What is ETS?

Although blushing is a normal biological response to certain environmental stimuli, for some people the embarrassment of excessive blushing can become mentally and socially debilitating. While many doctors prefer to treat excessive blushing as it relates to the psychology of the patient, others in the medical community support the classification of extreme blushing as a disease of the autonomic (involuntary) nervous system. As the condition can run in families, there is evidence that it may be a genetic condition. The emotional strain of dealing with the daily possibility of inappropriate or untimely blushing episodes leads some sufferers to consider extreme measures. One such measure is Endoscopic Thoracic Sympathectomy, or ETS.

ETS reportedly has a success rate of 80-90 percent in reducing blushing in patients. The procedure involves the selective destruction of parts of the symapthetic nerve chain located in the chest cavity. Some websites claim success depends on the complete destruction of the Kuntz nerve, a small nerve fiber sometimes seen on the second rib. However, others in the medical community disagree with this conclusion as the function of the Kuntz nerve is not fully understood. Taking approximately 40 minutes, the procedure is considered minimally invasive and is usually performed by a vascular surgeon.

As ETS is a surgical procedure it shares possible complications associated with any major surgery such as complications pertaining to the administering of anesthesia, excessive bleeding, and accidental death (there have been at least nine deaths worldwide related to ETS surgeries, mostly occurring in the care of surgeons or institutions inexperienced with the ETS procedure). Possible complications specific to ETS include lung problems resulting from the need to collapse the lung during the procedure and Horner's syndrome . Horner's syndrome is damage to the stellate ganglion which is part of the sympathetic chain. The syndrome can lead to an observable droopiness in one eye.

Possible side-effects associated with ETS vary. The most common side effect is compensatory or reflex sweating. ETS usually hinders the ability to sweat on the face, scalp, and hands and increases sweating in other areas of the body, such as the chest, back, groin, and thighs. Other side effects include gustatory sweating, which is excessive sweating in parts of the face when stimulated by the smell and taste of food and drink. Other side effects include dry hands, circulation changes, fainting, and a prickly sensation in the scalp. Although some surgeons have had success in reversing the ETS procedure and repairing the sympathetic nerve in order to treat the side effects, ETS is generally considered a permanent treatment.

Medical professionals who do not support the use surgery believe that extreme blushing is better treated as a social phobia. This position is supported by the observation that those who fear blushing often believe they are blushing much worse than they actually are. Secondly, most of the published evidence supporting the success rates of ETS comes from uncontrolled studies. Lastly, there is evidence that displaying emotions through blushing serves an important psychological function, the removal of which could have significant unknown consequences.

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