Complete Paralysis of Skin Function
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.
Anhidrosis is considered dangerous.
Dysfunctional Thermoregulation
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 should reduce skin surface volume and conserve heat loss.
The end result? 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.
Bradycardia, Reduced Capacity for Exercise
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.
Blunted Blood Pressure Response
Also part of the "Beta-Blocker" effect, ETS patients are unable to raise the blood pressure normally during exercise and sex. Artificially low blood pressure can in turn cause dizziness, weakness, tiredness and sexual dysfunction. Combined with the baroreflex problems, the paralysis of blood vessel constriction, and other measured blood flow problems, the result is thoroughly dysfunctional blood pressure.
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 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. Almost 100% of ETS patients will suffer from some degree of compensatory hyperhidrosis. This effect is often euphemistically referred to as "compensatory sweating" or "reflex sweating". It is clear why doctors avoid using the medically correct term "hyperhidrosis". How can they cure hyperhidrosis by causing hyperhidrosis?
The exact cause of compensatory hyperhidrosis is not known, but there are two main theories:
1. The "mainstream" or "common sense" theory
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.
2. The "reflex" theory
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.
Greatly Reduced Tolerance of Stress
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 is the opposite. People typically begin to avoid the social situations more than ever, either because of severe compensatory hyperhidrosis, or chronic fatigue, 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.
Loss of Goose Bumps and Physical Pleasure
The sympathetic nervous system controls goose bumps and the pleasurable sensation that goes with them. The sympathetic erection of an arrector pili muscle is much the same as a sexual erection. 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.
Frey's Syndrome (Pathologic Gustatory Sweating)
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.
Intercostal Neuralgia (Nerve Pain) / Numbness
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.
There can be permanent areas of numbness or tingling.
ETS can cause 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, most 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 either because the sympathetic nerves are damaged further down the chain than intended, or because some men have erection function further up the chain than others.
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.
We have not seen 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 may reduce the body's physical response to fear, excitement and sexual attraction. 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.
All this in turn can have profound long-term emotional consequences. Some ETS surgeons actually consider this to be a positive effect, and ETS has been used to treat social phobia and phobic schizophrenia. However, patients without mental disorders to begin with may feel it has left them "less than human" or "like an android" or "disconnected" or "spacey". Almost all ETS patients agree that it narrows the emotional range.
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.
Medical Disclaimer: The publishers of TruthAboutETS.com 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.
