<rant>

While I think it is important not to attribute every post-op physiological change or disturbance to the surgery, it is incorrect to say that CS is the only common side effect shared by all patients.

It is a fact that the surgery, regardless of location or technique, involves the sympathetic denervation of not only the sweat glands, but the heart muscle, vascular smooth muscle, erector pili and bronchioles. Many of the common complaints like fatigue, poor exercise capability, reduction of heart rate, reduction in blood pressure, reduced baroreflex response, unhealthy redistribution of heat radiation, thermoregulation problems, spaceyness, and overly dry/anhidrotic/aged skin can be directly attributed to the denervation of these glands and muscles. All of these glands and muscles work together to regulate temperature, heart rate, blood pressure and lung volume.

All of these effects have been recorded in humans and lab animals that have undergone sympathetomy. Much of this information has been known for over fifty years and is documented extensively.

What gets mixed up in the discussions of the surgery are the physiological facts and patient's subjective opinions/experiences. For instance, the surgery will decrease the cardiac output in all cases. Period. The extent of reduction and whether a particular patient notices the effect is another matter entirely. We must separate fact from subjective impressions. Patient satisfaction is an interesting statistic, but should not be used as the sole source of information. Heck, the AMA specifically states in it's ethical guidelines that patient testimonials are not an appropriate means of advocating a treatment.

If the surgeons would simply use scientific methods and provide real informed consent there wouldn't be such a backlash. Give the patients the facts about what muscles, organs and glands are affected and to what extent (quantitatively) and let the patient decide whether he is willing to sacrifice the proper functioning of those things in order to have dry paws.

I realize that many would not notice the changes in cardiovascular function. However, I discovered that my maximum exercise heart rate had dropped 30 bps because I have been monitoring his heart rate during exercise for twenty years. An inactive person who is less in touch with his body might not have noticed the change.

But the point is, it's the doctors that are supposed to measure and report this stuff. Not me. I shouldn't have to discover this after surgery. These effects are not surprising to anyone versed in the fundamentals of human physiology. They are to be expected based on over a hundred years of scientific evidence. To not report them to prospective patients because they rarely turn up in answers post-op questionnaires (because they don't ask the question) is inexcusable.

Why is it that Songboy, Tim and Spirit must take the personal initiative to contact NINDS and undergo exhaustive testing to provide the scientific proof that the surgical effects extend far beyond perspiration changes? Why are the ETS surgeons not demanding these tests be performed on their patients who are complaining of severe side effects? Why do they fail to provide patients with the facts? Well, we know why. Because, they prefer to exploit the near term giddiness of recently sympathectomized patients to recruit new patients instead of practicing real, ethical science and medicine.


</rant>