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Tags ets surgery , hyperhidrosis , side effects , sympathectomy , treatise

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Old 16th March 2007, 07:20 PM   #1
Steven Lupo Grossi
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Corposcindosis - Treatise on ETS Surgery

Hello JREF -

There's a bit of a controversy over this ETS surgery. It's being done routinely to treat hyperhidrosis and facial blushing. The doctors say it's safe and effective with minimal side-effects. A lot of patients complain about all sorts of physical and mental problems from it.

h t t p://editthis.info/corposcindosis/Main_Page

Please remove the spaces between h t t p. I cannot yet post links.

This is the most comprehensive theory of ETS effects. I'd like any comment, criticism, praise, etc, especially if there happen to be any MDs around.

Thanks.

Steven Lupo-Grossi.
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Old 16th March 2007, 08:35 PM   #2
trvlr2
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Steve- here's your link.

http://editthis.info/corposcindosis/Main_Page

I think I'd rather sweat.
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Old 17th March 2007, 07:34 PM   #3
Steven Lupo Grossi
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Thanks Tvlr2. The nerve ganglia that are cut in ETS surgery lead to the heart, the lungs, the blood vessels, the sweat glands, the thyroid, bone, bone marrow, fat tissue, and more. It is common sense to suspect that the surgery will affect the function of all of those. Yet surgeons portray the procedure as safe and effective, and do not mention these body systems to the patient. Most people have never even heard of the sympathetic nervous system.
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Old 17th March 2007, 09:07 PM   #4
T.A.M.
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Interesting "blurb" about it. Any articles from established journals on the matter would be helpful.

A search of Google "Scholar" produces ZERO results, so I am assuming it is not an official disease/condition. I personally have never heard of it. I will see if I can find anything elsewhere.

A regular google search picks you up asking this question at another forum, the "doctors lounge." seems you've searching for some answers on this.

Do you, or someone you know, suffer from these symptoms?

TAM

Edit: I am a Family Physician, not a surgeon, and in particular, not a thoracic surgeon, so it is not unexpected that I would know little of it, but it is unusual to produce NO results for it on Google Scholar.
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Old 17th March 2007, 09:13 PM   #5
T.A.M.
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you may find these helpful....

http://ats.ctsnetjournals.org/cgi/co...tract/76/3/886
http://ats.ctsnetjournals.org/cgi/co...ract/71/4/1116

TAM

Go to Google Scholar and type in "T2 sympathectomy morbidity" into the search, and read away.

Cheers

TAM

Last edited by T.A.M.; 17th March 2007 at 09:16 PM.
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Old 17th March 2007, 10:07 PM   #6
Steven Lupo Grossi
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I should clarify. The Corposcindosis site is a treatise written by a layperson, and now being edited and expanded on a wiki, predominantly by me, another layperson. Corposcindosis is not "an official" disease, but it certainly appears to meet the definition for one. This is the most comprehensive theory of thoracic sympathectomy, so far as we know. It does currently have one endorsement from David Goldstein, M.D. Ph.D, of NIH. We seek any comment, review, corrections, criticism of the thesis.
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Old 17th March 2007, 10:16 PM   #7
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The article you linked to looks like a hoax.
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Old 17th March 2007, 10:44 PM   #8
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I don't really understand how an elective surgery that has an outcome that destroys 4% of patients lives is considered an ethical treatment, but then I am not a doctor.

This seems like an example of suffering people being taken advantage of to make a dollar, and I don't really agree that they could ever be "informed" in the sense that they fully understand the risks of undergoing voluntary nerve damage.

Quote:
To: The American Medical Association

We, the undersigned, wish to send a message to the medical community and the public at large about thoracic sympathectomy for excessive sweating and facial blushing, a surgical procedure commonly known as “ETS” (Endoscopic Thoracic Sympathectomy), and which has several variations that go by the names like ESB (Endoscopic Sympathetic Blockade), VATS (Video-Assisted Thoracoscopic Sympathectomy), micro-ETS and likely other names as well. They are all common in that the aim of the surgery is to stop function in the upper thoracic region of the sympathetic chain of ganglia.

First, we object to the classification of excessive sweating and facial blushing as diseases. While it is true that these conditions can be very embarrassing, causing the afflicted to dislike or avoid social situations, and this can indeed have a negative impact on the quality of life, from a physiological point of view they are entirely harmless. We believe that the recent “official” classification of these conditions as diseases is borne not of medical accuracy, but rather out of a desire to legitimize and justify the surgery in the eyes of both prospective patients and their insurance carriers.

Second, and more importantly, we object to the procedure itself. Interrupting the sympathetic chain in the thoracic region (by whatever means) is proven to cause a litany of permanent physical and mental disabilities, including anhidrosis, lowered heart function, lowered mental function, diminished lung volume, loss of baroreflex, paralyzed blood vessels, dysfunctional thermoregulation, chronic pain, paresthesia, lowered alertness, decreased exercise capacity, lowered response to fear, thrills, and other strong emotions. Thousands of unsuspecting patients are having psychiatric surgery without consent, forever robbed of their strongest feelings.

And, infamously, ETS surgery can cause uncontrollable, clothes-drenching sweating from the nipple-line down. In other words, the “cure” for hyperhidrosis can actually cause WORSE hyperhidrosis. Some cure.


Third, we believe that the total combined effects of thoracic sympathectomy constitute a physiologic disorder, a disease in and of itself, one worthy of its own name, and that this newly christened disorder shall hereafter be known as “Corposcindosis” meaning “split-body syndrome” defined as “An autonomic neuropathy in which sympathetic nerve function has been divided into two distinct regions - one dead and the other hyperactive”. Victims of ETS often complain of “living in two separate bodies”. Corposcindosis is definable, diagnosable, predictable, measurable, photographable, disabling and incurable.

The results of ETS surgery have been so catastrophic that a large percentage of patients say it has ruined their lives. There have been suicides by distraught ETS patients who could not tolerate the nerve damage another minute. We, the undersigned, hope and pray that they found some relief.



List of Demands

1. We, the undersigned, demand that ETS surgeons establish a clearly defined standard of care for their practice.

2. Foremost in this newly established standard of care shall be a standard ETS surgery consent form which includes warnings about the risk of all of the following: anhidrosis, compensatory hyperhidrosis, loss of vascular function, lowered heart function (possibly requiring a pacemaker), diminished baroreflex, thermoregulatory problems, loss of strong emotion, lowered alertness, Horner’s syndrome, Frey’s syndrome, and chronic pain. Patients must be warned that they may be forced to change their lifestyle or career, especially if those activities involve warm weather, exercise, or reliance upon strong emotion or alertness.

3. We demand that every patient consenting to sympathectomy (in any variation) be advised and sign a written consent form which contains all of the warnings in #2, and which also contains a simple picture showing the predicted areas of anhidrosis and hyperhidrosis.

4. We demand that each and every ETS surgeon website be updated to include all of the warnings in #2

5. We demand that each and every ETS surgeon website be updated to include at least one “negative” patient testimonial alongside the positive ones.

Having said all that, we, the undersigned, fully support the right of the patient to undergo surgical sympathectomy, and the right of the surgeon to perform and derive income from surgical sympathectomy, so long as informed consent (as defined above) has taken place.

Sincerely,

The Undersigned

http://www.petitiononline.com/consent/petition.html
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Old 18th March 2007, 05:59 PM   #9
T.A.M.
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As a physician, I can tell you that 4% is not that high a figure for extremely negative, but non-fatal outcomes in surgical procedures. You are not talking about removing a mole, the surgery is delicate, and intricate, particularly in terms of access.

For instance, a Cardiac Catheterization, not a corrective procedure, but simply a diagnostic one, carries a 0.1% Mortality (1:1000).

Cholecystectomy, as a whole, carries a 0.6% Mortality rate (6:1000).

And those are mortality (death) figures.

I am not defending the procedure, as I know little about its exacts, but I just want to put medical procedures in perspective here wrt negative outcomes.

TAM
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Old 18th March 2007, 06:03 PM   #10
T.A.M.
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Originally Posted by Kopji View Post
I don't really understand how an elective surgery that has an outcome that destroys 4% of patients lives is considered an ethical treatment, but then I am not a doctor.

This seems like an example of suffering people being taken advantage of to make a dollar, and I don't really agree that they could ever be "informed" in the sense that they fully understand the risks of undergoing voluntary nerve damage.
As I have said, the exact procedure (T2 Sympathectomy) I am not overly familiar with. However, plastic surgery is elective, and look at the outcome it has had for people, even some celebrities, who have access to the best.

I think it depends on (1) an honest physician, honest with his patients, and (2) realistic expectations of the patient. As well, one has to look at the risk:benefit. The procedure may be "elective" but so is Gallbladder surgery in many circumstances. It depends of the sufferage of the patient if the procedure is NOT performed, weighed against the benefit, and the potential side effects, and potential negative outcomes.

TAM
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Old 18th March 2007, 07:43 PM   #11
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Originally Posted by T.A.M. View Post
As a physician, I can tell you that 4% is not that high a figure for extremely negative, but non-fatal outcomes in surgical procedures. You are not talking about removing a mole, the surgery is delicate, and intricate, particularly in terms of access.
Also as a physician, my opinion is that this is an unacceptable risk for what is essentially a cosmetic procedure. It is indeed hard to truly give an informed consent in this case, especially since the patient will (usually) be paying a lot of cash out of pocket for such a procedure when done for hyperhidrosis of the palms. Nerve fibers do regrow if the pathways aren't obliterated, and this goes for the efferent fibers of the sympathetic system as well.

Likewise, blocking the sympathetic outflow at that level usually results in a compensatory outflow to other centers. So, I'm not sure how well studied or understood exact problems as a result of this procedure would manifest themselves in separate individuals. I've heard stories of cutaneous flushing around the face, increased facial sweating, and other serious "side effects" of this procedure.

My sister's ex-fiance several years ago looked at this option. He was ultimately well-managed with medications. He, too, decided that the risk of the surgery was too great. I do not believe the surgery is even offered in the U.S. (I might be wrong now), and IIRC he was looking at traveling to Karolinska to have it done. The costs, when all totaled, would have been outrageous for what was tantamount to sweaty palms. Sweaty palms, I should say, that were essentially and ultimately effectively managed by proper medications.

-Dr. Imago
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Old 19th March 2007, 09:24 AM   #12
T.A.M.
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Originally Posted by Dr. Imago View Post
Also as a physician, my opinion is that this is an unacceptable risk for what is essentially a cosmetic procedure. It is indeed hard to truly give an informed consent in this case, especially since the patient will (usually) be paying a lot of cash out of pocket for such a procedure when done for hyperhidrosis of the palms. Nerve fibers do regrow if the pathways aren't obliterated, and this goes for the efferent fibers of the sympathetic system as well.

Likewise, blocking the sympathetic outflow at that level usually results in a compensatory outflow to other centers. So, I'm not sure how well studied or understood exact problems as a result of this procedure would manifest themselves in separate individuals. I've heard stories of cutaneous flushing around the face, increased facial sweating, and other serious "side effects" of this procedure.

My sister's ex-fiance several years ago looked at this option. He was ultimately well-managed with medications. He, too, decided that the risk of the surgery was too great. I do not believe the surgery is even offered in the U.S. (I might be wrong now), and IIRC he was looking at traveling to Karolinska to have it done. The costs, when all totaled, would have been outrageous for what was tantamount to sweaty palms. Sweaty palms, I should say, that were essentially and ultimately effectively managed by proper medications.

-Dr. Imago

I totally agree with most of what you said. Even though I practice in Canada, cosmetic procedures are paid for out of ones pocket. I am not sure how this one would go. If one made a case for mental durress due to the symptoms they were suffering, Public Health Care might pay for it.

As for the Unacceptable risk, as I have said, I'm not overly familiar with the procedure, but as you well know, 4% is not extra-ordinarily high for a serious side effect of such a delicate surgery, adjacent to so many important viscera (I am unsure of the approach, through the back versus through the abdominal wall. This is not an excuse, but merely a reality check on how frequent side effects of procedures are...even benign, seemingly simple ones.

If as you say, most times it is done for "sweaty palms" than I 100% agree, the risk is unacceptable.

Aside from the above points, I essentially concur with your comments.

TAM
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Old 20th March 2007, 01:26 PM   #13
Steven Lupo Grossi
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Originally Posted by T.A.M. View Post
you may find these helpful....

TAM

Go to Google Scholar and type in "T2 sympathectomy morbidity" into the search, and read away.

Cheers

TAM
The second article you hints at a systemic problem with surgeon deception about ETS surgery:

Quote:
Patients should be clearly warned that TES is not as minor a procedure as usually asserted.
They go on to to advise:

Quote:
Complications as well as adverse effects should be considered when discussing this surgical indication.
Yes, but what does that include, exactly? The French authors do not say, but the Corpscindosis treatise does:

Quote:
Primary regional (above the nipple line) symptoms of corposcindosis may include: anhidrosis (inability to sweat), increase (up to 12 degrees F) in skin temperature, decreased heart rate, decreased heart contraction strength, diminished baroreflex response, diminished lung volume, decreased carbon dioxide transfer out of blood, loss of vasoconstriction, loss of goose bumps, increased fat cell count, diminished lypolysis (fat burning), increased bone resorption, decreased osteoblast formation, confused stem cell function within bone marrow, delayed skin healing and chronic pain. Compensatory regional (below the nipple line) symptoms may include: hyperhidrosis (excessive sweating), loss of libido.
Changes to systemic function may include: poor thermoregulation (including loss of selective brain cooling), diminished exercise capacity, and calcification of arteries. Primary psychiatric effects may include: diminished experience of strong emotions. Secondary psychiatric effects may include: anger, depression, suicide and suicidal thoughts.
h t t p://editthis.info/corposcindosis/Abstract
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Old 22nd March 2007, 05:19 PM   #14
T.A.M.
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Originally Posted by Steven Lupo Grossi View Post
The second article you hints at a systemic problem with surgeon deception about ETS surgery:



They go on to to advise:



Yes, but what does that include, exactly? The French authors do not say, but the Corpscindosis treatise does:



h t t p://editthis.info/corposcindosis/Abstract

My first response to the surgery is that it is far from simple. The location, the structures themselves, not to mention the adjacent anatomical structures, would make this anything but routine and simple, and anyone who claims such is just too full of surgeon bravado.

TAM
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Old 22nd March 2007, 05:47 PM   #15
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Originally Posted by T.A.M. View Post
As a physician, I can tell you that 4% is not that high a figure for extremely negative, but non-fatal outcomes in surgical procedures.

...

For instance, a Cardiac Catheterization, not a corrective procedure, but simply a diagnostic one, carries a 0.1% Mortality (1:1000).

...

And those are mortality (death) figures.

...

TAM

I had a Cardiac Catheterization on December 16th, 2006! This is the first that I've heard about my chances of dying during the procedure!

Of course, those chest pains and shortness of breath were a bit distracting at the time...

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Old 23rd March 2007, 02:04 AM   #16
Steven Lupo Grossi
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David S. Goldstein, MD, PhD Endorses Corposcindosis

Link to Goldstein's endorsement:

h t t p://editthis.info/corposcindosis/Peer_Review

Link to updated abstract:

h t t p://editthis.info/corposcindosis/Abstract

From the abstract:

Quote:
Symptoms

Primary immediate regional (above the nipple line) symptoms

Primary regional (above the nipple line) symptoms of corposcindosis may include: anhidrosis (inability to sweat), increase (up to 12 degrees F) in skin temperature, decreased heart rate and contraction strength, diminished baroreflex response, diminished lung volume, decreased carbon dioxide transfer out of blood, loss of vasoconstriction, loss of goose bumps, increased fat cell count, diminished lypolysis (fat burning), increased bone resorption, decreased osteoblast formation, confused stem cell function within bone marrow, delayed skin healing, calcification of arteries, chronic pain and parethesia.

Cannon Effects (Denervation Supersensitivy)

Over time, as some denerved receptors become supersensitive to catecholamines, symptoms may include: rapid weak heart beat (Post Orthostatic Tachycardia Syndrome), additional pain syndromes, hypersensitivity to sound and/or light, and many other possible supersensitivity effects.
Compensatory regional (below the nipple line) symptoms

Compensatory regional (below the nipple line) symptoms may include: hyperhidrosis (excessive sweating), loss of libido, plus several other possible hyperactive sympathetic responses.

Changes to systemic function

Changes to systemic function may include: poor thermoregulation in response to both hot and cold, loss of selective brain cooling, diminished exercise capacity, and lowered endocrine function.

Primary psychiatric effects

Primary psychiatric symptoms may include: diminished subjective experience of strong emotions, such as fear, thrills, and excitement; diminished alertness.

Secondary psychiatric effects

Secondary psychiatric sympatoms may include: anger, depression, suicide and suicidal thoughts.


Corposcindosis is a disease

Corposcindosis is a disease in every sense of the word. ETS surgery causes the interruption, cessation, and disorder of body functions, systems, organs, glands, and muscles. It has a proven etiolgy, ETS surgery. It has an identifiable group of signs and symptoms, and presents consistent anatomical alterations. (see above). The word "disabled" and "disabling" appear in the literature with reference to the effects of thoracic sympathectomy in humans. The National Institutes of Health have included thoracic sympathectomy in their list of "neurocardiologic disorders".
Corposcindosis is definable, predictable, measurable, photographable, disabling, preventable, and, for now, incurable. Subjectively, ETS surgery patients may consider their corposcindosis to be “life ruining”, “hateful” and “disturbing”.
QED.
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Old 11th April 2007, 12:46 PM   #17
Steven Lupo Grossi
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ETS surgery causes disease?

I think this paper makes the case quite overwhelmingly that ETS surgery causes a terrible disease, an autonomic neuropathy to be exact. Anyone agree or disagree?
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