Several years after ETS

[rajmta]

Hi Admin,

I am planning to undergo a staged T4 ETS for palm hyperhidrosis. The surgery is done first on the right side (my dominant side) and then on the left side. I'd be considering the second half of the surgery only if I'm satisfied with the first half of it.
I may even forego the second half if I'm able to live a happy life with a one-sided surgery. What is your opinion about a unilateral surgery?
I'm told that CS is the only scientifically proven side-effect. You mentioned in your forum that you talked with many people who had the surgery several decades ago. Is CS the only side-effect they are experiencing? Are the side-effects likely to show up after several years? Is the surgery effective after several years? I don’t know much about the long term side-effects. Are any of those life-threatening?

Thanks,
Raj

[steve_nf]

Hi Admin,

I am planning to undergo a staged T4 ETS for palm hyperhidrosis. The surgery is done first on the right side (my dominant side) and then on the left side. I'd be considering the second half of the surgery only if I'm satisfied with the first half of it.
I may even forego the second half if I'm able to live a happy life with a one-sided surgery. What is your opinion about a unilateral surgery?
I'm told that CS is the only scientifically proven side-effect. You mentioned in your forum that you talked with many people who had the surgery several decades ago. Is CS the only side-effect they are experiencing? Are the side-effects likely to show up after several years? Is the surgery effective after several years? I don’t know much about the long term side-effects. Are any of those life-threatening?

Thanks,
Raj

Hi rajmta,

I had ETS surgery a little over a year ago. You've made a great decision going for 1 side first; you will be able to test the side effects to see if ETS is for you. I don't recommend going for a T4-only ETS. A T4-only ETS has a higher rate of recurrence. I remember reading a forum post about one person having to do ionto after a T4-only ETS. The recommended route for palmar is a T3/T4 (which is what I got). Also, make sure you get the nerve clamped, so that if you don't like the side effects the surgeon can remove the clip (though even this may not reverse the op, there's a post on here about someone who got the clips out a couple days after the surgery, and months later the CS didn't fully go away). Be aware that you won't be able to sweat from your face or your nipple line up. This is serious, and your upper body will sometimes feel like you're overheating. I try to stay out of the sun more after ETS (but then again I do live in Florida... so it's more humid/hot here). Forgoing a second surgery will be your decision, as you can see if the 1 sided surgery works well for you. The dryness above the nipple line is a worse side effect than CS imo. CS I just handle with wearing dark clothing and Sutran shirts (google Sutran). Also, I don't sweat so much as I'm a more calm person after ETS.

Good luck.

[rajmta]

Hi Steve,

Thanks a lot for the reply. I am told that by getting a T4-only, chances of CS and upper body becoming dry are remote, if not impossible. T2 and T3 seem to have a stronger link with Endocrine and Cardiovascular systems than T4. Some surgeons claim that clamping has a higher rate of recurrence than cutting. I am trying to do an optimal trade-off between my current situation and the side-effects post ETS. If the surgery were partially successful, I'd be considering complementary alternative treatments, so that there is at least 60-70% benefit with minimal long term side-effects.

Thanks,
Raj

[steve_nf]

Hi Steve,

Thanks a lot for the reply. I am told that by getting a T4-only, chances of CS and upper body becoming dry are remote, if not impossible. T2 and T3 seem to have a stronger link with Endocrine and Cardiovascular systems than T4. Some surgeons claim that clamping has a higher rate of recurrence than cutting. I am trying to do an optimal trade-off between my current situation and the side-effects post ETS. If the surgery were partially successful, I'd be considering complementary alternative treatments, so that there is at least 60-70% benefit with minimal long term side-effects.

Thanks,
Raj

There is definitely a lot of ambiguity regarding the surgery. Whether to cut the T3/T4, or do a T4-only, or T-3 only, etc. I haven't met many people that have done a T4-only, but if you're adamant about doing it, then by all means. I deeply recommend clamping rather than cutting though. Yes cutting assures the nerve is excised, but the titanium clamps are extremely powerful. They do the job just fine; and at least you will have SOMETHING to fall back on if the surgery doesn't go as planned...

Also, you say that you're doing it for palmar hyperhidrosis. Can you touch on how the palmar hh has affected you throughout your life? Is it so bad that it's disabling? Do you soak papers, avoid handshakes at all costs, leave sweat marks after holding something, can't use touchscreen phones, etc? I'm just curious to know a little bit of your backstory

Best Regards,
Steve

[rajmta]

Hi Steve,

I have palm sweating while driving a car, holding a mobile phone or a Computer mouse. Fortunately I don't soak papers.
Occasionally, I have an embarrassing experience of a people abruptly ending a handshake. I also sweat when I feel anxious.
You mentioned that ETS made you calm, so are you more confident in social settings now? Are you performing better at work? Nobody still knows what changes occur in the body to account for the loss of nerves, and how those changes affect life. That's why I chose a selective surgery and to use other non-surgical treatments to complement it.
I wouldn't want a clamp, a foreign object, to be permanently pressing over the nerves. Many years later, some ETS patients report a painful sensation over the nerves due to the pressure on them. Did you hear such stories?
So I prefer to cut the nerve on the right side and use clamps on the other side if necessary. These are my thoughts; do you think I have made the right decision? So far, none of the non-surgical treatments have been good enough..

Thanks,
Raj

[steve_nf]

Hi Raj,

Being more calm since the surgery does have a positive impact on social situations and work. My sweaty hands don't dictate my every move anymore. As cliché as it sounds, it feels like a heavy boulder has been lifted off my shoulders.

About the painful sensation from the clamps - Yes, I have heard one or two stories about this. I haven't thought about it too much before my surgery. The benefits of clamping are much more lucrative than that side effect in my opinion. I suppose if it does become a problem, the surgeon can just go back and take out the clamps and cut the nerves instead. Problem solved.

My top recommendation would be to clamp the nerves. The benefits outweigh the risks by a huge margin. If it so happens that you regret the surgery, you at least have a shot at a decent reversal. I would also suggest that you talk to your ETS surgeon and get to know him/her. Go for a consultation and talk about the surgery, past patients, what nerve you want operated on, etc.

Have you tried iontophoresis? If so, how do it go? If you didn't you must try it before opting for surgery. Some people just 'click' with ionto really well.

Good luck,
Steve

[rajmta]

Hi Steve,

If the underlying cause is anxiety, I don't think Ionto works.

Thanks,
Raj

[rajmta]

Does ETS reduce blood circulation?

[severelyadd]

i really hope im not too late. as others have said DEFINITELY do only 1 side first. then wait 5 or so years (yes, years) to see if you want both done. my surgeon did the right side T2-T4 cutting the nerve, not clipping. i had the surgery around 9 years ago. only about 2 years ago CS started kicking in, then i was diagnosed with add, and now my doc thinks i may have had cushing's disease (brain tumor on the pituitary gland). don't get me wrong though. the surgery has changed my life for the better. i would do it over again. i just hope my kidneys can keep up from the dehydration from CS haha. just make absolutely positively sure that you want this done. and if you arent comfortable with the surgeon in any way, go to another.

also, here's an inside tip..call the operator of the hospital and tell them to let you speak to the operating room. tell the OR people what you plan on having done, and ask questions about the surgeon. i say this because i work in the OR as a nurse and many docs are completely different once the pt is asleep. if the doc has a good reputation with the staff, ding ding! good luck!