DrSclafani answers some questions

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

Gratitude

Postby SandyK » Sat Jun 12, 2010 5:15 pm

I would like to say thank you Dr. S for all the help and support you have given all of us. I just listened to you speak at the conference in Italy and I heard a man speaking to me with hope and compassion. You aren't my doctor nor have you ever been yet I have learned more from you than any other. Thank you. May I be fortunate enough to meet you some day. :)
Diagnosed 1994, Self EDSS is 6.5
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Postby drsclafani » Sun Jun 13, 2010 1:02 pm

CureOrBust wrote:Dr Scalfani, I truly hope this does not come across in any manner as appearing like "second guessing". Would you think a cutting balloon would possibly make a difference in a balloonings "staying" power? And if it didn't, would the use of a cutting balloon affect to any degree the option to stent in the very same location immediately after?


CBs generally cause a crease in the vessel which fatigues the inner lining and allows a larger easier venoplasty. they do not cut through the wall completely.

i would not stent anything immediately unless there was NO improvement. Balloons are indicated for clinical failures of angioplasty. did you all know that Dr Zamboni and his interventionalist roberto galleoti have NEVER needed a stent except in the azygous?
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Postby drsclafani » Sun Jun 13, 2010 1:03 pm

Cece wrote:CureorBust, they do inflate at lower pressures when using a cutting balloon compared to a regular one, so: good question!! Maybe? The advantage of the cutting balloon comes later, when it appears to have less restenosis.

Lower pressure and less force during dilation = more likely to close immediately?

i do not think so
but remember these cutting balloons were not designed for veins. so we do not know everything about their use
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Postby drsclafani » Sun Jun 13, 2010 1:04 pm

1eye wrote:Was he standing up when it collapsed? Sounds a bit like there was negative pressure. Hoses do not flatten on their own. Either you have to run over them with a tractor, or melt them in the hot sun, or something has to be sucking pretty hard on them. Newer hoses are less prone to flattening but once patent, positive pressure should not collapse them - just the reverse, I would think. Or am I missing something? That seems the most likely. Gravity?


oneye
do not know for sure what you are referring to, so cant comment
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Postby drsclafani » Sun Jun 13, 2010 1:09 pm

hope410 wrote:Have a great trip, Dr. S. I hope you return full of exciting ideas and a great sense of the wonderful prospects and possibilities ahead for you/us!


i was very energized and full of ideas. Will speak more later after answering all these questions
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Postby drsclafani » Sun Jun 13, 2010 1:16 pm

scorpion wrote:What is being murdered is science and common sense. Back to the general forum for me where logic still exists.


yes scorpion, sometimes emotions must be vented. Come back and ask a question
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Postby drsclafani » Sun Jun 13, 2010 1:19 pm

Zeureka wrote:
NZer1 wrote:Once again, we in the MS community have reason to celebrate the amazing genius of Professor Roy Laver Swank.


http://www.takingcontrolofmultiplescler ... icleID=117

That's very intersting to hear, NZ ! In fact Swank is in my view another heroe that should have had a noble prize - and I'm on the Swank diet since diagnosis.

And where's the question to Dr Sclafani? Ah, yes, maybe to ask what do you think about this Swank diet?


i stuck my foot in this once. I learn from my mistakes. I am a plumber not a chef

I do not want to bother anyone by my opinion.
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Postby drsclafani » Sun Jun 13, 2010 1:24 pm

garyak wrote:One of the neurologists I have seen for my M.S. told me last week that " one of the big holes in Dr. Zamboni's theory is in regards to the source of iron found in MS brains". This neurologist claims ( through his own research ) that " increased iron in the MS brain is an accumulation ( for some reason ) of iron normally found in the brain and is different than iron that would be found there if it's source was reflux of blood from jugular veins".
Now, does anyone know what this difference might be?
I had so many questions for him I forgot to get him to clarify what he felt was different .


Hi garyak,
There are some on this forum (and elsewhere) that believe that iron loading in the body may have something to do with hemochromatosis &/or iron loading anaemia. Ck out the "phlebotomy anyone?" & "iron metabolism panels should be first" threads. There is also lots of info on the hemochromatosis.org & ironloading.org sites. This intrigues me a little for reasons I won't bore you with! But have a look - maybe your doc might have an interest in some of this??
I used to live near GP, in fact I saw an optometrist in GP...


Dr S. any thoughts here?


the theory is that venous insufficiency results in loosening of tight juctions between the endothelial cells (inner lining cells) that lead to leakage of red blood cells into the brain. red blood cells are full of iron (hemoglobin). the hemoglobin breaks down into hemodiserin and then breaks down further into iron

there are other causes of iron in the brain, but the pattern seen on SWI imaging suggests a venous origin of the iron
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Postby drsclafani » Sun Jun 13, 2010 1:28 pm

Stacemeh wrote:I don't know about iron types but here is something I wonder about:

Hemolysis can occur when normal red cells are exposed to turbulent blood flow in large vessels, an example of which includes tramatic disruption (sounds like reflux to me) of red cells in heart disease.

Hemolysis = rupture of erythrocytes (red blood cells) with release of hemoglobin into the plasma (the fluid portion of blood).

What I wonder is if refluxed blood (due to venous stenosis) is sometimes releasing a bit of hemoglobin and that free hemoglobin is "sticking" to the vessel walls and over years (perhaps in a vicarious luxuriant fashion :) ) this hemoglobin is accumulating and breaking down leaving iron behind.

From past experience in Vet practice I happen to know that heme staining leave a kinda redish tint, not unlike that in pictures I've seen of MS lesions.

So, I wonder if this might explain the discoloration seen on the plaques formed in MS and if it might also explain why red cells have not been found by pathologists in MS lesions.

But I am not a doctor, I can only speculate.


i am a doctor and i often speculate. Not everything is proven and after being proven some facts get unproven.

it is a theory that red cells break down outside the vessel in the brain, then break down leaving hemoglobin that breaks down into elemental iron
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Postby drsclafani » Sun Jun 13, 2010 1:29 pm

JUST A THOUGHT. IF EVERYONE CAN HOLD OFF FOR A LITTLE WHILE FOR ME TO CATCH UP, IT MIGHT BE EASIER FOR ME.

HOLD OFF ON NEW QUESTIONS FOR THE MOMENT :D :) :( :o 8O :cry: :wink: :idea:
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Re: Interesting

Postby drsclafani » Sun Jun 13, 2010 1:34 pm

larmo wrote:I was watching the live feeds from the ROV's working on the oil spill. Whenever the picture was obscured (with oil flow, etc.) they would switch to another format to get a better picture. I think they tried the red, green & blue filters along with infrared. I see weapon/troop testing where they use an infrared camera also with excellent results.

I wonder if something as simple as this would be helpful with different types of imaging to show stuff you wouldn't normally see - that would be more helpful in a diagnosis.

I'm just trying to think outside the box. Any thoughts or comments would be welcome.


infrared has been used but it is a superficial type of imaging. i am no expert but i do not see how it would help here.
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Postby drsclafani » Sun Jun 13, 2010 1:38 pm

dlb wrote:Larmo,
I went to the info session that Dr. Zivadinov & Dr. Weinstock-Guttman presented at in Calgary. They described the testing that they do (in laymen's terms) and showed videos & slides of patients with MS as well as normal controls. Can't remember the name of the test but I think it was actually the doppler?? The flow of blood was shown in colors, so that you could clearly see when the blood was refluxing. Is this kind of what you are speaking of?


dlb
in doppler ultrasound color is used to represent the DIRECTION of flow. generally red and blue are used. which direction is red and blue is variable dpeending on how you hold the probe. suffice it to say, arteries go away from the heart and veins goes toward the heart.......so the key finding is not the color but that the color in the vein is normally the opposite of the artery. when the color is the same it means that both artery and vein are in the same direction and thus abnormal this is seen in two of the five signs of ccsvi on doppler ultrasound.
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Postby drsclafani » Sun Jun 13, 2010 1:40 pm

larmo wrote:
1eye wrote:
I'm just trying to think outside the box. Any thoughts or comments would be welcome.


Quite right, Larmo. Not to be morbid but maybe more post-mortem stuff is appllicable. The police use great tools, and for this they might use an ALS. Because human eyes don't see some other wavelengths too.


dlb, this is more along the lines I was thinking about. Something that can't be seen with the naked eye in the spectrum's that we humans can see.


that is mostly what we imagers do: look for ways energies traverse through and reflect away from tissues using ultrasound, xray , magnets, infrared, heat, etc
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Postby drsclafani » Sun Jun 13, 2010 1:45 pm

mshusband wrote:Today is a BIG day. I'm sure Dr. Sclafani has computer access ... but he also needs to focus on studying ... and (though I don't want to speak for him in any way) he doesn't want to give us hope and the IRB not respond in the way he seems to think they will (approval) today.

He has said there are 2 scenarios where the treatment will be allowed to start immediately, 1 scenario where treatment will be pushed month-to-month until approval, and 1 scenario where the IRB outright rejects CCSVI.

Let's not forget Dr. Sclafani is a researcher, author of papers, author of textbooks, getting him involved in CCSVI will change text books one day ... maybe we should all go out and read his resume today ... this is a great man who knows what he is talking about.

I hope we hear something soon ...


i will have to wait until i return to work for find out where we stand.
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Postby drsclafani » Sun Jun 13, 2010 1:47 pm

newlywed4ever wrote:In my mind, I envision Holly and Dr S having a space-age office whereas when they get IRB approval TODAY, all they have to do is push a big green button and the ball starts rolling :D


actually my office is a cross between the flintstones and the jetsons

yabadabado
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