Friday, April 6, 2007

Analysis of Dr. Fischel's Marketing Video - Part 2


Part 2


Dr. Fischel: Okay. What we did was then develop a way to do this without having to do that big operation. The patients still go to sleep, but it is a very simple procedure. We're intubating them with a very small breathing tube to be asleep, and we then lay them on their tummy. We blow in a little air around the lung to help us see it, and this is what things look like when you're doing this.


Dr. Fischel: You know this is sort of a cartoon drawing but it shows a tiny little scope down here, and a tiny little instrument up there. And we're actually watching the whole thing on a TV screen. That's how this kind of surgery is done.


Dr. Fischel: So what we do is create two very small little incisions. And the operation now instead of taking seven hours takes 10 to 15 minutes on each side. The patients wake up right after the operation, lay around the hospital for a couple of hours to feel better, and go home the same day.


We remove the nerve, which in my opinion gives the absolute best results.

Alexander Baker: Dr. Fischel removes T2, T3 and T4 nerve ganglia, bilaterally, for a total of 6 ganglia removed. It is medically incorrect to refer to a ganglion as a “nerve”. A nerve is one axon that extends outward from one cell body of one neuron.

In contrast, a ganglion is 20,000 to 30,000 afferent and efferent nerve cell bodies that run along on either side of the spinal cord. Afferent nerve cell bodies bring information from the body to the brain and spinal cord, while efferent nerve cell bodies bring information from the brain and spinal cord to the rest of the body. See

It is simply false for Dr. Fischel to say he removes “a nerve”.


Dr. Fischel: This is what it looks like in an operating room. Patients laying on their tummy. And right here we mark the tip of the scapula, Okay. There's a tiny little spot where the incision is gonna be. And here's the very thin little instrument that ends up being the camera that we use to do the surgery.


Dr. Fischel: When we're looking inside the chest here's what you see. These are the ribs and here's this nerve. It lays right on the surface of the chest. It's not near the spine. It's not near anything important, and I tell people it's like picking up candy off the sidewalk.

Alexander Baker: After repeating the “nerve” deception, Dr. Fischel informs us that “it’s not near anything important”. First, the sympathetic ganglia are located inside the chest cavity. Needless to say, there are all sorts of extremely important things inside the chest cavity.

But more to the point, the closeness or proximity of a ganglion has to do with what it is connected to, not how many inches of distance might separated it from something else. The sympathetic nerves run out (afferent) from the ganglia and to essentially every other organ, gland and muscle system in the human body. In addition, signals come the other direction, in (efferent) to the ganglia, relaying information about temperature, stress, oxygen levels, and many other important things both known and presently unknown.

The sympathetic nerve ganglia are very near things that are very important, and Dr. Fischel cuts them completely out. Dr. Fischel conceals this from his patients.


Dr. Fischel: So what he used to have to go through the back and spend all these hours getting to, we look right in the chest nuts laying right there. We use a very special instrument called the Harmonic Scalpel to take out this nerve. The harmonic scalpel vibrates at ultrasonic speed. It cuts tissues and it creates absolutely no bleeding during the operation and it generates no heat, which is very important as to causing side effects and I'll talk about that in a moment.

Alexander Baker: It is true that the Harmonic Scalpel is a brilliant surgical instrument.


Dr. Fischel: And what we see here is when we've done, we actually take this little piece of nerve right out of the body. Because we do it this way, we've had excellent results. We always succeed, because we get what exactly we came for. And we proved it by looking at it pathology specimen.

Alexander Baker: “Success” is simply removal of the ganglia, which causes complete anhidrosis (inability to sweat) on the entire top 1/3 of the body. Cutting out the sympathetic ganglia and calling anhidrosis “success” for hyperhidrosis is like severing the spinal cord and calling lower body paralysis “success” for foot pain.

Or, as another author put it, doing sympathectomy for facial blushing is like severing the tear duct to treat depression.


Dr. Fischel: We then went and studied our first 350 patients with a confirmed diagnosis of hyperhidrosis and to find out what our results were, and how they were better or and or different than what anybody else was doing. We had a group that ranged anywhere from 9 years old to 72 years old, with the average age being about 28 years old. Most it was pretty evenly matched between men and women, and one third of the patients had a family history of hyperhidrosis in another relative.

Alexander Baker: Performing ETS on a 9-year-old child is beyond the pale. A 9 year-old-has not even gone through puberty, a time at which changes in sweating patterns can and do occur. Of course, sweating is only the beginning of the changes after a sympathectomy. Denervation to the heart is a major problem. It seems entirely unfair to ETS a child for excessive sweating, which is entirely a cosmetic, rather than a medical problem. From a physiological perspective, there is nothing wrong with it.

Moreover, ETS surgery increases the total amount of sweat, according to the only study which studied it. See

Dr. Fischel (and others) are treating hyperhidrosis by causing worse hyperhidrosis.


Dr. Fischel: Most of our patients had tried at least one if not more surgical or non-surgical methods. The results are what I'm very, very happy with. So far to this point, out of those 350 patients, 100% of the patients wake up from the surgery with warm dry hands that never sweat again. That's been a fantastic result. We have 100% relief so far of axillary sweating when we add the addition of taking out the t4 nerve ganglia. 100% relief of facial sweating, and the feet actually get better 70 to 90 percent of the time.

Alexander Baker: Dr. Fischel is clearly stating that it is the “hands” that never sweat again. That is true, but he is “forgetting” to mention that the entire top 1/3 of the body will never sweat again. Patients have a right to know that, and Dr. Fischel conceals it. That’s wrong, in my opinion.


Dr. Fischel: And people ask me, “Well why would that be if you're taking out a nerve to the hand?” And what we notice is that people say when their hands sweat, their feet sweat at the same time. So there's a brain to hand to foot connection, and we interrupt that connection. So most of the time the feet are better. Again most people say,  “I don't care, I shake hands with my hand. I don't shake hands with my feet. If they get better that's a bonus.” And we treat it that way.

Alexander Baker: There is no “brain-to-hand-to-foot” nervous system connection. Dr. Fischel is just saying stuff. In addition to his MD, Dr. Fischel holds a Ph.D. However, his Ph.D is in surgery, which is unusual. 


Dr. Fischel: There are a couple of problems that can happen with this operation. I will talk about those in a moment. But what we found is we get about one out of five patients who will develop a mild and transient problem with some moisture over their chest or the back that's called compensatory sweating. And it has tended to go away over the first year in all of the patients that we've studied.

Alexander Baker: Note the word “couple”. “Couple” means “two”.


Dr. Fischel: We've also had a 0% incidence of Horner's syndrome that I'll describe for you soon.

Alexander Baker: I can report that I have developed a Horner’s syndrome in my right eyelid, which droops far lower than the left.  


Dr. Fischel: Okay the advantages of doing what we do based on 25 years of experience of resecting [removing] the nerve is that one we get a 100% cure of hand sweating and a 0% recurrence rate. The other methods of doing this, which involve burning, cutting or clipping the nerve are fairly good at treating this. They get about 95% success in treating the hand sweating, but it's not a hundred percent. They also get about a 15 to 20 percent recurrence rate, where the problem comes back, and they have to suggest either another operation or the patient’s just very unhappy. Axillary sweating has been very difficult to treat with any of those burning, cutting or clipping techniques, because those patients all develop severe compensatory sweating if you try to burn the nerve at 2, 3 & 4. But with removing the nerve we've had much better results.


Dr. Fischel: They used to treat, and some people still do treat armpit sweating by removing the skin of the armpit, taking out the hair, doing liposuction, using Botox. All of these things are either disfiguring, or painful, or ineffective.  But a VAT sympathectomy with removal of the t4 ganglia, so far in our hands, has resulted in a 100 % cure rate of axillary sweating.

Alexander Baker: Defining the ability to perspire as a “disease”, Dr. Fischel notes that there is a “100 % cure rate” and  “zero recurrence”. He is simply reporting what we know – that nerve damage is permanent. Perhaps one day stem cell or other technology will regrow nerves.


Dr. Fischel: The major problems… This would be a magic sort of thing if we could take anybody who sweats and take out this tiny little nerve with a 10-minute operation. It would be wonderful.


Dr. Fischel: There are two main problems that can happen with this operation. One is called a Horner’s syndrome where you essentially get a little bit of a droopy eyelid. Okay? That happens if you get damage to the stellate ganglion. That's where T1 comes into play. If my finger… you pretend is the nerve and my knuckle here is T2 and T3… those are the pieces that we cut out. If you hurt T1 you can get a Horner’s syndrome when someone burns, cuts or clips the nerve. They utilize heat in this area and heat can travel down or heat can travel up and you may get a Horner's syndrome. In the incident ranges between 1 and 5 percent with those techniques of getting Horner's syndrome. We've not had that again because we use the Harmonic Scalpel.

Alexander Baker: Again, note the number “two”. Two main problems. Dr. Fischel refers to the two (2) “side effects” that he warns his patients about – Compensatory sweating and Horner’s syndrome. He says nothing about decrease in heart contraction strength, decrease in heart rate, diminished lung capacity, temperature regulation, anhidrosis, etc. Yes, these effects, particularly with regard to cardiac function, have been known for many decades.


Dr. Fischel: The other problem is called severe compensatory sweating. Now this is where instead of sweating from your hands, your feet, your face or your armpits, you sweat from your chest, your back, your legs or other uncomfortable places. Doing it the way we do, again as I've mentioned, we've had some mild moistness that has gone away. While doing it with burning, cutting or clipping, actually in published papers, has resulted in 90% of the patients getting compensatory sweating, with a third to a half of those patients getting a severe dripping compensatory sweating.

Alexander Baker: All these numbers are meaningless. The effect of ETS surgery is to destroy the ability to sweat on the top 1/3 of your body, while the lower 2/3 will sweat much more than before. How hard is that to explain?


Dr. Fischel: Other things that can happen are very, very uncommon. They're just the standard things that could happen with any surgery. The complications, as I mentioned with us doing the video resection with the Harmonic Scalpel, so far, Horner's Syndrome, we've had a 0% incidence and significant Compensatory Sweating has been less than 1%. With burn, cut or clip of the nerve, Horner's syndrome is usually reported at 3 to 4 percent with reports up to 20% and Compensatory Sweating in up to 90% of the patients. So there's something different about what we're doing with taking out the nerve that ends up with a better operation with less complications. And that's why I like what we do.


Dr. Fischel: Okay. What are the reasons for the success of this technique? 1. Resection of the nerve allows us to look at it under a microscope. We prove that we've got it! We never miss! That's why we've got 100% success.

Alexander Baker: See definition of "success," above.


Dr. Fischel: Cutting it out mandates that you cut all these little branches that go into the nerve. Our best impression is that these little branches can control some of the compensatory sweating and that's why cutting those branches makes such a difference in people having compensatory sweating after the surgery.

Alexander Baker: “All these little branches” are nerves that carry information into and out of the ganglia, which are like little brains. Each is like a relay center, and also has some autonomous control. There is no reliable evidence that Dr. Fischel’s technique leads to less compensatory sweating, he’s just making this up. There are 3 leading theories of compensatory sweating – The “compensatory” hypothesis, the “reflex” hypothesis, and the “false message” hypothesis. See


Dr. Fischel: Using the Harmonic Scalpel lets us do bloodless surgery and the resected nerve provides about a one-inch gap so the ends never grow back together and that's why the disease does not recur.

Alexander Baker: Starting with his false premise that “hyperhidrosis” is a “disease” caused by a “defective nerve”, and knowing that nerves do not regenerate, Dr. Fischel can reach the conclusion that if he cuts out the “nerve”, the “disease” does not recur. Fabulous! See how that works?


Dr. Fischel: So in conclusion, what I would say is that the micro invasive sympathectomy that we do through the tiny little holes is a very safe and very effective therapy. The micro invasive nature of the procedure results in a minimal amount of post-operative pain and the patients recover quite quickly.

Alexander Baker: I have had chronic nerve pain ever since my ETS with Dr. Fischel in 2002. Ativan was fairly effective pain management, but Benzodiazepines are highly addictive and not recommended long term. Neurontin was minimally effective. Medical marijuana was by far the best pain management solution, although far from perfect.


Dr. Fischel: I tell the story of the patient had surgery on Friday and went out and played tennis on Saturday. These are very well tolerated incisions and most people are back to work at the end of a weekend after having the surgery.

Alexander Baker: What story Dr. Fischel doesn’t tell is that the patient’s ability to do any kind of exercise is compromised by that alterations to heart and lung function.


Dr. Fischel: The harmonic scalpel lets us do the operation safely and it doesn't generate any heat so it shouldn't cause complications. And so far in our hands this procedure has been 100% effective for eliminating hand, face and armpit sweating because the nerve and its branches are resected and not burned.

Alexander Baker: Saying “shouldn’t case complications” Dr. Fischel means he doesn’t usually cut anything by accident. I believe that much is true, but it misses the point. Dr. Fischel does a terrible disservice by so badly ignoring the effects of the nerve damage itself. That’s what people need to know about. Start here.  


Dr. Fischel: So in conclusion the micro invasive sympathectomy is effective treatment for hyperhidrosis with a minimal amount of pain and problems or morbidity and rapid patient recovery from surgery. I hope this has been helpful information. Thank you very much.

Alexander Baker: I suspect it’s been helpful all right. Helpful to Dr. Fischel’s bank account. If his patients knew what ETS was really all about, nobody would do it.