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

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

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/Pages/Home.aspx 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

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)

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

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.