Treatment for Sympathectomy (ETS/ELS) Patients

Treatment for Sympathectomy (ETS/ELS) Patients

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Are you, or someone you know, suffering from negative symptoms caused by a sympathectomy (ETS/ELS)? Do you want treatment available for those suffering? If so, please support our campaign to raise awareness by signing this petition, joining our online Facebook community, and/or sharing your story with us.

What is a Sympathectomy (ETS/ELS)?
Endoscopic thoracic and lumbar sympathectomy (ETS and ELS) are procedures that cut, clip, or remove a part of the sympathetic nerve chain in order to stop palmar (palm), plantar (foot), or facial hyperhidrosis (excessive sweating), facial blushing (reddening of the face), or Reynaud syndrome (excessively cold hands). ETS is the procedure for upper-body hyperhidrosis (face, palms, and underarms), while ELS is for treating lower-body hyperhidrosis (feet). ELS is rarely performed due to a greater risk of negative side effects. Both forms of sympathectomy are often generalized under the term, "ETS".

What are the Risks?
Many people that undergo ETS or ELS surgery report serious life changing complications. Thoracic sympathectomy can alter many bodily functions, including sweating[1], vascular responses[2], heart rate[3], heart stroke volume[4][5], thyroid, baroreflex[6], lung volume[5][7], pupil dilation, skin temperature, goose bumps and other aspects of the autonomic nervous system, like the fight-or-flight response. It reduces the physiological responses to strong emotion[8], can cause pain or neuralgia in the effected area[9], and may diminish the body's physical reaction to exercise[1][5][10]. It's common for patients to be misinformed of the risks, and the risk of post-operative complications are often underreported.

ETS and ELS have been banned in their birthplace, Sweden, due to inherent risks, and complaints by disabled patients. In other countries it is a notoriously unregulated procedure.

Resources
ETS Awareness Homepage
International Hyperhidrosis Society
Wikipedia Entry
ETS Facebook Community

Frequently Asked Questions
Q. What does compensatory sweating look like?
A. CS often results in patients soaking through their clothes. Reported rates of patients with mild CS vary from 14% to 90%, with severe from 1.2% to 30.9%[11]. Gallery of images: https://imgur.com/a/InEp8l0.

Q. When does compensatory sweating occur?
A. Compensatory sweating (CS) is caused by uncomfortably high temperature (often any temperature above 25°C), high humidity, physical activity, or times of stress and anxiety. Temperature tolerance varies from patient to patient, with many unable to tolerate relatively low temperatures. Some patients report having CS at all times, even in freezing temperatures.

Q. What does "lack of bodily theromoregulation" mean?
A. Many ETS and ELS patients describe feeling hot at all times in certain parts of their body, most commonly in their upper-body above the level of sympathectomy. Many of these patients describe feeling hot even in air-conditioned rooms and outside on cold days. Thermography images of this phenomenon can be seen here: https://imgur.com/a/xLOiWFd. In addition to heat intolerance, many patients report cold intolerance. Lack of bodily thermoregulation results in the inability to cool and/or warm oneself, causing an inability to maintain homeostasis (equilibrium of body temperature).
Note: Thermography imaging is done after a period of 15 to 20 minutes of acclimating (getting the tissues used to the thermal controlled room).

Q. Sympathetic Nervous System disorders can cause nerve pain?
A. Sympathectomies have been used to treat certain nerve pain disorders such as Complex Regional Pain Syndrome (CRPS), aka Reflex Sympathetic Dystrophy (RSD). Some experts think it is unwarranted and makes CRPS worse, whereas others report a favorable outcome. The mechanism of how/why SNS disorders can cause nerve pain are not fully understood[9][12].

Q. How does a sympathectomy affect emotions?
A. The sympathetic nervous system is responsible for the body's "fight-or-flight" mechanism. Some sympathectomy patients describe feeling less anxiety, excitement, and ability to concentrate after surgery. A study was conducted by a prominent thoracic surgeon known for his work with sympathectomies and concluded that they were, "useful in reducing the symptoms of severe social phobia."[8] While for some this may be a positive side effect, others react negatively to the dulling effect it can have on certain emotions, possibly similar to how some react to antidepressant or anti-anxiety medication.

References
    1. Sihoe, A. D., Liu, R. W., Lee, A. K., Lam, C. W., & Cheng, L. C. (2007). Is Previous Thoracic Sympathectomy a Risk Factor for Exertional Heat Stroke? The Annals of Thoracic Surgery, 84(3), 1025–1027. doi: 10.1016/j.athoracsur.2007.04.066
    2. Redisch, W., Tangco, F. T., Wertheimer, L., Lewis, A. J., Steele, J. M., & Andrews, D. (1957). Vasomotor Responses in the Extremities of Subjects with Various Neurologic LesionsCirculation, 15(4), 518–524. doi: 10.1161/01.cir.15.4.518
    3. Abraham, P., Berthelot, J., Victor, J., Saumet, J. L., Picquet, J., & Enon, B. (2002). Holter changes resulting from right-sided and bilateral infrastellate upper thoracic sympathectomyThe Annals of Thoracic Surgery, 74(6), 2076–2081. doi: 10.1016/s0003-4975(02)04080-8
    4. Chess-Williams, R. G., Grassby, P. F., Culling, W., Penny, W., Broadley, K. J., & Sheridan, D. J. (1985). Cardiac postjunctional supersensitivity to ?-agonists after chronic chemical sympathectomy with 6-hydroxydopamine. Naunyn-Schmiedebergs Archives of Pharmacology, 329(2), 162–166. doi: 10.1007/bf00501207
    5. Hashmonai, M., & Kopelman, D. (2003). The pathophysiology of cervical and upper thoracic sympathetic surgeryClinical Autonomic Research, 13(0), i40–i44. doi: 10.1007/s10286-003-1105-3
    6. Kawamata, Y. T., Kawamata, T., Omote, K., Homma, E., Hanzawa, T., Kaneko, T., & Namiki, A. (2004). Endoscopic Thoracic Sympathectomy Suppresses Baroreflex Control of Heart Rate in Patients with Essential HyperhidrosisAnesthesia & Analgesia, 98(1), 37–39. doi: 10.1213/01.ane.0000094984.90178.33
    7. Milner, P., Lincoln, J., & Burnstock, G. (1998). The neurochemical organization of the autonomic nervous system. In The autonomic nervous system (p. 110). Amsterdam: Elsevier Science Publishers.
    8. Pohjavaara, P., & Telaranta, T. (2005). Endoscopic sympathetic block as treatment of social phobiaEuropean Surgery, 37(3), 137–142. doi: 10.1007/s10353-005-0147-2
    9. Schlereth, T., & Birklein, F. (2007). The Sympathetic Nervous System and PainNeuromolecular Med., 10(3), 141–147. doi: 10.1007/s12017-007-8018-6
    10. Bassenge, E., Holtz, J., Restorff, W. V., & Oversohl, K. (1973). Effect of chemical sympathectomy on coronary flow and cardiovascular adjustment to exercise in dogsPflügers Archiv, 341(4), 285–296. doi: 10.1007/bf01023670
    11. Dumont, P. (2008). Side Effects and Complications of Surgery for HyperhidrosisThoracic Surgery Clinics, 18(2), 193–207. doi: 10.1016/j.thorsurg.2008.01.007
    12. Complex Regional Pain Syndrome Fact Sheet. (n.d.). Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Complex-Regional-Pain-Syndrome-Fact-Sheet

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