http://health.groups.yahoo.com/group/sympathetics/message/65

A documented case of ETS-C causing impotence with reversal. I wonder
why the mechanism is not discussed.

http://www.dreamwater.com/hyperhid/doctors/spratt.html

"I applaud you in attempting to get answers in these vital areas of
interest to both ETS doctors and individuals who have had ETS or are
considering the procedure. My answers are based on 200 cases, and
approx. 408 procedures. We are constantly attempting to update our
data by sending questionnaires to our patients, and our response rate
is about 60%.

1. Reversal. I have now performed the reversal procedure on 5
patients (a 2% incidence). Since I only do the clamping procedure,
this was simply a matter of removing the clamps. I did not find this
a problem from a technical standpoint. All reversal patients were
male. 4/5 were for severe compensatory sweating and 1 was for
impotence. They were reversed between one week and one year. The
timing on reversal is debatable, but I believe sooner is better, and
it probably should be performed within six months after the clamping
procedure.

It is too premature yet to comment on the results of these reversals,
except to say that original symptoms have not returned, and
compensatory sweating has not diminished significantly as of yet.

2. Clamping vs other methods. I believe that clamping is the only way
to go. Why damage the sympathetic chain if it is not necessary? I
have a feeling that the less damage that is done to the chain, the
less risk there is of compensatory sweating. Finally, and by far the
most important, is the ease with which reversal can be done if
necessary.

3. Reversal for ETS done originally done by cutting or
electrocautery. I have no personal experience in this area. I believe
the procedure of nerve transplant is complicated, technically
demanding, expensive, and I'm not sure about the results. I am hoping
that you will get accurate data from the surgeons who perform this.

4. Patient Satisfaction. Although some people may get relief of their
primary symptoms, they may not necessarily be satisfied because of
side effects. Therefore, I believe it is important to look at
satisfaction rather than cure of symptoms. Our best results have been
for palmar hyperhidrosis, with almost 100% satisfaction, and
occasionally minor concern about compensatory sweating. There has
been definite improvement in plantar hyperhidrosis if it is
associated with hand sweating (60-70%). Patients with facial sweating
also have a high satisfaction rate, over 90%. With axillary sweating
I do add a T3 clamp, and indicate to the patient there is a slightly
higher risk of compensatory sweating. For pure plantar hyperhidrosis,
I would not recommend ETS but rather a lumbar chemical sympathetic
injection, which we offer at our hospital. For whole body sweating, I
would recommend a workup for hyperthyroidism, and strongly recommend
against ETS because of the very high risk of severe compensatory
sweating.

For facial blushing +/- neck blushing, I do recommend T2 clamping. I
have not had anyone say they were not improved, but there is a wide
spectrum of results, from blushing similar to other people to no
blushing whatsoever under any circumstance. These individuals, who
are generally not used to sweating, have a much greater concern about
compensatory sweating. They must understand this annoying side
effect, and be legitimately debilitated by their facial blushing,
before proceeding to surgery. I do not recommend ETS to patients who
have only social phobia. Also, I do not recommend it for rosacea or
facial flushing. It appears that they are better treated by photoderm
therapy or the like.

I have treated patients with Raynaud's disease, and although they
seem to have excellent relief of their symptoms initially, it does
tend to recur after a period of time.

5. Compensatory Sweating. Compensatory sweating is by far the most
significant side effect which raises the most concern for those
undergoing ETS. It is present in some form in approximately 85% of
patients. Fortunately, in the vast majority of cases it is mild, and
a very acceptable tradeoff for relief of their hyperhidrosis or
facial blushing. In approximately 10% of cases it is moderate,
requiring some form of treatment, but they still feel that they are
better off than prior to the clamping procedure. In 2% of patients,
it is so severe that we have done clamp removal, so that hopefully
they can approach their pre-ETS state. Using a thoracoscopic
approach, we have had no incidents of Horner's syndrome. Gustatory
sweating does occur, but has not been a major problem or an
indication for reversal. Dry hands are managed easily by hand lotion.
We have had one unusual case of impotence, and he was reversed one
week after his surgery, with immediate relief of his impotence.
Interestingly, his original symptoms (FB) had not returned a month
after reversal. I am not aware of any loss of physical endurance or
performance in any of my patients.

6. Kuntz nerves. I do believe Kuntz nerves definitely exist, and I
have identified them and divided them in approximately 15% of
patients. Whether a Kuntz nerve can result in failure of relief of
symptoms is difficult to say. If we decide on a redo procedure (have
done 3) we make a special effort to divide all tissues on either side
of the chain, as well as reclamp.

Final comments. As will become apparent from the responses to your
questions, ETS is not for everyone who thinks they have hyperhidrosis
or facial blushing. In fact, after careful discussion I turn down 15-
20% of patients who come to me, because I feel their symptoms are not
severe enough to warrant a surgical procedure, they do not understand
the ins and outs of hyperhidrosis or what is involved in the surgery,
the surgery is inappropriate for their condition, or they are at high
risk for severe compensatory sweating. I also believe that they
should have attempted other less invasive forms of treatment. Surgery
should be the final step taken, not the first, to relieve a
legitimately debilitating disease which is interfering with their
lifestyle and career.

Thank you for the opportunity to participate in your excellent
website.

Dr. Spratt"