Any advertising above for ETS or ESB is NOT accepted by us as we are AGAINST ETS/ESB because of the side-effects

Q.1. Why do you think the sural nerve is better to use in the reversal rather than the intercostal nerve? Dr Lin believes it has the ability to survive better. Do you agree with this?

I do not think so personally. These are not directly comparable. The intercostal nerve is near, it is possible to preserve some of its vascularity, and thus its viability and regenerating ability may be better. I have been using both nerves as donors during 20 years. My personal predilection is sural nerve, because of its better treatability and diameter. However, there are no comparing studies whatever between these two different nerves. In the future we certainly will know more. I hope that all the surgeons doing the reconstructions are using the sweat measurements in another objective centre as we now are. If the results are based only on subjective feelings and personal inquiries of the performing Doctors, then the results will never be reliable and commensurable.

Q.2. Have you yet gathered any objective empirical data supporting your claims that the reversal works?

I have made sweat measurements for two years now, and I am finally getting some reliable results on the recovery. The cases that I have been able to measure (8) all show distinct normalization of the sweating pattern, of course the degree varies individually, but the direction is uniformly positive.

(I just have to mention here how important it is for you guy's to all participate in objectifying these results, so we can see if it works! So if you don't want to do it for the doc's, atleast do it for us - Meg)

Q.3. Is the methodology of the reversal similar to to the one used in the rat model described In a triumph of microsurgery(http://whyfiles.org/023spinal_cord/karolinska.html) Did you first realise that the reversal may work after seeing the results of this study?

No, it definitely is not at all similar. We are here talking about two entirely different phenomena:
- The scientists in the Karolinska Institute work on the spinal cord and its potential of recovery, something which I also have been earlier working with together with Dr.Thomas Carlstedt from Karolinska, although he is not there but now in London, and is no longer, to my knowledge, working on that issue.
- The reversal in the sympathetic nerves is quite similar to the reconstruction of the peripheral nerves, the field of my education and special interests for more than 20 years. This is a totally different topic, since the peripheral nerves still have their nerve cells viable in the spinal cord. The sympathetics differ from them only in that the nerve cells lie on the remaining ganglia and not in the spinal cord.

Q.4. I am wondering if there are non-invasive technologies available to determine whether this graft has survived and axons have attached (regenerated) to their intended targets, and to determine the future growth potential this graft may manifest over time? Are MRI or other imaging technologies available to answer these questions?

For the time being there is none, whatsoever.

Q.5. I understand from a lay position that stem cells from one's own body may provide real answers n the near future for person's with neurological maladies. I saw this on the Christopher Reeve's story shown on the ABC network. Would such technology be available to me to either potentiate the viability of my current graft, or to perhaps replace it entirely with an alternative source of nerve tissue that could regenerate the nerve gap between my neuropathy?

The stem cell research has no bearing to the nerve reconstruction nor recovery of the sympathetic nervous system. Only to the spinal cord. So, forget about the stem cells, they are of no relevance here.

Q.6. I've been told that you believe in performing a reversal straight away, while other surgeons wait. Why do you disagree with that, and ask patients to have the reversal straight away?

I have been doing nerve surgery for such a long time that I have seen its limitations, and also learned that the earlier you repair, the better will the result be. Of course the surgery must not be performed before it is certain, that there will be no real recovery without it.

Q.7. If someone came to you and showed evidence (i.e a psychiatric report) that they were so psychologically devastated by ETS, what could you do for them?

I could of course do the reversal surgery. However, it has to be born in mind, that the evaluation of psychological changes is extremely difficult and especially the valuation of the results of the recovery.

Q.8. Can you say 100% that ETS patients with clamps can be successfully reversed?

Nobody can guarantee a 100 % result in any kind of surgery or treatment.

Q.9. What if a patient has scarring under the clamp or the nerve is no longer viable? Can you still reverse them just by removing the clamp or would you have to do a conventional reversal?

In a badly scarred situation a reconstruction is the only way to proceed, though it might be possible without a graft.

Q.10. I've been consistently coming across doctor's who cauterize many levels on the sympathetic chain. What is your thought about this? Do you think these surgeons are inexperienced? Do you think there are many 'cow-boys' out there who shouldn't be doing this surgery?

Definitely so.

Q.11. Dr Cameron, who will also be participating in this site, sent me a report in which he mentioned there have been 6 deaths as a result of ETS surgery. Only three years ago there were no deaths reported. There should be a zero tolerance policy. What can we do to outlaw these surgeons? As far as i'm concerned it is meant to be a 'minimally-invasive' procedure. Why don't you have a particular society that only allows only experienced surgeons trained by you, Lin, Cameron or Reisfeld?

These deaths are a very sad thing. It is not true that there would not have been deaths before that tine, I know at least one clearly before that time. However, these deaths are not related in any way to the sympathetic system but to poor surgical technique and inexperience. They do not make this surgery any more life threatening than a simple appendectomy performed with poor conditions and skills. There always will be surgical deaths no matter how well the surgeons are educated, that will remain unavoidable. Of course the number will be all the time decreasing and the risks getting smaller all the time.

Q.12. I've come across the Lin-Telaranta Classification. I understand that different nerves should be clamped for different maladies, thereby also reducing side-effects. Have you noticed less reversals by your patients since using this method?

Since that time I have not had to perform any reversals yet. This is the biggest step in the sympathetic surgery together with the clamping method.

Q.13. Firstly, congratulations on your decision not to perform ESB anymore on patients who suffer from blushing and hyperhydrosis. I feel it's a move in the right direction to show that there are too many side-effects indicated. Will you now work towards documenting your objectified results of the Reversals in scientific journals and publications? Will you also aim to prove to other surgeons that overwhelming side-effects really do exist?

I will concentrate my efforts in helping people with Parkinsons's disease (go to my netsite and read the newest article by me), then there are other interesting topics which I only can mention such as Migraine; Schizophrenia; drug addiction; and of course social phobia, where the benefit with a modified procedure, often much more limited, seems very promising. This research will be main main stream interest, and of course the reversals.

Q.14. I've noticed you've now chosen to perform a Reversal using the intercostal nerve graft. Why the change of heart? Are you offering patients a chance to choose? Is the intercostal for everyone or only particular patients? You mentioned in a previous answer that "in the future we certainly will know more" about the superiority of one over the other. Have you discovered something about the use of the Intercostal graft in recent times, due to apparent benefits of ability to preserve some of its vascularity?

I've not chosen the intercostal method as a method of choice, I am still researching its potential benefits over the normal grafting procedure. I don't see many, but some are clearly better suited for the ICNG surgery than conventional grafting. Mostly these patients are those with small nerve defects and little, if any scarring aroung the original surgery site. I'm offering it as a choice whenever it can be performed. Then there are more chest pain related side effects - the chest region may become oversensitive, so that it will not be comfortable to even use clothing, because it may cause uncomfortable feelings.

Q.15. According to Dr Lin, there is no nervous degeneration and regeneration in his technique. Could it be inferred from "no degeneration and regeneration" that it never goes through that phase talked about by you where basically the center of the nerve graft is slowly replaced by new axons etc. and all that is eventually left of the original graft is the outer shell?
Britton

Dr. Lin is a good friend of mine, and I hate to disagree with his points of view, but sometimes I have difficulty in accepting this view which is very far from what I know about nerve functión and regeneration.

Q.16. If Dr Lin's technique works and the intercostal nerve has the ability to stay live, it therefore may allow nerve signals to pass through it and allow neurotransmission quickly, rather than the sural which dies and then of course acts like a "tube" for the axons to migrate along. Do you think the intercostal has the ability to stay live indefinately as opposed to the sural?

In my opinion the nerve cells cannot continue their function, but rather have to be substituted with new ones growing similarly from the sound nerve ends than with sural nerve grafts. The only difference in my opinion is that the nerve supporting tissue, that is the Schwann cells and other connective tissue, remain better alive and can act as a better channel for the nerves to grow in. Of course there always will be new findings and the old ones have to resign. I don't just yet know if this could be one of these. For the present time my knowledge and experience seem insufficient to understand this possibility.

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