腰痛が起きているがこれはリバーサル後の影響なのか？

ここ最近はずっと過去記事の英訳を進めてます。だいたい３日に１つのペースでやってます。英訳しておきたい記事はまだあるので、これを機にどんどん進めて行こうと思います。ちなみに コメント広場 にはネットで見つけたいろんな記事を随時（日本語で）載せたりしてますから、新着記事が英語の記事ばっかりの時でもぜひこっちを見にきてくださいね。


そんな英語の記事が並んでるところですが、今日は日本語のいつもの日記を書きます。

というのは、おととい腰に違和感を感じだして、昨日からは腰痛になってます。特に胴体をねじったり勢いよく起き上がったりすると、反動で腰が「う”っ」となったりしています。そのためのっそりと起き上がったり、腰に負担がかからないよう、かなり慎重に行動しています。

何で起きてるのかはちょっと分かりません。

• 母を車椅子に載せて毎日公園まで散歩してるのですが、取っ手の高さが低いので中腰の構えで押してます。それが影響したか。。。
• ここ最近夜食をたくさん食べてました。特に先日はペヤングの豚脂も食べてその後ものすごいゲップリ・・・胸やけを起こしました。そんなことが影響したか。。。
• 神経の回復に伴う前兆の可能性もあるんじゃないかという淡い期待もほんのちょっと持っています。

なぜ神経の回復の影響の可能性があるのかと言えば、ここ最近ずっと異常なまでの眠気があって、その眠気は過去にもリバーサル後の回復のプロセスの中で経験したことがあるからです。ただ、それはもう１５年以上も前のことなので、その時に腰痛が起きていたかはもう覚えてないのですが。。。

もちろん何らかしら別の原因がある可能性もあります。
今日は土曜日ですが、週が明けてもまだ痛むようであれば、整形外科で診てもらう予定で考えてます。

About the "feeling of nerve flow" that I feel after ETS reversal surgery #03

This article is a translation of an article written in January 2013.

▶ Japanese

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I usually work in the office, but today I went out during work. I took the subway and walked outside. Because I wore thick clothes, the sweat stain was hidden, but my upper body was wet with sweat.

The title of this post is "#3", which is a continuation of "#01" and "#02" written in June 2012.


【Attention】
The contents here are based on "the feeling I have received since I took reversal surgery", "a little what I have investigated", and "some of my assumption". Therefore, it is not known whether everything is correct or not, and there may be points that lack consideration. What you need to know in advance is that I am not a doctor but a patient, and that this is not a medical explanation.
So I hope you read this for the question and hope how much I will recover by taking ets reversal surgery.
And my thoughts may be changed in the future depending on facts and conditions that I do not know. This is my idea at the moment.
The "feeling of nerve flow" used in the title is just an explanation of my feeling as a result of taking ets reversal surgery by Dr. Timo Telaranta in Finland.
However, it doesn't mean that if you take reversal surgery, you will recover with such feeling. I know a number of people who have had the same reversal surgery in Finland, but no one has the same feeling of mine.
I'm the only one who used sural nerve for donner site (the others used intercostal nerve), so I'm not sure if it's due to the difference in technique or just due to individual differences...


About the structure of nerves in the arm

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The nerve page of Wikipedia has a diagram of the nerves in the arm.

The red part is the artery and the yellow part is the nerve.
By the way, the same figure is also used on the ulnar nerve page, the median nerve page, the medial pectoral nerve page, and the lateral pectoral nerve page on Wikipedia. The radial nerve page uses a little different figure, but the nerves of the arm are explained in the same way.
The reason why I dared to give the difficult nerve name is that these pages say that these nerves are derived from the brachial plexus. The brachial plexus page says, "formed by the anterior rami of the lower four cervical nerves and first thoracic nerve (C5, C6, C7, C8, and T1)." As mentioned on "How much can I recover having taken ETS reversal surgery?" page before, there is a sympathetic trunk in the chest, and it seems that T1 and T2, T2 and T3 ... and all sympathetic nerves are originally vertically connected by a nerve called a communication branch.

That is to say, even if I do not understand each of the yellow nerves in the upper figure, I think that they are the parts over the nerves reconnected by reversal surgery. In other words, I think that the extension parts of the nerve blocked by ETS surgery affects not only the palm but all the arms. And the nerves of the brachial plexus are connected not only to the arms but also to the face and head, but I will write about the feeling of the nerves flowing to the face and head at another time.

The figure below shows, though my imagination, how ETS surgery may remove the nerve. And I think that partial block means cutting off a part of the four points in the figure, rather than cutting all of them. ("4 points" is because this image figure happens to be that way. Actually, I think that doctors cut what they find during surgery. As I don't know exactly, welcome your advice.)
This diagram is from the sympathetic trunk of Wikipedia, and I wrote on the premise of the enlarged view of the red circle in the figure above.

→

About the place where I feel the flow of nerves

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As I mentioned in the diary the other day (※refer to here and also here, but I'm sorry these article are in Japanese), the green part in the figure is the most strong part that is feeling of flowing nerve right now.

This green part is below the clavicle and seems to come out from the rib gap. Positionally, it is the tip of the "balloon" on the left side of the three "balloons" below.

It's a place that feels terribly violent, so I thought it was clearly shown, but it didn't look in this figure.

And I think that the nerve passing near the yellow circle toward the right shoulder is linked to the nerves bunched around indicated by the balloon on the upper right in the area.

This time, I applied my feeling of nerve flow to the nerve diagram and compared them.

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About the "feeling of nerve flow" that I feel after ETS reversal surgery #02

This article is a translation of an article written in June 2012.

▶ Japanese

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When I was working this afternoon, sweat was exuded from my back for a moment.
It wasn't hot nor I was exercising, but I suddenly felt feverish only around torso and sweated, while sitting at my desk. This sudden sweat I had today wasn't enough to drop down, and stopped after only my back got a little wet. As I wrote in the previous article (About the "feeling of nerve flow" that I feel after ETS reversal surgery #01), sweat sometimes can be pouring out like a fall.

I am feeling the flow of nerves in my upper body all the time while I was awake, and I now still feel it flowing into my palm through my right shoulder. Though it's not numb, both hands have a tingling dull feeling. My right hand is shivering for few years all the time when I've been awake and unconscious (meaning I'm not aware of my hands).

※The figure is on the abdominal side,
but I feel the back side.
※Japanese annotation written above
means "The location varies from day
 to day".

Conversely, regarding the nerves below the chest, there is also a feeling that the nerves also move as well.
What is different from the upper half of the body is that there is a flowing feeling like a landslide from some part of the abdomen / back toward the inside of spine. This happened just before. I think it may be linked to sweating during the daytime.

When I have the feeling like a landslide, sometimes I have another flowing feeling going up along the spine, or sometimes other flowing feeling going down from the thigh to the bottom.
Once I feel it, the flowing will be intense for the next few days, and in particular I will feel a strong flow in my shoulders.

In this way,  I feel that the nerves reduction in the lower part does not provide overall smoothly like unplugging a bath or deflating a balloon, but somewhere in my nerves collapses all at once, as if a dam broke, and then flows over my chest over the next few days.  When the nerve movement settles down, I feel it at another place in the same way, and it is repeated again and again.


Though I have wrote at "Kingyo-Ita" of Japanese bulletin board system in the past that "the nerves under the chest have become like a pressurized hose, and it flows through the parts that are connected by reversal surgery while cutting off at some parts",  it comes from this feeling. (※Refer to this, but I'm sorry, it is written in Japanese)

This kind of thing happened not once or twice but tens of times, and happened over and over again, and at last, little by little, so very little, the abdomen / back sweat decreased.


This feeling is just a "my personal feeling", and it is not a summary of how to recover after a reversal surgery nor an explanation of how to recover. Please understand there.


By the way, I can commute to work on the train with my shirt and back dry without any compensatory sweating in spite of at the end of June. It's not summer yet, so it's early to put together this year's situation, but I feel that the recovery is more advanced than last year.

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About the "feeling of nerve flow" that I feel after ETS reversal surgery #01

This article is a translation of an article written in June 2012.

▶ Japanese

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It's been a week since the rainy season started.

I was at home today during the day, but the room temperature was over 29 degrees Celsius and I sweated from my back like a waterfall.
After I sweated like today, it will be continue for next few days that I feel nerve flowing intensely. It's been repeated for many years.
So I think that sweating like this is close to the sign that the nerve flow becomes stronger.


Since I made a blog, I'd write a little about the "feeling of nerve flow" that I feel.

The black horizontal line that extends from the throat to the left and right in the left figure is the clavicle and there are some ribs just below it. When I press the gap between its top rib and second rib (red point) with my finger, I can feel the nerve flow.

I've written on the bulletin board several times in the past that I often feel cracking inside my shoulder, and that place is the green and yellow area of the figure.
Especially about the green area, when I feel pain, it can be easier by pushing there with my left index finger as much as possible.

The part that I feel strongly that the nerve repeatedly connects and disconnects for the past 3-4 years is the blue part around my armpit.  I think that there is a part that interrupts the flow because the nerve tube is bent after it has withered once.　If pressing from underarm-side outside of the blue area toward inside of the body using my left index and middle fingers, I can feel the nerve flowing from red to green to blue. (Maybe red → yellow → green. I can't say "the feeling" clearly because there are various parts that I feel strongly and other parts that I don't feel at all...)

So there is a feeling that it flows from the red area to the yellow area. When I feel the flow in this yellow area intensely, I sometimes feel the flow to my right palm, around behind my neck, and to my left arm through behind neck, and in addition, (although both left and right) I may feel the flow to my temples through neck.

And I feel the flow of nerves from various places that I can not understand well, such as going from the green area to the back, or from the blue area toward the left shoulder through the back, etc... A lot of things happend, such as when I felt the flow of the green area strongly, the area around my right thumb and forefinger was numb, and when the blue area, the area around from my right middle finger to little finger was numb. There were so many different feelings that I can't clearly explain what kind of structure and flow it really is.

However, I think that the part to have reconnected my nerves, when I took ets reversal surgery 10 and a half years ago, was around the red area. And I think that the nerve blocked is one of the root important nerves, among spreading all over the body.

That is, even if the transplanted area is already connected, the nerve flow to each node of the body has not yet been regained, because I feel like this.

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Full Bloom on right side

This article is a translation of an article written in May 2018.
Thanks to this event of "full bloom", I'm feeling further changes. I think the current symptom of intense sleepiness is one of them.

▶ Japanese

I already wrote today's diary about two hours ago, but this is an additional diary.
I felt sick, so I had a dinner easily, and I lay down again, then I felt that the nerves on the abdomen flowed and moved to both arms at a frightening speed.
It was completely different from the feeling until now, and was a tsunami-like flow.
It may be a symptom close to panic.

I received the following advice from my doctor who had reversal surgery in Finland.
Compensatory sweating does not decrease at the same time as the nerves move, but sweating decreases at last when the nerves move to the fingertips and heads and connect to all. (※See here, but I'm sorry, it is written in Japanese)

This time, I think that the nerve through the cracked point in the right shoulder was connected to the fingertips, and became a "full bloom".

However, it isn't completely connected yet.
I still have the feeling cracked in my shoulder, and still feel the nerve flowing.
I don't know if it will continue to flow and be fully connected, or if it will gradually connect while repeating these things in a cycle of several months.
I felt like it was connected in one place in February of last year, but I know now that there was one more left. I don't know if there is another nerve to connect.

However, based on my experience until now, I think this should improve compensatory sweating and body temperature.

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For those who want to take ETS surgery

This article is a translation of an article written in December 2016.

▶ Japanese

I heard from the person who had ETS surgery that he consulted my blog prior to the surgery.
I think that the mind and method about ETS surgery has changed from the time I received it to the present.
So I'm not sure if everything is true, but I think I will write a message to anyone who would like to take ETS surgery.

I am negative about ETS surgery.
It is not reasonable at all for a person who has had reversal surgery to recommend ETS surgery. Therefore, I always say strongly that you shouldn't do it.
Still, there are people who want to undergo it.
This is the minimum advice to those people.


What you should try before taking ETS surgery
Aluminum chloride and Iontophoresis should definitely be tried before ETS surgery. If this works, you don't have to take the surgery.
You can also use Pro-Banthine (Generic: Prospas). Many people use it for compensatory sweating, so it should work on hand and foot sweats. If you want to stop your sweat only when important, I think that you might use such a drug. Some people say that just holding it as an amulet is effective.


Nerve burned out by ETS surgery
The nerves are burn out like this. (This is an overseas video excising T2 / T3 / T4)

ETS Surgery (Endoscopic Thoracic Sympathectomy)

Burnt nerves can no longer be undone.
Some people said "I didn't know it was like this. If I saw this in advance, I didn't undergo the surgery."


Excision position of ETS surgery
The resection place where all doctors have a consensus does not seem to be established, but commonly, that for hand sweat is referred to as T2 and T3. Though T4 becomes a candidate for underarm sweat, I heard from Dr. Shiotani that T4 alone won't stop hand sweat. Since T2 has strong compensatory sweating, I think that excising T3 may be the optimal solution.
However, there seems to be no method to confirm the excision site by X-ray or the like.


Compensatory sweating
Compensatory sweating occurs 100% when taking ETS surgery.
Satisfaction is a criterion for accepting compensatory sweating while hand sweat is gone, and is a personal judgment. Since the satisfaction rate published by hospital incorporates the hospital's intention, I'm not sure whether the overall patient satisfaction is reflected correctly.
Also, compensatory sweating may worsen over the years.


Are you satisfied with the one-sided cutoff?
This is a big problem.
I think that the dominant hand is selected first in the case one-sided cutoff, but then the extent of compensatory sweating is low so likely to be satisfaction. (Of course, some people were disappointed with even only one-sided, some of whom took reversal surgery.)

If you cut off on one side, you may have another problem such as left / right difference in sweat on your face. You may want to stop sweat with both hands.

However, I think it will happen if you cut off on both sides.

I think this is why even if compensatory sweating is not too much of a concern on one-side, it can be fatal on both sides.


What is the deadly aftereffects of ETS surgery?
Intense compensatory sweating limits your summer outings.
Clothes can only be selected depending on how sweat is inconspicuous, and you are desperate for odor control.
You cannot eat spicy food in public because of gustatory sweating.
Your head is hot in summer, your hands is cold in winter.
You lose your energy, lower motivation, and change your emotions.


Is it true that it will not look like it used to be?
There used to be a time when cutting all of T2 / T3 / T4. By comparison, it may be true that it is not what it used to be. However, unbearable amounts of compensatory sweating have also occurred in people who have taken ETS surgery in recent years. Some people with bilateral T3 resection go to Finland for reversal surgery .


If disappointed at ETS surgery, then can I say that I have reversal surgery?
No, I can affirm.
If you took it in Finland, it will cost over 1.5 million yen. There is a risk that it will not work and recovery will take time. Even now, 15 years later, I'm still recovering.


ETS surgeon I recommend (in Japan)
So, though I strongly insisted that you should not took ets surgery, if you still want to take it, I recommend the "Japanese Society of Thoracoscopic Sympathetic Surgery", which studies ETS surgery seriously.

There is also a link to this group in my link collection (in the right column), and their hospitals from north Hokkaido to south Kyusyu were introduced on the site.

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Panic-like symptoms that began to occur after ets reversal surgery

This article is a translation of an article written in August 2012.

▶ Japanese

This week was a week when many companies take summer vacation.
Since I was able to sit down on the train and the cooling effect was strong because of few people, I commuted to work more comfortably than usual.

As for this week's situation, I had the overflowing sweat on Friday which recently occurs frequently.
The air conditioning wasn't good during the day, and the room was at 29 degrees for a while,  so I felt hot from the daytime, but at that time I didn't sweat. But at night, I heavily sweated instantaneously.
When I felt its indication, my concentration is suddenly lost, and vague anxiety begin. And though I sweat only about 5 to 10 minutes, I feel it a very long time.
I haven't had such a bad thing recently, but sometimes I feel choked and get stuck. And after a while, these symptoms will calm down. Other people might think it's a panic condition, and I also think it might be the same principle as panic. But as I have not been diagnosed, I do not know the details...

What I feel is that my nerves are moving. Such indication occurs when it is ready to flow from my abdomen / back to my chest (It often happens after spending in the heat area, exercising, etc.), I feel a lot of nerve movements when resting due to pain, and It will calm down after a while.
But what I think is fundamentally different from panic syndrome is that I have never felt the fear or anxiety that I might die and I have the hope that "this helps my recovery" even in the middle of the symptoms. I thought so even when I felt suffocating, sicky, and grueling. Until now, there have been many times when I have had a terrible fear that makes me want to escape from the place where there are people, and an anxiety that I cannot express in words that stop my thoughts... is this panic at all?
Though it's not as bad as it used to be recently, I have been told from many people by now "have you been getting medicine?", "What if you see a doctor?", and so on. I escaped from people at the indication stage most of the time, but there were many times I couldn't do so, and I have been called an ambulance once in the past.
However, I always answered that there was no problem because the cause was known. It is because that I don't like doctors, that I think it's impossible that some medicine can cure me because the cause is the moving and flowing of my nerve, and that I think this symptom will disappear if the recovery after reversal surgery proceeds more and the feeling of the movements and flow of my nerve ends.


I went to the pool today.
It's great to spend hot daytime without worrying about the heat, to rehabilitate after reversal surgery by exercising, and to feel the flow of the nerve movement more intensely when you feel water pressure in the pool, so I go to the pool every week during summer.
Though sometimes the nerves that flow through my right shoulder make cracking sound inside, I feel the nerves flowing into my palms when flowing smoothly.

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Connecting the sympathetic trunk to one by ETS reversal surgery

This article is a translation of an article written in 2013, so it may be a little old...

▶ Japanese

Yesterday, after I took a bath, I heavily sweated all over my waist.
I had no feeling that I was sweating, and when I noticed, my underwear was wet both front and back. And when I realized it, my sweat had already stopped. I was surprised by the terrible amount of sweat, but I was lucky to happen at home.

Last year, when I sweat due to nerve movement, it was accompanied by breathless foretaste signs (that sweat is about to begin) in most cases, but this year, this kind of sweat was almost disappeared.

But with this, I think that the nerves move flowing from the lower body to the upper body again.

In fact, I had some feeling today that my nerves are flowing at area around from my right chest to abdomen. With the feeling written in "About the "feeling of nerve flow" that I feel after ETS reversal surgery #02" before, as I've been repeating this, my sweat on my abdomen and back is decreasing. The diagram at that time is shown below, and what was happening to me today is the height around the red line...
And around the base of my left foot was trembling as if bubble is bursting. (Things like this are frequently happening around my thighs and knees recently.) Without any pain or discomfort, I think that this is happening because the nerves flow too on the lower body side.

※Japanese annotation written above means "The location varies from day to day".

I proceed about the chest.
About the place where my sympathetic nerve was connected by reversal surgery, I have written on the page of "How much can I recover having taken ETS reversal surgery?", and  I think it is like this.

I think that what is important here is to connect vertical nerves called the sympathetic trunks on both left and right sides into one from top to bottom.

Because I feel such nerve movement like this.

I think that though the part transplanted by reversal surgery (that is, the part of blue bypass) is already connected, it is taking a long time of more than 10 years for migration of this green nerves.

I think that the reason why it takes so long is that not only the nerves in the upper half of the body have weakened, but also there have been numerous places where the flow of nerves has withered, and also with the momentum that pushes them out when they become active with exercising or staying in a hot place, they gradually regain their flow one by one and little by little.

※Japanese annotation means that I am feeling various nerve flows.

I think that the nerves that go to the upper body like this have various thickness.
For example, I think that when the thick nerves to the arm are withered and blocked by bending, the balance between the upper and lower sides may be greatly disturbed. Because what is about to be connected now seems very thick nerve toward my arm.
I believe that being connected through like these things is the reason why we are not recovering just by taking ets reversal surgery but gradually recovering over the years.

It never holds that 50% partial resection is safe or lower level resection is safe. I think that this is because ETS surgery creates a complicated situation like this in which the innumerable nerve branches of the upper body partially stop and the other not. Suppose that they were narrowly connected immediately after ETS surgery even if the nerves flow is trickling. However, the nerves that were active in the summer may not be active in the winter. When repeated such things year by year, I think that one of the thick nerves in the upper body may be bent and blocked. If so, I suspect that the compensatory sweating of the lower body may appear several years later.

It is so important base nerve that should not be touched. It is the root that acts not only on the hands but also on the sympathetic nerves to the head, isn't it? I think that ETS surgery is too much to sacrifice, with many things changing, such as mental aspects, taste, smell, concentration, positive thinking, and temperature regulation.


Next, I also consider doing ETS surgery on one side only.

First, suppose the state before ETS surgery is like this.

And suppose ETS surgery cuts off only one side.

Even so, I think that the nerve pathways shown by the blue arrows remain.
Compensatory sweating seems to occur in the lower right part of this figure, but I think that the nerve can move to the left along with the blue arrow. Therefore, I think that compensatory sweating may be mild.

When cut off on one side, you may have new troubles such as left / right difference in sweat on your face. You may want to stop sweating with both hands.

But I think this will happen if both sides are cut off.

I think this is why even if compensatory sweating is not much of a concern when one-sided blocking, it can be fatal on both sides.


Now let's apply this to my situation.
At first I had the feeling of being fully connected on the left side. It was about a year and a half after the reversal.

Actually, I took lumbar sympathetic blocks for foot sweat by alcohol injection on both sides at that time, so I think that my abdomen and back were under tremendous pressure neurologically. My compensatory sweat was a particularly terrible one. I don't know why my left nerve was connected first (not the right side). But why I could feel that one side was connected early might perhaps be because what I wrote above might have occurred to me. The feeling of flowing nerve that I felt on the left side at that time was much faster than now. (But I'm wondering if that might happen to the right side ...)

And when the left side was completely connected, I think that temporary lumbar sympathetic ganglion blocks had been no longer effective. As the sympathetic nerve to the foot was connected after the effect of the lumbar sympathetic block disappeared, and as the sympathetic nerve to the upper left half of the body was connected, I think the force pushing to the right is weaker than the force which I felt on the left.

Though it took me about a year and a half to feel that the left side was completely connected, the right side is more than 10 years and not over yet. I think that it may be the reason for this.
But I feel that the feeling of flowing the nerve is changing little by little every day, so I believe that I should be able to connect completely someday. I have never changed my mind about this since I took the reversal.

Next week, my friend will go to Finland for reversal surgery.
I wish the success of his surgery.

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ものすごく眠い

今日も日中29℃と暑かったです。まだ５月だというのに。。
暑くなってきたことで右脇を通じた神経の流れは激しくなっていて、頭にも神経の流れる感触があります。おそらくその影響で日中異常なまでに眠いです。ここ最近毎日そうで、今日は昼寝をしました。

これは昨日Twitterにつぶやいたコメントです。

リバーサル手術を受けた後の眠気がものすごくて生活に支障ありです。
私の場合はそれが一過性ということは分かってるのですが、意識を保つのが精いっぱいだし、気づいたら落ちてます。
左側がつながる過程の時にもこの状況になってましたが、その時は職場のトイレに駆け込んでました。

— まるとん (@marumarutonton) May 12, 2020

この時の眠気なのですが、あくびとかが出ることはなく、頭がぐわんぐわんする感じになって意識が遠のくように眠気が襲ってきます。普通の睡眠不足だとあくびが出て眠い～寝たい～となるかと思うのですが、そう思う余裕もないあたり、眠気の種類が違います。

今私は親の介護をしている生活のため、こういったことが起きてもさしたる問題にはなりませんが、仕事をしながらではまず無理だと思います。（昔はだましだましでなんとかなりましたが、今ではもう無理です。）
この眠気がいつまで続くかはちょっと分からないのですが、この生活をしている間に過ぎ去ってくれるのを祈っています。

How much can I recover having taken ETS reversal surgery?

This article is a translation of an article written in 2012, so it may be a little old...

▶ Japanese

So far, I have written on the bulletin board about the feeling I have received after ets reversal surgery. Through them, I'll write down my thought that my sympathetic nerve would be like this now, why compensatory sweating is occurring, and how much can I recover after ets reversal surgery.

【Attention】
The contents here are based on "the feeling I have received since I took reversal surgery", "a little what I have investigated", and "some of my assumption". Therefore, it is not known whether everything is correct or not, and there may be points that lack consideration. What you need to know in advance is that I am not a doctor but a patient, and that this is not a medical explanation.
So I hope you read this for the question and hope how much I will  recover by taking ets reversal surgery.
And my thoughts may be changed in the future depending on facts and conditions that I do not know. This is my idea at the moment.


About the structure of the sympathetic nerve

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Here is a diagram of the sympathetic and parasympathetic nerves on the Wikipedia page (Autonomic nervous system).

It is easy to understand that the vertical line at the left side is the spine, but the others are hard to understand. so let me give you a little supplement.

• The red line drawn in the original diagram is the sympathetic nerve. (The blue line is the parasympathetic nerve)
• The sympathetic nerve begins in each spine (thoracic and lumbar) and goes through the lateral line to the sympathetic trunk. The sympathetic trunk is vertically connected, and each intersection is called a ganglion. The ganglion that match T1 of the thoracic spine are T1 ganglion, and in the downward direction, T2 ganglion, T3 ganglion, ….

And I will also add the following.

• The sympathetic nerve runs with the artery, and works when it dissipates energy.
• Sympathetic neurotransmitters are different before and after the sympathetic ganglion (The nerve before the sympathetic ganglion is acetylcholine, while the nerve after the sympathetic ganglion is catecholamine.). But the transmitters that control the sweat glands is the only exception, and acetylcholine acts before and after the sympathetic ganglion.

About my resection area and reversal area

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I didn't know the area that was resected when I took ETS surgery, but I heard from the doctor who performed ETS reversal that the area is T3 and T4 on the right side, and T2 and T3 on the left.

I'll show it using the diagram above.

I think that the problem here is that the sympathetic trunk is divided up and down, and there are fewer nerves going up.

Therefore, because the parts cut by ETS surgery block the up and down flow, the substances that transmit through nerve (maybe it's acetylcholine?) have almost stopped flowing upwards. As a result, they accumulate in the abdomen, back, thighs, etc, so the more substances that promote sweating, the more these substances move toward the lower body and sweat as compensatory sweating...
Considering that large amount of compensatory sweating, not only the amount of neuromessenger that acts directly on the sweat glands in the upper body, but also the neurotransmitter on the pathway for propagation originally to every corner of the upper body, I think that they all reach the sweat glands in the lower half of the body and act directly to produce compensatory sweating.
The reason why I could say that it was caused by the stagnation of the flow to the upper part of the sympathetic trunk was because my doctor Timo Telaranta said to me about the surgical procedure that "I connected T2 and T5 to bypass on the right, and T1 and T4 to bypass on the left".

I think it's probably like this.

And even if the chest nerves was reconnected by this reversal surgery, as the sympathetic nerves on the upper side of the chest once became like a thin stream, so I think that there are many parts that have withered at the branches. Therefore, I feel that it takes time to restore the original flow even if the resected parts are reconnected.

I feel that the left side is already completely reconnected. I think that because there was only T1 nerve flowing up on left side, the force pushing upward might have flowed so strongly after reversal surgery. I think that's why I was connected first. (It took about a year and a half for my left nerve to be reconnected.)

I think that the reason why the right side is still moving more slowly not being connected even after 10 years is because the pushing force is weakened because the left side has finished moving and it is in an equilibrium state. But I still feel the moving flow of the sympathetic nerve, which runs with the arteries, so I believe it will recover more.


How much can I recover?

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Even if all the movements are over, I still think that a little compensatory sweat will remain.
The first is whether the bypass which made at the reversal has enough thickness to restore the original flow, and the second is that the nerve from the resected sympathetic ganglion to the whole body may not be reconnected by reversal surgery so may be lost.

However, I think that the nerves in these unconnected parts are much less than the nerves above the chest.

My Finnish doctor said, "When we do reversal surgery, we acturally look at the nerves after ETS in the chest and do the best we can on a case-by-case basis." So I believe that this bypass, which connects T2 and T5, was the most recoverable technique in my situation.
And I'm already satisfied with taking reversal surgery because I feel the recovery of considerable decrease of compensatory sweating.

Though I don't know how long it will take to connect the rest of the nerves that are still recovering, if the nerves are completely connected, I think that sweat that comes out when moving, numbness in the hands, headaches, and dizziness, etc.. will be alleviated or desappeared.

So, this time I wrote about what I think.

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Relation between Drowsiness, Melatonin and ETS reversal surgery

▶ Japanese

I wrote recently about intense drowsiness after ets reversal surgery.
Today, I write down about what I have researched about it.

The hormone that induces drowsiness is melatonin.

• Melatonin is a hormone that makes the parasympathetic nerve active, and it is secreted mainly between the evening and dawn. It is produced by a tissue called the pineal gland in the brain and is carried by the bloodstream into the body.
• Release of noradrenaline from the sympathetic nerve endings into the pineal gland causes melatonin synthesis.
• The body recognizes its readiness for sleep as melatonin lowers pulse, body temperature, and blood pressure, so melatonin has the effect of promoting sleep.

It makes sense to think that my intense drowsiness is caused by hypersecretion of melatonin.
It is written in the second part of the above bullet point that the increase of melatonin synthesis is started under the influence of the sympathetic nerve. Though I think that all of the various symptoms that occured me after ets reversal surgery, for example, sudden tears, panics, tooth nerve pain, white vision, dizziness, and so on, are caused by sympathetic disorder, it seems no contradiction to think this strong drowsiness as the same. and I know that this disturbing drowsiness would be temporary as these symptoms have all gone now.

In addition, I have never heard of these symptoms from other people who took this ets reversal surgery. Some people have the feeling that nerve flows or ripples, but as far as I know, I am the only one who has had these transient disorder.
I don't think this as a big issue because I think it's a process of recovery after the reversal surgery. However, there are many other people besides me who got the merits of this surgery. In this point, I don't know why...

I feel a little more refresh in my head recently, and that my mental condition has also improved slightly.

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Back to English articles

眠気とメラトニンとリバーサル手術

▶ English

先日リバーサル手術を受けた後、強烈な眠気に襲われることがあるってことを書きました。
それについて少し調べたことをまとめます。

眠気を誘発するホルモンはメラトニン

• メラトニンは副交感神経を優位にさせるホルモンで、主に夕方～明け方にかけて多く分泌される。脳にある松果体という組織で生成され、血流に乗り体中に運ばれる。
• メラトニン合成の上昇は、松果体に入力する交感神経終末からのノルアドレナリンの放出が引き金となり開始する。
• メラトニンが脈拍・体温・血圧などを低下させることで睡眠の準備が出来たと体が認識し、睡眠に向かわせる作用がある。

私の眠気はこのメラトニンの過剰分泌が起きて発生していると考えるとつじつまが合います。
というのも、上の箇条書きの２個目の所に交感神経の影響を受けてメラトニン合成の上昇が開始されると書かれています。私がリバーサル手術を受けてから起きたいろんな症状（例えば、涙が急にぼろぼろ出たり、パニックが起きたり、一過性の歯の神経の痛みがあったり、視界が真っ白になったり、めまいがおきたり、・・・といったこと）も全て交感神経の乱れから起きていると考えているのですが、この眠気もそれと同種のものということと考えても、だいたい合点が行くからです。それら症状は今はもう全て治まっているので、この強烈な眠気も一過性だろうということは分かっています。

気になることは、こういった症状について、リバーサル手術を受けた他の人達から聞いたことが全く無いことです。神経が流れる感触だったりざわつく感触だったりといった神経の違和感までは私と同種の感触だったり私とはまた別の感触を持ってる人は何人もいるのですが、神経系の異常ともとれるこれらの症状は、知り得る限り私しかいないです。。
私はリバーサル手術後の回復の一過程と考えているから大きな問題とは考えていないのですが、じゃあ私以外は回復を感じてないのかというとそうでもないようですし、正しい所は分かんないです。

最近頭のスッキリした感触があって、メンタル的な調子もまた少し良くなった気がします。

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参考URL：
メラトニン - 脳科学辞典
メラトニン - Wikipedia
松果体 - Wikipedia

Why did I get extreme sleepy after ETS reversal surgery?

▶ Japanese

The temperature in Japan suddenly rose from yesterday, and I had a strong drowsiness during the daytime today as well as yesterday.
It is so strong that it would interfere with my daily life.

What evokes this awful drowsiness? . .

Generally speaking, sleepiness occurs when the parasympathetic nerve is dominant, which anyway doesn't seem to apply to my situation.

After ETS surgery, I could not sleep well and became early awake at dawn during the summer. I think that I had become wide-awake during the day because I felt dizzy from my hotter head because of no sweat. It's almost 20 years ago, so it's difficult to evaluate correctly. .

After ETS reversal surgery, I began to feel a strong sense of nerve flowing, and I began to feel intense drowsiness during the day in summer. I was in that situation for several years, but I don't clearly remember when to when. And that hasn't happened in the last few years, but it has recurred since last year.

I have reconnected both right and left sympathetic nerves by ETS reversal surgery, but I feel that my recovery process between the left and the right are very different. The process on the left side is already over, and the right is in process, so current situation(of course, the sense of nerve flowing and extreme drowsiness) occurs to me.

It means that the feeling of nerves flowing through reconnecting the sympathetic chain causes a strong drowsiness. so I think that parasympathetic dominance is irrelevant in this point.

Anyone have an idea about this?


May. 8. 2020 Update
I did some research on drowsiness, so I wrote this.
→ Relation between Drowsiness, Melatonin and ETS reversal surgery

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Back to English articles

どうしてリバーサル手術を受けた後で眠気に襲われるようになったのか？

▶ English

昨日からいきなり気温が上がり、今日も昨日に引き続き昼間ずっと強烈な眠気に襲われてました。
生活に支障があるレベルの睡魔です。

どうして眠気が出るんでしょう。。。

一般に眠気が起きるのは副交感神経が優位になっている時って言いますが、それだけだとどう考えても私の状況に当てはまらないのです。

ETS手術を受けた後、夏の間は熟睡できず明け方にはもう目が覚めてしまうようになりました。昼間は頭がほてるようになってしまったこともあってか、昼間眠くはならなかった気がします。もう２０年近く前になってしまうので、正しく評価するのが難しいですが。。

リバーサル手術を受けた後、神経の流れる感触を強く感じるようになって、暑い季節に昼間強烈な眠気に襲われるようになりました。数年の間はそういう状態だった気がするけどいつ頃からいつ頃までだったかとかははっきり覚えてないです。ここ数年はそういうことは無かったのですが、去年から再発しました。

私はリバーサル手術で左右両方をそれぞれ神経移植でつないでいるのですが、左側の回復のプロセスと右側の回復のプロセスが大きく異なっています。既に左側のプロセスは終わっていて、今右側のプロセスの最中のために今の事象（神経の流れる感触および睡魔）が起きていると感じています。

交感神経をつなぎ直していて、その箇所を通じた神経の流れる感触で強い眠気が出るということなのです。ここでは副交感神経の優位性は無関係だと思うのです。

このことについて何か分かる方いらっしゃったら教えていただけたらうれしいです。

2020.5.8 追記：
眠気のことについて少し調べたのでまとめました。
→ 眠気とメラトニンとリバーサル手術

代償性発汗が心配になる季節になりました

とうとうGWに突入しました。
私がはじめて代償性発汗を感じたのはETS手術を受けた翌GWの最中のことで、GW明けの通勤電車から一気に深刻になりました。それ以降も、（ひと夏でリバーサル手術を受けたけれども）毎年GWを境に代償性発汗が出ていたので、今でもGWになると「あぁ、代償性発汗の季節がやってきたな」って実感します。

今日は快晴で、近所の公園まで母を車椅子で押しながら散歩してきたのですが、日に当たっていた時、（汗が出るまではいかなかったものの）脇から汗が出そうなすぐ手前までなってました。車椅子を押しながら出歩くのは軽いとはいえ身体を動かしますから、今年はもうそろそろ汗が出るようになるかもしれないです。（去年はお花見しか車椅子での散歩はしなかったので。。）

１時間ほど陽にあたり、散歩から帰ってきてからなのですが、脇を通じた神経の流れる強い感触と共にものすごい眠気に襲われました。強烈な眠気は昼間だけじゃなく晩ご飯を食べた後の夜も続いていて、座ってパソコンしてたらいつのまにか意識が飛び飛びになってました。
過去にもこの「強烈な眠気」に襲われ続けたことはあって、これはリバーサル手術後の回復の過程と考えています。今は右側の神経がつながりつつある過程にいて、昼間陽にあたったことがトリガーとなって右脇を通じた交換神経が活発になって頭に流れ、それで起きているんじゃないかということです。そして過去の経験からすれば、また当分の間は悩まされそうな気がしています。。。

でも今私は親の介護を中心とした生活をしているので眠気に襲われても大丈夫です。この生活をしているうちに、この期間を乗り越えられればいいかなといった程度に考えています。