surgeon Dr Murray MacCormick.

The Kiwi ETS Group has highlighted the following in the complaint:

-We believe that Murray MacCormick failed to fully inform the patient about common and documented side effects of ETS;

-We believe Murray MacCormick misdiagnosed the patient's midlife facial sweating as hyperhidrosis depite the fact there were numerous red flags indicating the patient's condition was not hyperhidrosis;

-We believe Murray MacCormick showed an overall lack of care, professionalism and ethics in dealing with this patient;

-The Kiwi ETS group has evidence and anecdotal evidence that Murray MacCormick has a history of unhappy ETS patients, all of whom we believe he failed to inform about the common and documented side effects of ETS.

Updates on how the complaint progresses will be posted here.

Excerpts from an interview with an ETS surgeon

2010-05-16T18:59:00.008+12:00

The following are excerpts from a recent interview between a member of the Kiwi ETS Group and a New Zealand ETS surgeon.

Interviewer: I spoke to a neurologist who said that the Sympathetic Nervous System plays a role in a lot of different functions in the body, and a couple of the ones he mentioned were: lung function, heart function…um, brain function, blood vessel function, sexual function, for example. So, what I wanted to ask you is…when the SNS is cut or cauterised – whichever method a surgeon prefers to use – how does that system maintain its equilibrium after it has been cut into?

ETS surgeon: Ah…I don’t think you can really say. A lot of the reason why the operation works is unknown. Like if you operate on someone for facial blushing…the four people I’ve done for that, I’ve told them beforehand that um, that we don’t really know why the operation should work because you’re cutting the sympathetics that normally supply the arm and they’re interested in the face.

It’s not very logical that the operation would work…like I say, you cut the sympathetics to the arm. But what you say, about what happens to the sympathetics afterwards and all that sort of stuff, I don’t really think anyone knows. And so the results...those who do get bad compensatory truncal sweating…it’s very unpredictable.

Interviewer: Is that not a concern – that the mechanism, what the surgery actually does, how it stops sweating and blushing, is not actually understood?

ETS surgeon: Yip.

************

Interviewer: There are two health practitioner insurers in Australia – MDVA and Avant – and they will not insure for ETS because they said they received too many complaints related to ETS for the number of surgeries being performed.

Again, is this something that is a concern to the community of surgeons doing the surgery?

ETS surgeon: Ah, I don’t think so. I don’t think that is that well known.

************

Interviewer: So related to all that, as well as those Australian insurance companies I mentioned not insuring practitioners for the procedure, in 2005 a Finnish Organisation – FINOHTA, the Finnish Office for Health and Technology Assessment – they did a review and their conclusion was that there was “a lack of controlled trials and no reliable evidence for the effectiveness of ETS for excessive sweating in the face and hands or for flushing in the face”. They also concluded that the treatment had no impact on social phobia and was associated with significant immediate and long term adverse affects.

Further to that, in August last year, the Australian Safety and Efficacy Register of New Interventional Procedures – surgical, they released a report. I believe it was passed on to the Royal Australasian College of Surgeons (RACS) that same month - August 2009. Their conclusion was very similar. They said there was a lack “high quality, randomised trial evidence” on the surgery that made it “difficult to judge the safety and effectiveness of the technique”. They said there is a potential number of safety issues associated with ETS surgery, and they suggested a full systematic review be undertaken to assess the safety and efficacy of the surgery.

As someone who is seeing a few patients every year for the surgery, what do you think about those two reviews? Do they concern you?

ETS surgeon: Yeah, that’s accurate. It doesn’t necessarily mean that it’s a bad operation.

Interviewer: Is it more that they’re saying there needs to be more research done?

ETS surgeon: Yeah exactly, it means that if you looked at all the studies, there’s not much useful information in it.

************

Interviewer: Further to what we talked about before, the review done in Finland and the one recently done by Asernip-s in Australia...you mentioned an American support group. There is also a support group in Sweden, there is also a support group in Australia and there’s also one here in NZ for people who had bad outcomes from the sympathectomy surgery, and I also believe there is a Japanese language website, and a Taiwan Chinese website that were created by people who had bad outcomes from the surgery.

All these support groups and all these websites seem to suggest quite a high number of unhappy patients. What do you think about that?

ETS surgeon: You shouldn’t undertake the operation unless you’re aware there is a possibility of a bad outcome like that.

Interveiwer: Do you think there are issues around the consent process – that people aren’t being adequately warned about the possible side effects?

ETS surgeon: Ummmmmmm....probably.

Update on complaint against NZ ETS surgeon Murray MacCormick

2010-04-20T20:53:00.005+12:00

The following was written by the ETS patient who is making the complaint. They have given their permission for this to be circulated.

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"Still no reply to my letter dated 2 April, 2010, to Murray MacCormick.

"My advocate from the Health and Disability Commissioner came over this morning and we talked. She had a copy of the Kiwi ETS Group's support letter to the Commissioner and was very impressed with it. She had also read the web pages I had given her and was quite surprised that the surgeon continues to perform ETS and said this is a very valid complaint.

"However, an advocate goes into the meeting and says nothing. They are there only to call a meeting off should it "get ugly". Without her being able to help or say anything it seems pointless. I would probably be so upset and make a complete fool of myself and my surgeon would probably suggest a shrink.

"All MacCormick is required to say is sorry. Not good enough.

"When you go to these meetings you are only allowed to talk about yourself, others are not to be mentioned.

"When or if MacCormick's response letter arrives, I will leave a message with his secretary saying that his reply took too long and my complaint has now gone to the Commissioner.

"I encourage others to do the same, whether our complaints go in together or separately."

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The Kiwi ETS group is supporting this patient in complaining to the HDC, and we urge any unsatisfied ETS patients of Murray MacCormick to make a complaint.

One complaint about one surgeon is nothing out of the ordinary to the Health and Disability Commissioner. However, several complaints about one surgeon from patients who all had the same surgery should hopefully be cause for alarm and warrant a thorough investigation.

NZ ETS patient makes official complaint about their surgeon

2010-04-12T19:02:00.010+12:00

A New Zealand ETS patient has just begun the process of making a complaint about their ETS surgeon, Dr Murray MacCormick, to the Health and Disability Commissioner (HDC).

Updates on how the complaint progresses will be posted here. The Kiwi ETS Group has written a letter in support of this ETS patient to the HDC, highlighting the fact that several New Zealand ETS patients we have had contact with are dissatisified patients of Dr MacCormick because of the disabling and devastating side effects their ETS surgeries have left them with - side effects Dr MacCormick never warned them about or downplayed the likelihood/severity of.

In addition, the letter highlights the following issues with Dr MacCormick's decision to offer ETS to this patient.

1.) The patient was suffering from excessive facial sweating as a side effect of medication they were taking. However, at that time, the patient was not aware what was causing the excessive facial sweating - after all, they are not a medical professional.

You would think that in such a case, an experienced doctor, which Dr MacCormick indeed is, would extensively question the patient about their medical history, any medication they were taking, and how long the sweating had been a problem for, and use their medical knowledge to determine that the sweating was not actually hyperhidrosis but a far simpler problem that could easily be alleviated by adjusting or changing the patient's medication.

Instead, within the space of a 15-minute consultation - the first ever consultation between Dr MacCormick and this patient - the doctor recommended ETS to treat the excessive facial sweating and scheduled the surgery to take place within the week.

2.) Even IF the patient had indeed had facial hyperhidrosis, ETS surgery is suppposed to be a last resort treatment for hyperhidrosis when all other non-surgical treatment options have been tried, and have failed. However, as the patient did not even have hyperhidrosis, they should never have been considered a candidate for ETS.

The letter also points out that Dr MacCormick, as a private practitioner, made a sizable sum of money from performing the ETS surgery on this patient.

The patient now lives with disabling severe CS and other side effects commonly reported by ETS patients - ongoing fatigue, painfully dry skin on the arms and mysterious pains in the limbs and extremities.

This patient's story is one of the most shocking we have heard to date about ETS in New Zealand.

If you are a dissatisfied past patient of Dr Murray MacCormick, now would be a good time to make your dissatisfaction known to the Health and Disability Commissioner. The higher the number of distressed patients, the harder it will be for the HDC to take the issue lightly.

ETS surgeons in NZ and abroad

2010-04-06T21:49:00.008+12:00

To help other ETS patients find this blog - whether they be potential ETS patients or patients who regret having had ETS - I will list the names of all the ETS surgeons I am aware of.

ETS surgeons in New Zealand:
Murray MacCormick (Auckland)
David Ferrar (Hamilton)
Thodur Vasudevan (Hamilton)
Ross Blair (Tauranga)
John Mercer (Christchurch)
David Lewis (Christchurch)
Malcolm Gordon (Christchurch)

ETS surgeons in Australia:
Peter Y Milne
Barry Beiles
Roger Bell
Hamilton White
Raffi Qasabian
John Preston Harris
Sanjay Sharma
Marek Garbowski
Philip Middleton
David Marshman
Spero Raptis
Ben Anderson
Chris Hensman
Richard Gilhome
Ray McHenry

ETS surgeons in the UK:
Christer Drott
-Drott used to practise in Sweden and performed ETS on thousands of patients throughout the '90s. Drott stopped practising in Sweden when a Swedish support group for those living with disabling side effects from ETS gained widespread media attention and ETS was temporarily banned in that country.

Goran Claes
-As above...Drott and Claes now practise on Harley Street in London.

There are likely many more ETS surgeons that I am not yet aware of. I will add more surgeons' names with time.

Want to make yourself heard, officially?

2010-04-02T01:06:00.008+13:00

I thought it was time to start putting some information on here about the legal options for people who have had bad outcomes from ETS surgery.

In brief, your options are:

-Make a complaint to the Health and Disability Commissioner

-Make a 'Treatment Injury' claim to ACC

-Take your surgeon to court

Click here for links to information on 'How to Complain About a Doctor' and 'How to be Aware of and Enforce Your Rights as a Patient'.

I will add more on this topic later.

For now, know that there are options available to you, and as ACC recently informed me, at least seven people right here in New Zealand have already made treatment injury claims in relation to their sympathectomy surgeries. Six of these seven claims were accepted.

Sydney ETS patient starts legal proceedings against surgeon

2010-02-10T19:55:00.005+13:00

Our friend in Sydney, who had ETS for palmar hyperhidrosis and now lives with numerous severe and disabling side effects as a result, has given me permission to announce the following.

I wanted to announce that I have started legal proceedings against my ETS surgeon.

I hope that the case will generate some much needed publicity, debate, awareness and will expose (debunk) the pseudoscience these surgeons rely on.

No matter what the outcome, it might also serve as a warning for insurance companies who no doubt will react very sensitively to the prospect of having to pay compensation for an unproven, unexamined 'cure'.

I truly believe that the publicity generated from this (or any other ETS case that is presented and represented well) can open the doors for a class action and a change in how doctors will have to inform their patients in general.

A theory and method for treating ETS side effects holistically and naturally

2010-01-14T18:41:00.017+13:00

In case anybody reads the comments on the first post on this blog and wonders, "What is Carter's diet? And how can it help treat my ETS side effects?", allow me to explain.

Chris Carter had ETS and suffered from horrible side effects. He researched the side effects of ETS, developed a theory on what was causing them, and came up with an eating plan to heal his body.

Check out this forum thread from ETS and Reversals Discussion, where Carter posted about his theory on what causes the side effects of ETS and the diet he has followed for several years, which he claims has cured his side effects. Scroll down the thread to see a list of foods that Chris Carter does and does not eat.

http://etsandreversals.yuku.com/topic/374?page=1

Please note that Chris Carter is a not a doctor or nutritionist but he speaks from experience and his own research.

Below is some further information written by Chris Carter, which has been copied from another post he wrote on the same forum. Chris wrote this post in June 2008. It has been edited only slightly for brevity and clarity.

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I believe natural food and the way you eat is the answer to all ETS side effects.

I'm a 30-year-old male and live in the UK. For those desperately looking for some sort of answer, wondering why your life has finished because of ETS, I am offering some advice. I want to tell you that there is life after ETS and it's a lot better than you think . . . . I'm living proof!

I had ETS at T2 and T3, four-and-a-half years ago for head, hand and armpit sweating. For five months after the surgery, I thought everything was good. Then the weather started to warm up . . . . oh shit, WTF have I done.

For the next two years my whole world fell down because of ETS side effects. I had become a shadow of who I was, a walking dead person with no vision of anything bright, sunny or happy. I had every known side effect and was in and out of hospital going for various scans, tests, scans and more tests, cameras in places, more tests, different consultants, being passed around like some f**king experiment.

Everything went wrong, as so many of you have experienced, and I couldn't believe that no one knew anything and no one could help me. I felt I had signed a death sentence.

After one-and-a-half years of all these terrible side effects, I started to research the human body, starting with the ETS operation. Coming from an engineering background, I like to find solutions and answers to problems. After looking at all my side effects and what causes the same conditions in people who have not had ETS, I started to work things out from the results of all my tests and scans and I began looking at the op and the sympathetic nervous system in more detail.

It took me about a year to fully come out of ETS side effects by changing my diet and lifestyle. For the last year and a half my body has been rebuilding. I was only going to get better as a result as coming out of the state of fight-and-flight.

The effects of fight-and-flight taken from Wikipedia
-Acceleration of heart and lung action
-Inhibition of stomach and intestinal action
-General effect on the sphincters of the body
-Constriction of blood vessels in many parts of the body
-Liberation of nutrients for muscular action
-Dilation of blood vessels for muscles
-Inhibition of lacrimal gland (responsible for tear production) and salivation
-Dilation of pupil
-Relaxation of bladder
-Inhibition of erection
-Auditory exclusion (loss of hearing)
-Tunnel vision (loss of peripheral vision)
-Increased sweating
-Digestion slows down, redirecting blood to the muscles and brain.
-Breathing increases and supplies more oxygen to the muscles.
-The heart beats faster and raises blood pressure.
-Perspiration increases to cool the body.
-Muscles tense up to prepare for action.
-Chemicals are released to help blood clot.
-Sugars and fats are released in the blood stream to provide fuel.

My Theory in Brief
The operation put our bodies, not our brains, in the state of fight-and-flight. The area that was cut on me (T2 and T3) stopped certain messages from the heart and lungs getting to my brain. Hence, by default, the internals of my body changed and began to operate in a different way, to keep me alive. One of the main changes in my body was how I convert food to energy. In a person who has had ETS, this process is very different to how it happens in a person who has not had ETS. Therefore it is really, really, really important what we eat every single day.

The main thing is NOT to eat any man-made substances, only 100% natural whole food. Basically anything that doesn't have a wrapper around it.

Foods To Avoid
All E-numbers, especially E101-199 E202-299 E301-399 E500-599 E600-E700, E800-E900 or anything that has an X or a Z in the name, and any sulphates - the less you eat, the better. In addition, don't eat anything that has been modified or contains an ingredient whose name you can't pronounce.

You will need to read the ingredients of everything you eat.

You also need to massively reduce (or even better, stop) eating sugary, processed refined food and any liquid stimulants (coffee, tea, fizzy, energy or coloured drinks). You will need to reduce salt, as this is a natural preservative. Most sauces, drinks, packaged foods and cheap processed stuff contains loads of these bad things.

As most of you are probably aware, the best thing to drink is WATER and that is very true for ETS patients, any other drink seems to affect me and probably will affect you. Sports drinks, protein shakes, coffee, energy drinks, caffeine drinks, etc. will affect us even more as these are all stimulants that effect the body (i.e., they are quickly absorbed into the blood stream through the kidneys and liver).

Basically, make everything you eat from scratch. Learn to cook! Eat fruit and veges, drink lots of still water. Yes, this may be very boring but you get used to it.

It's a lot better than taking any medication, most medication does contain stimulants, sugars, salts or preservatives, so really it's no good for us either. Also, multi-vitamin tablets contain loads of man-made s**t, therefore they will affect you, especially if you are not out of the fight-and-flight.

The reason certain foods affect our bodies is because lots of man-made chemicals in food have the same basic chemical formula as adrenaline, or noradrenaline - E-numbers and modified foods with added substances especially! These foods keep ETS people in fight-and-flight, and the longer it goes on the deeper you get into losing normal, healthy, bodily functions.

I think you will all agree, all the symptoms of fight-and-flight are the same as ETS side effects. Normal people may only be in that state for hours, most of us who have had ETS have been in that state for years.

If you suffer from ETS side effects then I recommend you look into and change your diet, cut out foods containing the chemicals/substances that I have mentioned above for at least 9-12 months (maybe longer). When you start seeing improvements and getting better then maybe start re-introducing things and see how they affect you.

I'm living proof this works as I'm so much better now after two-and-a-half years on my diet. I work in London and wear a suit every day, don't have to even think about wearing a vest underneath my clothes don't even have to think about taking my jacket off really and its June (UK summer). Three years ago I would change my vest underneath my shirt about three times a day in June.

I have just returned from holiday in Spain with my girlfriend, where it was 28 degrees Celsius. I was lying on the beach all day.

I am not on any medication. ETS and its horrible side effects are behind me now but what I know and what I'm going to do with that knowledge for the rest of my life is all in front.

For those who want to try this, please have a sustained go at it. It's better than medication. You just need to eat natural foods.

Things to Read Up On (use Google)
GI Diet (this details high GI foods and low GI foods, low and medium GI foods have proved to be better for me)
Effects of fight-and-flight
Food stimulants
Processed food
Microwaves and their effect on natural foods
Natural whole foods

I have put this information out there for people like me who have had ETS and are devastated about the results.

ETS was the maddest/worst/hardest/most amazing and terrible experience of my life, but now having my normal life back, doing normal things again is the best experience ever!

Thanks for reading

Chris Carter

Welcome : )

2009-12-28T15:00:00.009+13:00

Hello,

My name is Francesca and I am a New Zealander. I had ETS in 2001 for dripping, disabling palmar hyperhidrosis. Today, I still have dry palms and I have never suffered any major or ongoing adverse side effects of ETS.

I have come to learn that a significant number of ETS patients are not so fortunate – the results of their ETS surgery for Hyperhidrosis, Facial Blushing or Raynauds syndrome do not match what their surgeons promised. Many ETS patients deal with terrible side effects from this surgery – side effects that their surgeons typically never mentioned OR downplayed the likelihood/severity of.

It is not for me to advise anyone on whether or not they should have ETS. However, I can say that from 2009 - 2011, I have communicated with a significant number of ETS patients from the US, Canada, the UK, Australia, New Zealand, and Peru who report having experienced some or even all of the following side effects and health problems after ETS:

-Uncontrollable sweating on the body from the chest down that, for hyperhidrosis patients, can be far more distressing than the original excessive sweating condition(doctors call this side effect 'compensatory sweating')
-Inability to sweat on the face/head
-Painfully dry eyes/scalp
-Hair loss/thinning and/or loss of eyebrows
-Lowered resting and maximal heart rate and reduced exercise capacity
-Bradycardia
-Breathlessness
-Ongoing fatigue
-Cold hands (can be painfully cold)
-Sweating on the face and head only when eating or eating certain foods. The sweating can be mild or severe (e.g., from a dampness to sweat that is continuously dripping off your head/face) (doctors call this side effect 'gustatory sweating')
-Poor thermoregulation – inability to cope with changes in temperature, especially hot weather
-Extremely dry hands
-Erectile Dysfunction
-Difficulty reaching orgasm
-Loss of libido
-Blood pressure problems
-Stress intolerance
-Depression
-Mental fogginess
-Loss of emotion
-Sensitivity to sounds and light
-Ongoing pain, particularly in the chest, back, limbs, or under the arms
-Unexplained prickling, burning, numbness or tingling sensations in the body/limbs

Brief descriptions of medical conditions ETS surgery is commonly offered for:

Hyperhidrosis – Excessive sweating of the hands, feet, underarms, face, head or body. The sweating can be so severe that sweat forms on and/or drips from the affected body part(s) almost continuously during waking hours. Hyperhidrosis is considered to be socially and professionally disabling by those affected.

Facial Blushing – This condition is also known as 'erythrophobia', or 'fear of blushing'. It is a sudden and severe blushing of the face (the neck and upper chest can also be affected), sometimes to the point that it is burning and painful. Facial blushers typically find it impossible to look others in the eye without blushing deeply. Those affected consider the condition to be socially and professionally disabling.

Raynauds – Discoloured, painful and excessively cold hands/feet/limbs. Raynauds is a vasospastic disorder, the cause of the phenomenon is believed to be the result of vasospasms that decrease blood supply to the respective regions. Sufferers can develop the first signs of frostbite in the affected body part(s).