Article on ETS published in The Press, Christchurch's daily paper

A shorter (but still substantial) version of the article on ETS surgery that was published in Australia (see details in the previous blog dated April 2, 2012) was recently published in the New Zealand mainstream print media. It appeared in the Saturday April 7 weekend edition of The Press in the magazine supplement called 'Your Weekend'.

The NZ version of the article included some brief comment, in a separate section at the end of the article, from NZ ETS surgeon David Ferrar (based in Hamilton).

The article does not appear to have been published online so I will scan it at some stage and link to it here.

In the mean time, here is a copy of the mini interview with Hamilton-based ETS surgeon David Ferrar that appeared in The Press' version of John Van Tiggelen's article.

Sugrery may do more than spare blushes
By Beck Eleven

Hamilton surgeon Mr David Ferrar says there are fewer than 20 vascular surgeons in New Zealand and of those, only about six perform endoscopic throacic sympathectiomies.

The vast majority relate to severe sweating conditions and he would perform about 10 of these surgeries a year. However, people who come to Ferrar solely for problem blushing are rare. In the past five or six years, he's seen ten blushers, with six choosing to go through with the operation after being advised of potential side-effects.

"Most people would be sweating so profusely from their hands they find it hard to use a keyboard or hold a piece of paper. The blushing is part of the procedure, but the best results are for people who sweat as well."

He knows the procedure is controversial because of the unpredicatability of side-effects.

"If blushing is the only problem, you can expect to come away with very, very dry hands. Also, 30 to 40 percent of people get compensatory sweating on the front or back of their trunk.

"So if you sweat profusely from your hands and that's been cured, the patient doesn't mind too much if their hands are dry and they sweat a bit more on their trunk. However, if blushing is the only problem, people are more likely to complain."

People who consult Ferrar about severe blushing are usually at the end of the line, having already exhausted other methods such as therapy.

"They worry about things like public speaking or embarrassment in the office.

"Imagine you're a lawyer and the first thing you do when you meet a client is shake their hand but you are sweating and going bright red. You can see why that would be upsetting."

Ferrar believes much of the controversy lies in surgeons, mainly in the United States, who perform the surgery on anyone who asks for it, rather than the severe end of the spectrum.

"In America, there are so many that have been operated on when it hasn't been necessary, or the surgeon has given the patient false expectations, that there are support groups for people who've had complications or adverse effects. The people that come to me are almost self-selecting; they've tried everything else."

The youngest patient he has performed an endoscopic thoracic sympathectomy on was 8-years-old, with most being in puberty (when the condition tends to arise). Or they are in their 20s when they are beginning relationships and jobs.

He sasys older people tend to have lived with the condition and grown used to it.

Excerpts from an interview with an ETS surgeon

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.