Tuesday, June 18, 2013

Discussion and Conclusions

The effects of thoracic sympathectomy in humans will only be fully understood when humans are fully understood. Many of the direct effects of thoracic sympathetic denervation such as anhidrosis, reduction in cardiac output, and loss of vascular tone, have been well known for many decades. Other aspects of this neuropathy, such as its effects on immune function and bone metabolism, are only now beginning to be studied on humans.

So far, the corposcindosis theory holds up quite well to empirical confirmation. The predictions generated by the model are falsifiable. Of the 24 predictions about changes to individual effectors, 12 have been confirmed in human studies, 7 confirmed in animal studies only, while 5 remain unstudied. Of 9 predictions about changes to systemic function, 5 have been confirmed in human studies, 2 are confirmed in animal studies only, and 2 are unstudied. None of the predictions are falsified by any of the available data, and this research is summarized in the accompanying tables.

There are a great number of ETS “hyperhidrosis” papers in which the author/surgeons made no empirical measurements of any kind, relying instead on subjective patient questionnaires (see ISSS Questionnaire). These questionnaires are typically gathered in the first few weeks after surgery, and only cover the subject of sweating, nothing else. Often they euphemistically refer to compensatory hyperhidrosis as “compensatory sweating”, and then attempt to divide patients in to categories “mild”, “moderate” and “severe” compensatory sweating. Evidently there are no objective distinctions that allow for these categories, so this appears to be merely a method of generating low statistical numbers. Many surgeons, touting their particular surgical method over the others, claim rates of “severe compensatory sweating” as some low number, like “1%”, leading the patient to believe that only 1% of patients get “compensatory sweating”, when in fact, the correct number is approximately 100%, and a more correct term is “compensatory hyperhidrosis”.

Mailis and Furlan express disappointment at the state of the literature. They say, “The practice of surgical and chemical sympathectomy is based on poor quality evidence, uncontrolled studies and personal experience. Furthermore, complications of the procedure may be significant . . .” (Mailis et al. 2003).

Significant indeed. Corposcindosis (Split Body Syndrome) is the predictable result of thoracic sympathectomy, and patients often find it disturbing. Sentiments such as “ETS surgery ruined my life” are common among patients. Prior to undergoing surgical sympathectomy for any reason, patients should be warned about corposcindosis, i.e. all of the proven consequences to the heart, lungs, blood vessels, arrector pili muscles, and sweat glands. They should be informed of ramifications to overall systemic function, including loss of strong emotion, reductions in alertness, thermoregulatory capability, and exercise capacity. Finally, based on sound theory and animal data, there is strong reason to suspect that sympathectomy alters bone metabolism, immune function, and thyroid function, but these aspects are largely unstudied and unknown in humans. As such, sympathectomy remains highly experimental, and patients should be informed accordingly.
It is recommended that surgeons begin various types of clinical studies designed to measure differences in all of the different body systems known and strongly suspected to be affected by thoracic sympathectomy. This knowledge is important, and long overdue.

The ETS Surgeon's Dilemma

Clearly, if patients complaining of cosmetic conditions such as excessive sweating or facial blushing were informed about all the potential consequences of ETS surgery, very few (if any) would consent. Thus, the pool of prospective participants in the recommended clinical trials would be drastically reduced, if not eliminated altogether. Surgeon incomes would be expected to suffer. This is “The ETS Surgeon’s Dilemma”.
The conflict can be characterized as the individual patient’s right to give informed consent versus "society’s" right to further its knowledge, push back the frontiers of ignorance, and continue the grand experiment that is medicine.

Is Corposcindosis a Disease?

University of Ontario Health Glossary offers three possible definitions of "disease", and corposcindosis easily meets all three, including all of the criteria in number 2:
  1. An interruption, cessation, or disorder of body functions, systems, or organs. Synonym: illness, morbus, sickness.
  2. A morbid entity characterized usually by at least two of these criteria: recognized etiologic agent(s), identifiable group of signs and symptoms, or consistent anatomical alterations. See also: syndrome.
  3. Literally, dis-ease, the opposite of ease, when something is wrong with a bodily function (Ontario Health Glossary)
Current mainstream literature does not include "corposcindosis", or any disease-name for the effects of ETS. "Anhidrosis" is an established disease-name; and is but one of many proven, unhealthy, abnormal, disorderly interruptions and cessations of body functions, systems, organs, glands, and muscles. Corposcindosis has an identifiable group of signs and symptoms; and is caused by a recognized etiologic agent - ETS surgery. Yet mainstream literature does not dare refer to the effects of ETS as a disease. Why not? Is it simply that whatever surgeons do is theraputic by definition? Did we learn nothing from the experience of lobotomy? (see psychosurgery.org)

Neuropathy is neuropathy, regardless of what initiates the nerve damage. This point was made in a 2005 paper on diabetic neuropathy:
The occurrence of peripheral vasomotor instability and peripheral sudomotor neuropathy is termed "autosympathectomy.” The patient with autosympathectomy has peripheral vasomotor reflexes similar to those in a nondiabetic patient after sympathectomy. (Aring et al. 2005)
Mailis and Furlan titled their 2000 survery, "Are We Paying a High Price for Surgical Sympathectomy?". They state:
Surgical sympathectomy, irrespective of approach, is accompanied by several potentially disabling complications. Furlan et al. 2000
Reasonable people must agree that "disabling complications" is equivalent to a disease state, especially when there are potentially "several" of them. Corposcindosis is a disease.