The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis -- Cerfolio et al. 91 (5): 1642 -- The Annals of Thoracic Surgery: "Recurrent hyperhidrosis is another potential side effect from hyperhidrosis surgery. Incidence rates vary considerably and have been described as 0% to 65%"
'via Blog this'
Saturday, December 15, 2012
Monday, December 3, 2012
BioEdge: Leveson Inquiry recommends reform of science reporting
BioEdge: Leveson Inquiry recommends reform of science reporting: "Remember patients: don't call something a "cure" that is not a cure."
'via Blog this'
'via Blog this'
Sunday, November 18, 2012
Limited heart rate variability, autonomic nervous system imbalance implicated in Chronic Fatigue Syndrome
The Conversation: "The stress-response neural systems of chronic fatigue syndrome (CFS) patients remain on high alert even when they sleep, signalling that it’s not safe to relax, researchers have found.
Researchers also discovered that reduced heart rate variability, or changes in heart beat timing, are the best predictors of cognitive disturbances, such as concentration difficulties commonly reported by CFS sufferers. This adds to the growing body of evidence linking autonomic nervous system imbalance to this disorder.
The findings could lead to new ways to improve cognitive difficulties in people with CFS, which remains a poorly understood condition."
Researchers also discovered that reduced heart rate variability, or changes in heart beat timing, are the best predictors of cognitive disturbances, such as concentration difficulties commonly reported by CFS sufferers. This adds to the growing body of evidence linking autonomic nervous system imbalance to this disorder.
The findings could lead to new ways to improve cognitive difficulties in people with CFS, which remains a poorly understood condition."
ETS result in limited (reduced) heart rate variability and alters the ANS (sympathetic and parasympathetic balance). This article might provide some insight into the cases where ETS resulted in a variety of unwelcome and detrimental side-effects, including fatigue, altered cognitive function ('brain fog'), etc.
Tuesday, November 13, 2012
No compensatory sweating after botulinum toxin treatment of palmar hyperhidrosis
No compensatory sweating after botulinum toxin... [Br J Dermatol. 2005] - PubMed - NCBI: "Recordings were made at 16 skin areas and compared with subjective estimates of sweating.
RESULTS:
Following treatment, palmar evaporation decreased markedly and then returned slowly towards pretreatment values, but was still significantly reduced 6 months after treatment. No significant increase of sweating was found after treatment in any nontreated skin area.
CONCLUSIONS:
Successful treatment of palmar hyperhidrosis with botulinum toxin does not evoke compensatory hyperhidrosis in nontreated skin territories."
'via Blog this'
RESULTS:
Following treatment, palmar evaporation decreased markedly and then returned slowly towards pretreatment values, but was still significantly reduced 6 months after treatment. No significant increase of sweating was found after treatment in any nontreated skin area.
CONCLUSIONS:
Successful treatment of palmar hyperhidrosis with botulinum toxin does not evoke compensatory hyperhidrosis in nontreated skin territories."
'via Blog this'
Thursday, November 8, 2012
Saturday, November 3, 2012
A randomized placebo-controlled trial of oxybuty... [J Vasc Surg. 2012] - PubMed - NCBI
"Palmar and axillary hyperhidrosis improved in >70% of the patients, and 47.8% of those presented great improvement. Plantar hyperhidrosis improved in >90% of the patients. Most patients (65.2%) showed improvements in their quality of life. The side effects were minor, with dry mouth being the most frequent (47.8%).
CONCLUSIONS:
Treatment of palmar and axillary hyperhidrosis with oxybutynin is a good initial alternative for treatment given that it presents good results and improves quality of life."
http://www.ncbi.nlm.nih.gov/pubmed/22341836
CONCLUSIONS:
Treatment of palmar and axillary hyperhidrosis with oxybutynin is a good initial alternative for treatment given that it presents good results and improves quality of life."
http://www.ncbi.nlm.nih.gov/pubmed/22341836
Monday, July 2, 2012
Petition never received - claims the Office of the Health Minister
Our previous Petition on this matter, sent on the 30th of March 2012, (and confirmation received on that day) to the Office of the Health Minister went unanswered. Following our inquiry we were told that the office never received the signed Petition.
Sending the Petition (this time) to the Senate will ensure transparency and accountability.
The revised text of the Petition (in compliance with the rules) can be read and signed here:
Text of the updated Petition to the Senate
Thank you for your support.
Sending the Petition (this time) to the Senate will ensure transparency and accountability.
The revised text of the Petition (in compliance with the rules) can be read and signed here:
Text of the updated Petition to the Senate
Thank you for your support.
Sunday, May 20, 2012
Drug warning - Karvezide, AVAPRO HCT - you must tell your doctor if you have had sympathectomy
Tell your doctor if:
* you have had a sympathectomy
* you have been taking diuretics
*you have a history of allergy or asthma
www.racgp.org.au/cmi/swckarvz.pdf
* you have had a sympathectomy
* you have been taking diuretics
*you have a history of allergy or asthma
www.racgp.org.au/cmi/swckarvz.pdf
2. Before you start to take AVAPRO HCT
Tell your doctor if:- you suffer from any medical conditions especially-
- kidney problems, or have had a kidney transplant or dialysis
- heart problems
- liver problems, or have had liver problems in the past
- diabetes
- gout or have had gout in the past
- lupus erythematosus
- high or low levels of potassium or sodium or other electrolytes in your blood
- primary aldosteronism - you are strictly restricting your salt intake
- you are lactose intolerant or have had any allergies to any other medicine or any other substances, such as foods, preservatives or dyes.
- have had a sympathectomy
- you have been taking diuretics
- you have a history of allergy or asthma
Published by MIMS/myDr March 2011
UBM Medica Australia uses its best endeavours to ensure that at the time of publishing, as indicated on the publishing date for each resource (e.g. Published by MIMS/myDr January 2007), the CMI provided was complete to the best of UBM Medica Australia's knowledge.
Friday, May 11, 2012
Number of sympathectomies is on the increase in Australia
Number of ETS procedures performed in Australia between 2000 - 2010
years 2000 - 2001:
Total: 1034
years 2001-2002:
Total: 1575
years 2002 - 2003
Total: 1228
years 2003 - 2004
Total: 1193
years 2004 - 2005
Total: 1483
years 2005 - 2006
Total:1358
years 2006 - 2007
Total: 972
years 2007 - 2008
Total: 850
years 2008 - 2009
Total: 891
years 2009 - 2010
Total: 1083
source: aihw.gov.au
years 2000 - 2001:
Total: 1034
years 2001-2002:
Total: 1575
years 2002 - 2003
Total: 1228
years 2003 - 2004
Total: 1193
years 2004 - 2005
Total: 1483
years 2005 - 2006
Total:1358
years 2006 - 2007
Total: 972
years 2007 - 2008
Total: 850
years 2008 - 2009
Total: 891
years 2009 - 2010
Total: 1083
source: aihw.gov.au
Tuesday, April 10, 2012
most surgeons do not have a clear understanding of their short-term outcomes for the majority of procedures they perform
The public would probably be surprised to know that most surgeons do not have a clear understanding of their short-term outcomes for the majority of procedures they perform.
Of even greater concern is the lack of data on long-term outcomes associated with surgical interventions.
Many surgeons argue that they are too busy and do not have the time and resources to conduct this sort of follow-up. This is not entirely without foundation, but it does seem difficult to defend a stance that says “I will continue to work feverishly at the operations I do but not assess how successful my results are”.
Of even greater concern is the lack of data on long-term outcomes associated with surgical interventions.
Many surgeons argue that they are too busy and do not have the time and resources to conduct this sort of follow-up. This is not entirely without foundation, but it does seem difficult to defend a stance that says “I will continue to work feverishly at the operations I do but not assess how successful my results are”.
Guy Maddern (ASERNIP-s): No excuse for poor surgical outcomes
MJA INSIGHT, 8 August 2011
Tuesday, February 21, 2012
Petition to the Health Minister - Australia, February 2012
The Hon Tanya Plibersek MP, Minister for Health
House of Representatives
Parliament House
Canberra ACT 2600
Dear Minister,
In response to the recent decision by the Health Minister to fund Botox treatment for axillary hyperhidrosis we have been prompted to submit this petition.
We would like to bring to your attention that palmar, facial, pedal and severe compensatory hyperhidrosis can have a negative social effect on a person’s life. Due to its high cost, Botox treatment is not accessible to many patients in Australia. We would like to petition for extended funding for Botox treatment for these conditions, rather than the current surgical treatments such as Endoscopic Thoracic Sympathectomy (ETS).
ETS has many common and undisclosed side-effects, including severe compensatory hyperhidrosis as found in reviews by FinOHTA [1] and 'ASERNIP-S' [2] . We wish to argue that the Medical Benefit Scheme (MBS) listing for ETS should be immediately suspended and urgently reviewed according to the strict guidelines set out by the Medical Services Advisory Committee (MSAC).
The level of endorsement (MBS listing) might impact on how the procedure is perceived by the public.
The recent MBS listing for Botox for axillary hyperhidrosis treatment sets out clear conditions and restrictions on its availability. There are no such conditions set out for the availability of the irreversible neurosurgical procedure, ETS.
We trust that decisions regarding funding are based on best available evidence regarding safety, effectiveness and cost effectiveness - and in this order. Available evidence however, cannot, and does not support the use of ETS as a safe procedure, and MSAC has never evaluated it.
In consideration of the provided supporting evidence, we hereby ask the Health Minister to:
Remove funding for Endoscopic Thoracic Sympathectomy and review the availability of this procedure, and the public’s exposure to it (including advertising, and infomercials), due to lack of reliable supporting evidence, and reports of adverse effects from the literature.
Extend funding for less harmful procedures (Botox and Ionthoporesis) for people with palmar, facial, pedal and severe compensatory hyperhidrosis. Patients with hyperhidrosis (and blushing) are evaluated by thoracic, vascular, general surgeons, with no training in treating or evaluating these conditions, nor in the field of Autonomic Nervous System (ANS). Patients should be evaluated and treated by specialists who are qualified to assess and treat these conditions (psychologists, dermatologists, neurologists).
Specify the alternative treatments patients have to trial before being able to undergo ETS - with sufficient funding, and time for these treatments to prove effectiveness.
Provide comprehensive and uniform information to all patients (including the internet) that describe the nature and consequences of this procedure, the foreseeability of complications, and recurrence, all based on high level evidence.
Clinical decision making can be tainted by bias, especially in the context of entrepreneurial medicine and elective procedures. Information provided to patients, especially in this setting can fall short of accepted standards of ‘informed consent’.
We look forward to your assistance in ensuring all Australians have a right to a fair medical system, where all surgical procedures have an objective trial, supporting evidence regarding safety, and alternative treatments are offered at a reasonable cost.
Sincerely yours,
[1] http://finohta.stakes.fi/NR/rdonlyres/A4F5CFC3-A6B4-43F5-8E2A-49689F3B7980/0/r026f.pdf
[2] http://www.surgeons.org/media/17412/RPT_2009-09-10_Evidence_essential_ETS.pdf
T(2)-T(3) ganglionectomy significantly decreases pulse rate and systolic blood pressure, reduces myocardial oxygen demand, increases left ventricular ejection fraction and prolongs Q-T interval. A certain loss of lung volume and decrease of pulmonary diffusion capacity for CO result from sympathectomy.
Histomorphological muscle changes and neuro-histochemical and biochemical effects have also been observed.
Clin Auton Res. 2003 Dec;13 Suppl 1:I40-4.
http://www.ncbi.nlm.nih.gov/pubmed/14673672
Several reports also demonstrate significantly lower heart rate increases during exercise in subjects who have undergone bilateral ISS [9–12] compared to pre-surgical levels. In spite of this high occurrence, recent reviews on the usual collateral effects of thoracic sympathectomy still do not include these possible cardiac consequences [6].
Eur J Cardiothorac Surg 2001;20:1095-1100
http://www.sciencedirect.com/science/article/pii/S1010794001010028
House of Representatives
Parliament House
Canberra ACT 2600
Dear Minister,
In response to the recent decision by the Health Minister to fund Botox treatment for axillary hyperhidrosis we have been prompted to submit this petition.
We would like to bring to your attention that palmar, facial, pedal and severe compensatory hyperhidrosis can have a negative social effect on a person’s life. Due to its high cost, Botox treatment is not accessible to many patients in Australia. We would like to petition for extended funding for Botox treatment for these conditions, rather than the current surgical treatments such as Endoscopic Thoracic Sympathectomy (ETS).
ETS has many common and undisclosed side-effects, including severe compensatory hyperhidrosis as found in reviews by FinOHTA [1] and 'ASERNIP-S' [2] . We wish to argue that the Medical Benefit Scheme (MBS) listing for ETS should be immediately suspended and urgently reviewed according to the strict guidelines set out by the Medical Services Advisory Committee (MSAC).
The level of endorsement (MBS listing) might impact on how the procedure is perceived by the public.
The recent MBS listing for Botox for axillary hyperhidrosis treatment sets out clear conditions and restrictions on its availability. There are no such conditions set out for the availability of the irreversible neurosurgical procedure, ETS.
We trust that decisions regarding funding are based on best available evidence regarding safety, effectiveness and cost effectiveness - and in this order. Available evidence however, cannot, and does not support the use of ETS as a safe procedure, and MSAC has never evaluated it.
In consideration of the provided supporting evidence, we hereby ask the Health Minister to:
Remove funding for Endoscopic Thoracic Sympathectomy and review the availability of this procedure, and the public’s exposure to it (including advertising, and infomercials), due to lack of reliable supporting evidence, and reports of adverse effects from the literature.
Extend funding for less harmful procedures (Botox and Ionthoporesis) for people with palmar, facial, pedal and severe compensatory hyperhidrosis. Patients with hyperhidrosis (and blushing) are evaluated by thoracic, vascular, general surgeons, with no training in treating or evaluating these conditions, nor in the field of Autonomic Nervous System (ANS). Patients should be evaluated and treated by specialists who are qualified to assess and treat these conditions (psychologists, dermatologists, neurologists).
Specify the alternative treatments patients have to trial before being able to undergo ETS - with sufficient funding, and time for these treatments to prove effectiveness.
Provide comprehensive and uniform information to all patients (including the internet) that describe the nature and consequences of this procedure, the foreseeability of complications, and recurrence, all based on high level evidence.
Clinical decision making can be tainted by bias, especially in the context of entrepreneurial medicine and elective procedures. Information provided to patients, especially in this setting can fall short of accepted standards of ‘informed consent’.
We look forward to your assistance in ensuring all Australians have a right to a fair medical system, where all surgical procedures have an objective trial, supporting evidence regarding safety, and alternative treatments are offered at a reasonable cost.
Sincerely yours,
[1] http://finohta.stakes.fi/NR/rdonlyres/A4F5CFC3-A6B4-43F5-8E2A-49689F3B7980/0/r026f.pdf
[2] http://www.surgeons.org/media/17412/RPT_2009-09-10_Evidence_essential_ETS.pdf
T(2)-T(3) ganglionectomy significantly decreases pulse rate and systolic blood pressure, reduces myocardial oxygen demand, increases left ventricular ejection fraction and prolongs Q-T interval. A certain loss of lung volume and decrease of pulmonary diffusion capacity for CO result from sympathectomy.
Histomorphological muscle changes and neuro-histochemical and biochemical effects have also been observed.
Clin Auton Res. 2003 Dec;13 Suppl 1:I40-4.
http://www.ncbi.nlm.nih.gov/pubmed/14673672
Several reports also demonstrate significantly lower heart rate increases during exercise in subjects who have undergone bilateral ISS [9–12] compared to pre-surgical levels. In spite of this high occurrence, recent reviews on the usual collateral effects of thoracic sympathectomy still do not include these possible cardiac consequences [6].
Eur J Cardiothorac Surg 2001;20:1095-1100
http://www.sciencedirect.com/science/article/pii/S1010794001010028
The results of endoscopic sympathectomy deteriorate progressively from the immediate outcome
British Journal of Surgery ISSN 0007-1323 1999, vol. 86, no1, pp. 45-47 (12 ref.)
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