Side Effects from ETS Surgery for Hyperhidrosis and Facial Blushing

About ETS Side Effects

Each effect is followed by three check boxes -




Anecdotal		Empirical
	Theoretical

Anecdotal means that patients themselves are complaining about the effect and believe it to have been caused by sympathectomy.

Theoretical means that there is a plausible explanation for the effect based on textbook understanding of the autonomic nervous system.

Empirical means that there is at least one published scientific study which confirms the connection between sympathectomy and the effect.

No distinction is made here between primary effects and side effects. All ETS patients will experience the consequences of denervation. It is impossible to predict in advance who will and who will not tolerate them. It is true that some ETS patients consider the physical effects to be an acceptable trade-off to the original cosmetic problem. It is also true that many ETS patients consider the physical effects to be disabling and life-ruining. Because surgeons do not appear to be doing meaningful long-term follow-up studies, we really don't know how many fall into each category. Below are the known effects of ETS, and as you read them bear in mind that ETS surgery is performed to treat a completely benign, cosmetic problem (excessive sweating or facial blushing). TruthAboutETS does not support the notion that either excessive sweating or blushing are diseases.

Medical Disclaimer: The publishers of TruthAboutETS are not doctors. We are a group of ETS patients and concerned citizens who have done extensive research and been educated by leading scientists at National Institutes of Health. We believe the above information to be medically accurate, and have provided links to published medical data. This is not a substitute for the advice of a medical professional. If you are considering ETS surgery for any reason, we strongly urge you to seek the advice of a neurologist or other specialist who has no financial stake in the surgery.

ETS surgery can cause the permanent paralysis of all skin function from the nipple-line up. This amounts to about 1/3 of the total skin surface of the body. This skin cannot sweat to cool itself, nor form goose bumps to guard against the cold, nor experience the pleasure from a rush of emotion. The sensation of touch is deadened and dry in this entire area, as tens of thousands of tiny Arrector Pili muscles lie wasting.

ETS surgery can cause a total inability to sweat from the nipple line up. If the sympathetic chain is interrupted at the T4 level, the anhidrosis will also include the armpits. All skin in this area is bone dry. Besides robbing skin of needed moisture and cleansing, anhidrosis also compromises thermoregulation. Heat rises, so the human body needs to sweat from the head to cool itself off. Sweat contains a substance called bradykinin, which normally dilates blood vessels, helping to counterbalance the constriction caused by direct sympathetic stimulation of the smooth muscle.

The human body has two methods of dissipating excess heat: evaporation of sweat, and dilating blood vessels near the skin (cutaneous arteries). ETS creates a bizarre situation where the top part of the body has lost vascular control and cannot sweat, while the bottom part retains vascular control and sweats way too much. Patients feel as though they are living inside two different bodies, and attempting to treat one aggravates the other. There can be up to a 12 degree (F) difference in skin temperature between the two body sections.

Despite the dilated cutaneous arteries, ETS patients typically cannot tolerate hot temperatures, because they cannot sweat from the head. Lower body sweating is far less efficient at dissipating heat than upper body sweating.

Adapting to cold temperatures is compromised too. Ordinarily, cold temperatures cause the cutaneous arteries to constrict, and the deep vessels to dilate, which allows the core of the body to retain its warmth. ETS patients lack vascular control in the upper body, and also lack the ability to form goose bumps, which ordinarily raise hairs and trap little pockets of warm air next to the skin.

The end result? Sympathectomy patients are less able to cool off in the heat and less able to warm up in the cold. Many ETS victims report feeling too hot and too cold at the same time. Hot skin sends a message that the upper body is warm, but it's false information because the deep core is actually too cold.

ETS partially denervates the heart muscle, causing bradycardia. Bradycardia is an abnormally low resting heart rate, and an inability to sufficiently raise the heart rate during exercise, or in response to fear. This leads to a greatly diminished capacity for exercise, sex, etc. Bradycardia is also known as the "Beta-Blocker Effect", because it is similar in some ways to the effects of beta-blocker medication. In some cases the effect is relatively mild, in other cases it is severe enough to require a permanent pacemaker.

ETS significantly suppresses baroreflex control of heart rate. Special nerve cells called baroreceptors are located in the walls of the heart and large arteries. These receptors are specialized to monitor changes in blood pressure. If the receptors sense a rise in blood pressure, then, though a 'negative feedback loop', the heart will slow down to compensate. If they sense a drop in pressure, the heart will speed up. ETS destroys a relay station in the pathway, so the heart never gets information one way or the other.

The sympathetic ganglia innervate the smooth muscles surrounding blood vessels. Sympathetic stimulation normally causes the arteries near the skin surface to constrict and the deep muscle arteries to dilate, so the body is able to reallocate blood as needed. ETS patients lose vascular control in the upper extremities. This leads to a redistribution of blood flow throughout the arms, hands, neck and face, and it is not a good thing. An overabundance of blood is sent to the skin, causing the skin temperature to rise, while not enough blood is sent to the muscles. The human body needs to be able to dilate and constrict blood vessels for all sorts of reasons, including blood pressure regulation, temperature regulation, response to exercise, fear, anxiety, and sexual stimulation.

Many ETS victims become "hand lotion addicts", unable to tolerate even 5 minutes without it. The hands and fingers feel so dry that the patient cannot tolerate touching dry textures, such as paper, cardboard, cotton fabric, hair, fur, etc. The hands and fingers have a drastically altered sense of touch. Due to complete lack of moisture, the fingertips are very slippery, causing a decline in manual dexterity.

Almost all ETS patients sweat more, not less than they did before surgery. The hyperhidrosis problem has been worsened, and moved to new areas of the body.

The most common areas for compensatory hyperhidrosis are the abdomen, lower back, crotch, and the backs of the legs. Complaints of soaked underwear or shirts are not uncommon. Patients report sweating at lower temperatures than before surgery, greater volumes of perspiration, and longer times waiting for sweating to stop. Many ETS victims will sweat profusely with the slightest physical activity.

Compensatory sweating can be categorized as either "mild", "moderate" or "severe", but surgeons do not agree on what differentiates one from the other, and typically do not take any actual measurements of sweating. Almost 100% of ETS patients will suffer from some degree of compensatory hyperhidrosis. Surgeons often euphemistically refer to this effect as "compensatory sweating" or "reflex sweating", but since the amount of sweating is excessive, we feel the correct term should use the word "hyperhidrosis".

The cause of this surgically-induced excessive lower body sweating is not known, but there are two main theories:

The body begins to sweat, expecting to cool itself down. When it doesn't sense that it is cooling enough (because evaporative cooling is so much less efficient on the lower body than it is on the head), and lacking vascular control in the upper body, then it does the only other thing it knows how to do: It sweats more.

Nerve impulses from the lower body travel upwards along the sympathetic chain and encounter dead ends and scar tissue, which causes a rebounding or reflexive signal to be sent back down the chain, stimulating excessive lower-body sweating.

The bronchial tubes are innervated sympathetically from T1 - T5. ETS denervation can diminish the ability to dilate the bronchial tubes, thus causing reduced lung capacity. This in turn causes shortness of breath, difficulty exercising, etc.

One of the tragic ironies of this surgery is that many people undergo it because of nervous sweating in social or business situations. The hope is that it will reduce stress by eliminating embarrassment. The actual result can be the opposite. People typically begin to avoid the social situations more than ever, either because of severe compensatory hyperhidrosis, or chronic fatigue, oversensitivity to sound and light, or hand lotion addiction, or just the general feeling that they can’t handle nervousness as well as they used to.

ETS robs the body of some of its natural pathways for dealing with stress. Therefore the remaining stress channels are overloaded. The bottom line is that any given amount of stress will be felt more, not less. Other things being equal, this logically must lead to an increased risk of stress-related illness.

ETS surgery slows the healing process in the denerved area. This is predicted because of the loss of catecholamines, often reported anecdotally, and has now been confirmed empirically in this study. Other immune system failings, such as arthritis, are predicted and have been reported.

Receptor cells that are denervated will, over time, become super-sensitive to the neurotransmitter which activates it. This is a well established principle in physiology, and is known as "Cannon's law of denervation super-sensitivity" (Walter B. Cannon was the physiologist who coined the terms "fight-or-flight" and "homeostasis"). This phenomenon is responsible for certain chronic pain syndromes.

Anecdotal reports about of over-sensitivty to loud noises and stress. In theory, any of the denerved structures can become super-sensitive.

The sympathetic nervous system controls goose bumps and the pleasurable sensation that goes with them. Goose bumps are formed when the sympathetic nerves deliver a message for tiny arrector pili muscles to contract. This pulls down little patches of skin, leaving bumps in-between and making nearby hairs stand up. Goose bumps can form in response to cold, or in response to emotion, the latter is famously known to be accompanied by a pleasurable sensation, "the chills", which some people describe as being almost orgasmic.

ETS patients may have no goose bumps on the arms, chest, upper back, or the back of the neck because without sympathetic innervation, tens of thousands of tiny arrector pili muscles are paralyzed. ETS victims can be physically unable to experience a rush of emotion. You know that wonderful feeling of chills that go up and down your spine when your hear a beautiful song, see a great movie, or fall in love? Gone. Pleasure from a good neck or scalp massage? Gone.

Many ETS patients report a strange sweating or tingling response in the face or scalp when tasting certain foods. This is Frey's Syndrome, or Pathological Gustatory Sweating. As damaged sympathetic nerves attempt to regenerate, messages to salivate get mixed up with messages for sweating, flushing, and goose bumps. Though rare in nature, Frey's Syndrome is very common in ETS, usually developing 6 months to 2 years after surgery.

ETS surgery can cause severe pain in the ribs under the armpit, or between the shoulder blades. This is due to damage to the intercostal nerves, which originate from the spinal cord and run outwards between the ribs. This pain may go away within a few weeks, or last for years, or be permanent.

Damage to the thoracic sympathetic nerves can cause temporary or permanent paresthesia, which is a prickling, burning, "pins and needles" sensation. One study showed that ETS surgery caused paresthesia in 50% of patients, with 17% still suffering it after 12 months.

ETS can cause temporary or permanent "phantom pain" or "referred pain" in a host of different areas. This means there is no actual damage to the site that perceives the pain, but rather the actual damaged sensory nerves near the sympathectic chain play a cruel trick on the brain.

Horner's syndrome is characterized by a droopy eyelid. It is also accompanied by a constricted pupil, and dryness, redness and soreness of the eye. The whole eyeball sinks down out of place. Horner's is caused by accidental damage to the T1 (stellate) ganglion, and is rare these days in sympathetic surgery. It is properly referred to as a complication of ETS, rather than a side effect. It is included here because it is one of the few problems actually mentioned by all ETS surgeons.

A number of male and female ETS patients have reported premature loss of hair or eyebrows. Likely this is due to anhidrosis of the scalp, denervation of the hair follicles, and/or changes in blood circulation.

Even above and beyond all of the other disabilities mentioned, ETS victims report feeling "strange" or "altered" or "not right" in ways that are very hard to put into words. This may be because the sympathetic nerve ganglia relay the "fight or flight" response, a very primitive and non-verbal function. It is a part of our anatomy inherited from much lower animal species.

Normal people are used to the skin on their entire body feeling the same. ETS causes you to have 2 very different skin regions, with opposite problems. The top is too dry and too hot while the bottom is too wet and too cold. It's just bizarre.

When all these side-effects are added together, one can understand why ETS victims suffer from chronic fatigue. Muscles don't work efficiently because blood is misallocated, the heart rate doesn't increase normally in response to effort, patients get winded very easily because of the decreased lung capacity and the bradycardia, the severe sweating is dehydrating the body and robbing it of electrolytes but still failing to keep it cool, the overheating overtaxes the brain and drains energy some more, etc., etc., etc. Nearly 100% of ETS patients report a significant drop in energy level.

Many male ETS patients have reported inability to get or maintain erections, difficulty ejaculating, or retrograde ejaculation. Erection is achieved by the parasympathetic nervous system, due to vasodilation. Ejaculation is controlled via the sympathetic nerves, but from T12 - L2, lower down the chain than the region destroyed by ETS. The sexual problems may be caused by a hyperactive sympathetic response, similar to what may cause "compensatory hyperhidrosis". Two other plausible explanations are: Sympathetic nerves are damaged further down the chain than intended; some men have erection function further up the sympathetic chain than most.

ETS alters the ability to regulate blood pressure, causing it to be artificially low, and abnormally unresponsive to stimuli. It is not surprising that ETS could cause sexual problems, just as blood pressure-lowering medication can. Female patients have also reported loss of libido.

There are no published medical studies attempting to confirm or deny a causal relationship between ETS and sexual side-effects. However, reports of such problems abound on ETS discussion forums.

ETS reduces the body's physical response to fear, excitement and sexual attraction. A large study of psychiatric patients given ETS for social phobia found significantly reduced alertness and fear. It is as if the "high end" of the emotional spectrum has been lopped off. The hypothalamus still increases sympathetic tone, but it fails to stimulate the heart rate, because of the cardiac denervation, and loss of baroreflex. The circadian rhythm of sleep and wakefulness may be interfered with, because the pineal gland, responsible for the production of melatonin, has also been partially denervated.

A group of Japanese surgeons have reported severe eczema on the hands following ETS. They theorized that "a reduction of sympathetic activity in the sweat glands of the palms following ETS induced an irregular alteration in thoracic sympathetic domination, which resulted in the formation of pompholyx-like eczema."

Once the reality and permanence of ETS disability sink in, many victims understandably become angry. The anger can be directed at the surgeon, for having blantantly lied and mutilated another human being for a few thousand dollars. Or there can be relentless self-anger and blame for not having researched the matter more thoroughly, or not asking the right questions. The ETS discussion boards and support groups are full of very depressed people who feel that this surgery simply ruined their lives.