Some ETS surgeons, particularly in the United States, claim that their version of ETS results in fewer side effects because they operate only at T4 (thoracic vertebrae level 4) on the Sympathetic Nervous System.
These ETS surgeons typically claim that sympathectomies for hyperhidrosis or facial blushing performed at the T2, T3 or T2 and T3 levels are more likely to result in side effects, in particular the common ETS side effect of compensatory sweating, aka compensatory hyperhidrosis.
Many ETS patients experience compensatory hyperhidrosis to varying degrees that affects mainly the trunk (back, chest, stomach) and sometimes the groin and legs. A significant number of ETS patients report that their compensatory sweating is so severe that the excessive sweating on their trunk (and often groin and legs) soaks through their clothing every day, leaving them professionaly and socially disabled, fatigued, and with much worse quality of life compared with their pre-surgery, localised hyperhidrosis condition.
Naturally, compensatory sweating is a much-feared side effect of ETS among prospective patients - unsurprisingly, none of us want to swap sweaty hands, a sweaty face/head, sweaty underarms or a blushing face for a dripping wet torso, groin and legs.
Aware of this fear among prospective patients, some ETS surgeons have been claiming for several years now, with no scientific basis, that by performing ETS at the T4 level only, the chance of compensatory sweating developing as a side effect is greatly reduced.
Well, researchers Kopelman and Hashmonai at Ha'emek Hospital in Afula, Israel, reviewed much of the published literature on ETS surgery to evaluate the validity of the claim that a lower level of sympathectomy, and other techniques such as limiting the extent of nerve ablation (aka limiting the number of nerve levels cut, cauterised or clamped), reduces the occurrence of compensatory sweating.
Their paper was published in the World Journal of Surgery in Nov. 2008, and their conclusion was that there was no validity for the claim. Their conclusion stated:
"The compiled results published so far in the literature do not support the claims that lowering the level of sympathetic ablation, using a method of ablation other than resection, or restricting the extent of sympathetic ablation for primary palmar hyperhidrosis result in less compensatory hyperhidrosis. In the future, standardization of the methods of retrieving and reporting data are necessary to allow such a comparison of data."
Link to the abstract of this study:
http://www.ncbi.nlm.nih.gov/pubmed/18797962
So what does this mean if you are considering ETS surgery and worried about the side effect of compensatory sweating?
If any surgeon tries to claim that their version of the surgery is less likely to cause side effects such as compensatory sweating, I encourage you to be wary of what is effectively marketing spin with no scientific basis. It is your (only) body and your health. Do your research: read about the Sympathetic Nervous System, talk to others who have had the surgery, and read the online testimonials of ETS patients. Note the wide range of levels (T2, T3, or T4, or combinations of) that patients who did and did not develop compensatory sweating (and other side effects) were operated on. In addition, note the different types of surgical method used for different patients when you read their testimonials - were their nerves cut, clamped or cauterised?
Do testimonials from different patients operated at different levels, using different methods, often mention side effects - sometimes severe, life-changing side effects?
Do patient testimonials support the claim of some ETS surgeons that one method of surgery is safer than another and guarantees specific results?
For example, I was cauterised at T2 only - a level that some ETS surgeons claim is associated with much greater risk of compensatory sweating if operated on. Yet I have never experienced any compensatory sweating in the 11 years since I had my surgery, but I know of others cut or cauterised at T2 only who have experienced everything from mild to severe compensatory sweating (and other adverse side effects). And I have read testimonials of at least two ETS patients clamped at T4 who experienced severe compensatory sweating.
Images of severe compensatory sweating, courtesy of an Italian ETS patient:
http://www.ago972.altervista.org/index.html
Showing posts with label Isn't T3/T4 safer?. Show all posts
Showing posts with label Isn't T3/T4 safer?. Show all posts
Sunday, July 29, 2012
Wednesday, May 25, 2011
"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?"
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.
*****
*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.
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