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Q.1. What do you think about ETS (cauterising) and ESB (clamping) surgery?
ETS is a last resort if a patients life is ruined by their symptoms
Dr Alan Cameron (ETS surgeon based in U.K)
Q.2. What other options do you think there are for patients suffering from social phobia or sweating?
Counselling. I am against antidepressants
Dr Alan Cameron
Q.3. A general concensus from ETS and ESB patients has been that their situation has not been taken seriously by G.P's. Their blushing and social phobia has either been inappropriately dealt with, by prescribing inappropriate medication, or dismissed as a passing phase. How will you now deal with it?
I agree GPs have little concept of how upsetting flushing can be.
Dr Alan Cameron
Q.4. What sort of medications do you think are the best for this problem?
I do not think any medication helps. Biofeedback is a better way
Dr Alan Cameron
(b) Dr. Cameron, why are you against medications for social phobia/blushing? From my own experience, it was the single most effective thing, by itself. I found some further relief through therapy, but mainly in coping, it did not decrease the blushing. The medications also helped in bring anxiety down to a level where I could carry out CBT.
Tom
Q.5. Why are patients not told about the biology of the body when we see the surgeon's about ETS? For example, we are NOT told that by clipping a nerve, such as the T2 or any other nerve on the sympathetic chain, it controls the gastrointestinal, reproductive, cardiovascular, respiratory, and all sensory nerves of the body. We are not told that the entire system is connected and that they are not seperate nerve nodes! Why are we not explained in full detail the effect it will have on us?
The effects on gastrointestinal function are not severe from ETS. Also there is no effect on reproductive function. However, I would never do a lumbar sympathectomy for feet hyperhidrosis for fear of these disturbances.
Dr Alan Cameron
Q.6. Do you think that clamping (ESB) is the way to go? We've heard that scarring can occur after a period of time and the nerve can deaden making a reversal impossible unless going under the conventional reversal surgery. Do you agree with this?
There is no objective evidence for or against clamping.
Dr Alan Cameron
Q.7. Have you heard of 'denervation supersensitivity of sympathetic organs'. Alot of ETS patients have heard of it now...after the fact. We know that the remaining skin signal nerves become extremely sensitized to any stimulation (heat, cold, sweat etc.) due to the loss of the cut or clipped nerves and this is why people are having such severe problems with adjusting to any changes in heat or physical exercise. We know the sensitivity decreases with time (1-4 years), but we know that it doesn't return to normal. What do doctor's think of this? Why aren't we told of this in literature about ETS surgery?
Q.8. For all ETS Surgeons who cut or clamp T2 or T3 - why do you cut this nerve? ETS patients now know that the T2/T3 locations are cut/clamped from access to the hypothalmus of the human brain, therefore the brain CAN NO LONGER distinguish what the "Tone" for the bodies temperature is. We know the hypothalmus is the temperature control centre of the brain and we also know that T2 location specifically (as well as T3) is the centre for the "Sympathetic Tone" for the bodies temperature. When the T2 and T3 are cut/clamped we know the brain has no reference point! We know in defence to the sudden loss of the "Sympathetic Tone", the body responds by turning on the cooling mechanisms. So...we know that this is when CS or reflex sweating happens! Why do some surgeon's still not acknowledge this effect and continue to cut/clamp these locations?
I deal with T2 because I think anatomically it controls the face. For palmar hyperhidrosis I now prefer T3.
Dr Alan Cameron
Q.9. Do any surgeons believe patients when they complain of fatigue? Do they believe that tiredness could be linked with loss of sympathetic innervation of the heart and loss of neurotransmission of chemicals such as adrenaline, norepinephrine and ATP?
Maximal heart rate is indeed reduced, but I believe this effect would only be noticed by top-class athletes. So I do think that some cases get fatigue symptoms after ETS but these cannot be explained by cardiac denervation. (I must be careful to point out that I do indeed believe this can occur; the fact that it cannot be explained on current knowledge does not alter the fact of its existence).
Dr Alan Cameron
Q.10. Is there a difference between a thoracic and a cervical sympathectomy? My medical records say 'cervical sympathectomy'.
Confused.
The correct terminology for the procedure should be upper dorsal ganglionectomy. This is because it is the upper parts of the sympathetic chain which are destroyed. The confusion comes because there are 4 ways of doing the procedure a; By the neck (or cervical) approach b; by the open transaxillary approach c; by the back (posterior) approach d; all rendered obsolete in 1942 when the English surgeon Hughes described the endoscopic way.
Dr Alan Cameron
Q.11. I have suffered from loss of libido since I had ETS five years ago. It has just about ruined my marriage. I have heard Apophen can increase libido. However, I cannot locate it in Norway. I have tried Uprima but it doesn't do anything for me. Are these the same medications with different names? Or is there another name for Apophen in Norway? Also, what do you think of Wellbutrin to increase libido?
Norwegian boy.
Q.12. Dr Telaranta recently stated he "will not operate any longer on blushing or hyperhidrosis patients, because [he] feels that these indications are not sufficient alone and lead to unnecessarily heavy side effects". How do you feel about this? Does it concern you that a leader in this field is now turning his back on the industry to focus on the Reversals and research in the area of Parkinson's Disease, mainly because of the indication of heavy side-effects?
This is a difficult question to answer in an e-mail which is thereby in the public domain, but I might make the following observations.
a. I first met Timo Telaranta in Sweden at the first congress. I always thought he was a great advocate for ETS and he was perhaps more enthusiastic than some others. With time all surgeons come to realise the truth of the maxim that "all surgery is a failure of medical management".
b. ETS is not a panacea for life's ills, but it does have a place in my experience. At least one-third of the people I see refuse the operation after I have talked to them. I actually feel that I deter too high a proportion at present and more could be helped.
c. Inappropriate ETS operations have been done so there is a need for reversal and it is a good idea to concentrate these in a few surgeons hands, and if Timo feels this is his place now then he should pursue it. I know ETS works in carefully-selected cases so I have no hesitation in carrying on.
Dr Alan Cameron
Q.13. Dr Telaranta has put a link to my site on his site to inform every patient of the possible side-effects. Would you be willing to do this, if you have a website, to give a patient every possible opportunity to be educated about possible 'trade-offs'?
In my practice 10% of cases think ETS is so wonderful that everybody should have it. A tiny minority think it was the worst thing they ever did. Both of these are wrong; there is a middle ground in that the operation is successful.......but. I hope I am realistic about the "but" and would not like a link which would make even more people decline.
Dr Alan Cameron