major effects on local blood flow and temperature are elicited by TES. Complex autonomic reflexes are also affected. The patient should be completely informed before surgery of the side effects elicited by transthoracic endoscopic sympathicotomy (TES).
http://www.ncbi.nlm.nih.gov/pubmed/18540897
Acta Neurol Scand. 2008 Dec;118(6):402-6.
stellate ganglion block in the treatment of panic/anxiety symptoms
Both patients experienced immediate, significant and durable relief as measured by the PCL (score minimum 17, maximum 85). In both instances, the pre-treatment score suggested a PTSD diagnosis whereas the post-treatment scores did not. One patient requested repeat treatment after 3 months, and the post-treatment score remained below the PTSD cutoff after 7 additional months of follow-up. Both patients discontinued all antidepressant and antipsychotic medications while maintaining their improved PCL score.
http://www.ncbi.nlm.nih.gov/pubmed/20412504
CONCLUSION:
Selective blockade of the right stellate ganglion at C6 level is a safe and minimally invasive procedure that may provide durable relief from PTSD symptoms, allowing the safe discontinuation of psychiatric medications.http://www.ncbi.nlm.nih.gov/pubmed/20412504
Stellate ganglion block "reboots" the insular cortex
The following is a summary from our publications in Lancet Oncology and Medical Hypothesis
 | The picture demonstrates the connections from the stellate ganglion to other neural structures. This was demonstrated using retro rabies virus techniques and functional MRI. Both are objective data demonstrating the effect on the insula by the stellate ganglion. Stellate ganglion block effectively "reboots" the insular cortex, allowing for a reduction in hot flashes |
| The stellate ganglion refers to the ganglion formed by the fusion of the inferior cervical and the first thoracic ganglion as they meet anterior to the vertebral body of C7. It is present in 80% of subjects. It usually lies on or above the neck of the first rib. http://dardipainclinic.com/stellate_ganglion_block.php |
Patients need to be able to value and trust the knowledge and judgement of doctors
http://ama.com.au/node/6569
To date, sufficient importance has not been placed on the long term effects that could cause dorsal sympathectomy
A scientific society has been created for surgery of the sympathetic nervous system, the International Society of Sympathetic Surgery (ISSS); and in the most recent thoracic surgery and related specialities congresses it fills up a considerable percentage of the programme.
On the other hand, this surgery, especially for hyperhidrosis and facial reddening, is the one that on a percentage basis generates more demands and complaints from the patients, even with medico-legal connotations.7 Despite that the majority of the patients show a very high degree of satisfaction, the presence of a patient operated for hyperhidrosis with important compensatory sweating that repeatedly manifest their dissatisfaction to the surgeon is a very annoying situation with an intractable solution. There are even forums on the Internet that constantly manifest their discomfort with this type of surgery in a violent and insulting tone, for example, the World Against Sympathectomy Website.
In summary, we are faced with a new disorder that is being attended massively in our hospitals and needs a moment of contemplation. What are we doing? Are we doing it properly? What are the future implications in these patients of dorsal sympathetic denervation? For the first 2 questions, we could find the answer in the new clinical guidelines and scientific society norms and with the publication of linger series, randomised systematic studies, reviews and meta-analyses. However, it is perhaps the latter of these that implies greater consideration. To date, sufficient importance has not been placed on the long term effects that could cause dorsal sympathectomy, and the effects on lung function, heart function, skin colouring and psychological state are being studies, among others;10 the most important being the first 2. secondary consequences of the operation.
The consequences of sympathetic denervation after a dorsal sympathectomy on lung function have been studied on several occasions11 and reductions in forced vital capacity, forced expiratory flow in the first second and maximum mesoexpiratory flow have been found, but with no clinical significance. It therefore seems that, despite sympathetic innervation being scarce, it directly influences motor tone, especially of the fine respiratory tracts, which cause a light obstructive pattern after the operation and favours bronchial hyperreactivity.12 It is of great interest to know the results of the research being carried out to recognise the long term effects.
Something similar occurs with heart function, the sympathectomy in the short term causes bradycardia due to a lack of sympathetic stimulation to the heart. Several cases of myocardial infarction13 and
chronotropic heart failure requiring the insertion of a pacemaker14 have been reported. In the long term, dorsal sympathetic interruption causes an effect similar to beta blockers on the heart, and produced a decrease in average heart rate, but with no significant changes in the electrocardiogram (normal Q-T).15 It may be good to know through long term prospective studies which effects it truly has on heart function and what it could mean for the daily lives of the operated patients. For the time being, those individuals who practice aerobic sports (for example, long distance runners and cyclists)
should be informed that with sympathectomy their heart rate may be reduced in situations of maximum effort and lower their performance.16
M. Congregado / Arch Bronconeumol. 2010;46(1):1-2
On the other hand, this surgery, especially for hyperhidrosis and facial reddening, is the one that on a percentage basis generates more demands and complaints from the patients, even with medico-legal connotations.7 Despite that the majority of the patients show a very high degree of satisfaction, the presence of a patient operated for hyperhidrosis with important compensatory sweating that repeatedly manifest their dissatisfaction to the surgeon is a very annoying situation with an intractable solution. There are even forums on the Internet that constantly manifest their discomfort with this type of surgery in a violent and insulting tone, for example, the World Against Sympathectomy Website.
In summary, we are faced with a new disorder that is being attended massively in our hospitals and needs a moment of contemplation. What are we doing? Are we doing it properly? What are the future implications in these patients of dorsal sympathetic denervation? For the first 2 questions, we could find the answer in the new clinical guidelines and scientific society norms and with the publication of linger series, randomised systematic studies, reviews and meta-analyses. However, it is perhaps the latter of these that implies greater consideration. To date, sufficient importance has not been placed on the long term effects that could cause dorsal sympathectomy, and the effects on lung function, heart function, skin colouring and psychological state are being studies, among others;10 the most important being the first 2. secondary consequences of the operation.
The consequences of sympathetic denervation after a dorsal sympathectomy on lung function have been studied on several occasions11 and reductions in forced vital capacity, forced expiratory flow in the first second and maximum mesoexpiratory flow have been found, but with no clinical significance. It therefore seems that, despite sympathetic innervation being scarce, it directly influences motor tone, especially of the fine respiratory tracts, which cause a light obstructive pattern after the operation and favours bronchial hyperreactivity.12 It is of great interest to know the results of the research being carried out to recognise the long term effects.
Something similar occurs with heart function, the sympathectomy in the short term causes bradycardia due to a lack of sympathetic stimulation to the heart. Several cases of myocardial infarction13 and
chronotropic heart failure requiring the insertion of a pacemaker14 have been reported. In the long term, dorsal sympathetic interruption causes an effect similar to beta blockers on the heart, and produced a decrease in average heart rate, but with no significant changes in the electrocardiogram (normal Q-T).15 It may be good to know through long term prospective studies which effects it truly has on heart function and what it could mean for the daily lives of the operated patients. For the time being, those individuals who practice aerobic sports (for example, long distance runners and cyclists)
should be informed that with sympathectomy their heart rate may be reduced in situations of maximum effort and lower their performance.16
M. Congregado / Arch Bronconeumol. 2010;46(1):1-2
ETS story
I had ETS surgery (cutting of T2) about 10 years ago for facial HH. The surgery worked very well and I had virtually no immediate complications from the surgery (infection, nerve damage, etc). I now experience severe CS on my trunk (worse on my back) that is pretty debilitating. At this point I'm considering reversal surgery (and am very open to any insight).
I had the surgery done in San Francisco, CA by a now-retired thoracic surgeon (I live in the Portland, OR area). He did mention CS as a possible side effect but didn't present it as a huge risk. To be fair, I was so desperate that I probably wouldn't have listened anyway. That's why it is incumbent on doctors to save us from ourselves. Any surgeon that performs invasive, irreversible surgery to treat conditions where patients are despondent and vulnerable should overemphaasize the risks and minimize the possible benefits (under-promise and over-deliver).
The surgery was uneventful and recovery was quick and I had no immediate complications. In terms of efficacy, the surgery was tremendously successful. My facial HH was immediately and completely resolved, as was my hand-sweating (which wasn't a huge problem, but they are 100% dry now). I still experience gustatory sweating occasionally with very rich or spicy foods but it's not a problem at all. I also still experience blushing but I believe it may be better than it was.
That's the good part. Like many others, I now have severe CS on my trunk (worse on my back). I don't have any of the other dry scalp or pain syndromes that others have though, so maybe I'm one of the lucky ones.
Interestingly, having no moisture on your hands does cause some problems. It's hard to count out money (seriously) or pick things up and it's almost impossible to deal cards (and I used to be a BJ dealer in Las Vegas in college!). It's also hard to play basketball as you really need a little moisture on your hands to properly grip and put spin on the ball.
I've tried hyoscyamine and Robinul and find that Robinul seems to work better but really only reduces the CS about 20-30% most of the time. Often, it doesn't matter what I take.
http://www.no-ets.com/forums/viewtopic.php?p=1489&sid=6ff9da7866e646365a7b8ba9bfcbd845
I had the surgery done in San Francisco, CA by a now-retired thoracic surgeon (I live in the Portland, OR area). He did mention CS as a possible side effect but didn't present it as a huge risk. To be fair, I was so desperate that I probably wouldn't have listened anyway. That's why it is incumbent on doctors to save us from ourselves. Any surgeon that performs invasive, irreversible surgery to treat conditions where patients are despondent and vulnerable should overemphaasize the risks and minimize the possible benefits (under-promise and over-deliver).
The surgery was uneventful and recovery was quick and I had no immediate complications. In terms of efficacy, the surgery was tremendously successful. My facial HH was immediately and completely resolved, as was my hand-sweating (which wasn't a huge problem, but they are 100% dry now). I still experience gustatory sweating occasionally with very rich or spicy foods but it's not a problem at all. I also still experience blushing but I believe it may be better than it was.
That's the good part. Like many others, I now have severe CS on my trunk (worse on my back). I don't have any of the other dry scalp or pain syndromes that others have though, so maybe I'm one of the lucky ones.
Interestingly, having no moisture on your hands does cause some problems. It's hard to count out money (seriously) or pick things up and it's almost impossible to deal cards (and I used to be a BJ dealer in Las Vegas in college!). It's also hard to play basketball as you really need a little moisture on your hands to properly grip and put spin on the ball.
I've tried hyoscyamine and Robinul and find that Robinul seems to work better but really only reduces the CS about 20-30% most of the time. Often, it doesn't matter what I take.
http://www.no-ets.com/forums/viewtopic.php?p=1489&sid=6ff9da7866e646365a7b8ba9bfcbd845
Surgical Sympathectomy should be first line treatment according to 'Center for the Cure of Sweaty Palms™' surgeon
Given the clear superiority of BTS (bilateral thoracoscopic sympathectomy) for severe palmoplantar hyperhidrosis, deliberately using medical treatments that are known with near certainty to be eneffective and at times considerably noxious simply as a requisite to surgery may not be in the best interest of such patients, nor is such an approach ultimately cost-effective. There is no evidence that surgical intervention should be considered a "last resort" for this form of hyperhidrosis. BTS can safely and confidently be recommended as first-line treatment for the typical, severe form of palmoplantar hyperhidrosis.
(no conflict of interest has been declared by the authors)
Fritz J. Baumgartner
, a, 
, Shana Bertina and Jiri Konecnya
Annals of Vascular Surgery
Volume 23, Issue 1, January-February 2009, Pages 1-7
http://www.sciencedirect.com/science/article/pii/S0890509608001854
(no conflict of interest has been declared by the authors)
Fritz J. Baumgartner
, a, , Shana Bertina and Jiri KonecnyaAnnals of Vascular Surgery
Volume 23, Issue 1, January-February 2009, Pages 1-7
http://www.sciencedirect.com/science/article/pii/S0890509608001854
fraudulent or unethical medical research represents an unacceptable breach of trust for clinicians, health policymakers and the general public
http://www.mja.com.au/public/issues/194_12_200611/myb10505_fm.html
medical professionals have a feeling of invincibility
Medical practitioners are surprised when their performance is called into question. Many have a feeling of invincibility based on a lifetime of accumulated educational and professional successes.
The public add to this assumption by placing complete faith in their selected practitioner — until some misadventure occurs. Then the blame game starts.
When defending a claim, it is unreasonable to expect defence counsel to be cognisant of international medical literature concerning the condition in dispute. The defendant doctor should make it their job to amass expert opinion so lawyers can filter and present appropriately.
MJA INSIGHT Aug. 1. 2011
The public add to this assumption by placing complete faith in their selected practitioner — until some misadventure occurs. Then the blame game starts.
When defending a claim, it is unreasonable to expect defence counsel to be cognisant of international medical literature concerning the condition in dispute. The defendant doctor should make it their job to amass expert opinion so lawyers can filter and present appropriately.
MJA INSIGHT Aug. 1. 2011
most surgeons do not have a clear understanding of their short-term outcomes for the majority of procedures
The public would probably be surprised to know that most surgeons do not have a clear understanding of their short-term outcomes for the majority of procedures they perform.
Of even greater concern is the lack of data on long-term outcomes associated with surgical interventions.
Many surgeons argue that they are too busy and do not have the time and resources to conduct this sort of follow-up. This is not entirely without foundation, but it does seem difficult to defend a stance that says “I will continue to work feverishly at the operations I do but not assess how successful my results are”.
Of even greater concern is the lack of data on long-term outcomes associated with surgical interventions.
Many surgeons argue that they are too busy and do not have the time and resources to conduct this sort of follow-up. This is not entirely without foundation, but it does seem difficult to defend a stance that says “I will continue to work feverishly at the operations I do but not assess how successful my results are”.
Guy Maddern: No excuse for poor surgical outcomes
MJA INSIGHT, 8 August 2011
lumbar sympathectomy results in loss of ejaculation
Sympathectomy for the long term management of such patients has been carried out (Abel et al., 1974) and success reported. Loss of ejaculation does follow sympathectomy but his is a minor problem in patients who have an already destroyed sacral cord. (p. 410)
During fever pyrogen is released from leucocytes and his agent causes the disturbed thermoregulation (Atkinson, 1960). For his response to occur, an intact efferent sympathetic system is requred because fever can be markedly reduced by bilateral sympathectomy in he cat (Pinkston, 1935). (p.193)
The autonomic nervous system: an introduction to basic and clinical concepts By Otto Appenzeller, Emilio Oribe, Elsevier Health Sciences, 1997 - Medical
During fever pyrogen is released from leucocytes and his agent causes the disturbed thermoregulation (Atkinson, 1960). For his response to occur, an intact efferent sympathetic system is requred because fever can be markedly reduced by bilateral sympathectomy in he cat (Pinkston, 1935). (p.193)
The autonomic nervous system: an introduction to basic and clinical concepts By Otto Appenzeller, Emilio Oribe, Elsevier Health Sciences, 1997 - Medical
Intentional misrepresentation of the elective surgical procedure is common practice
"Sweating is one form of regulating the body's temperature. If the operation prevents sweating in one area, it is possible that patients will notice a greater amount of sweating elsewhere in their body in order to compensate. This is called "compensatory sweating" and can occur on the face, abdomen, back, buttocks, thighs, or feet. While this is a mild nuisance for most patients, occasionally (5-10% of the time) it can be severe and interfere with the patient's lifestyle. If it occurs, it usually improves within 6 months."
http://thoracic.surgery.virginia.edu/general-thoracic/general-thoracic-conditions-treatment/hyperhidrosis/
Mia: None of the 'facts' listed in the above text can be supported by scientific evidence. The information illustrates the myths spread on the internet by those who have a financial interest in offering ETS, - an interest that overrides the medical and ethical obligations of the medical profession.
The so called "compensatory sweating" is NOT compensatory, and the only study looking into this concluded that patients did sweat more after ETS.
If this side-effect of the elective surgery (intentional neurological injury/lesion) would be "compensatory" in order to maintain thermoregulation, it would be observed after botox or ionthoporesis treatment as well. Hyperhidrosis (reflex hyperhidrosis) is an usual finding in people after spinal cord injuries (especially above T6) and in diabetics due to damage to the SNS. It is a pathological response to injury.
No evidence can support - and there is clear contrary evidence - that if this compensatory sweating would occur, it would diminish in 6 months. It is all part of the intentional misrepresentation of elective surgeries to make them appear more appealing and safer than they are.
http://thoracic.surgery.virginia.edu/general-thoracic/general-thoracic-conditions-treatment/hyperhidrosis/
Mia: None of the 'facts' listed in the above text can be supported by scientific evidence. The information illustrates the myths spread on the internet by those who have a financial interest in offering ETS, - an interest that overrides the medical and ethical obligations of the medical profession.
The so called "compensatory sweating" is NOT compensatory, and the only study looking into this concluded that patients did sweat more after ETS.
If this side-effect of the elective surgery (intentional neurological injury/lesion) would be "compensatory" in order to maintain thermoregulation, it would be observed after botox or ionthoporesis treatment as well. Hyperhidrosis (reflex hyperhidrosis) is an usual finding in people after spinal cord injuries (especially above T6) and in diabetics due to damage to the SNS. It is a pathological response to injury.
No evidence can support - and there is clear contrary evidence - that if this compensatory sweating would occur, it would diminish in 6 months. It is all part of the intentional misrepresentation of elective surgeries to make them appear more appealing and safer than they are.
'Singing praises for ETS' and other predatory practices
I had ETS and am cured!!!!!!!
It's the best thing ever!!!!!!!
Forget about Botox, Dryonics, topicals, etc. Go right to surgery
http://singingpraisesforets.blogspot.com/
Following a complaint in May 2012, the surgeon - author (HyperhidrosisDoc) of the blog edited the text to:
"When Botox, Dryonics, topicals, etc. fail,
Go right to surgery"
It's the best thing ever!!!!!!!
Forget about Botox, Dryonics, topicals, etc. Go right to surgery
http://singingpraisesforets.blogspot.com/
Following a complaint in May 2012, the surgeon - author (HyperhidrosisDoc) of the blog edited the text to:
"When Botox, Dryonics, topicals, etc. fail,
Go right to surgery"
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