DrSclafani answers some questions

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

Postby Drury » Fri Aug 20, 2010 2:17 pm

No Doctor Sclafani!!!!!

I think I am going into withdrawal !!!!!!!!!!

Have a well deserved break and thanks goodness there are no phones, electricity, etc. PEACE AT LAST.

Now those deep discussions - hmmmmmmmmmm!

Drury
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Postby Cece » Fri Aug 20, 2010 9:45 pm

Have you had time to give any thought to the atlas, the registry, or the ivus paper?

Hope all the vacationing is as fun as it sounds!

Somebody here reported that she went to see an IR, who I am assuming hadn't heard about CCSVI except from her, and the doc came in excitedly with a copy of Endovascular Today in his hands! And another patient, when looking for something to bring in to yet another inexperienced new doc, came up with your paper as the thing to bring. Thank you for getting this out there.
"However, the truth in science ultimately emerges, although sometimes it takes a very long time," Arthur Silverstein, Autoimmunity: A History of the Early Struggle for Recognition
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Re: Statins and ms

Postby drsclafani » Fri Aug 20, 2010 10:31 pm

Rogerp117 wrote:Dr.,

Thank you for answering my query so quickly. The two studies that I have found regarding Statins and ms, the first at UC Berkeley, the second, at the medical University of South Carolina, were both small studies . But, they both showed significant, 33% and 41% respectively, reductions in relapses compared to controls. I would venture that this is a more significant reduction in relapse rates than any other currently approved ms drug. Quite a coincidence. I would also note that the absence of evidence linking cholesterol in the veins is very different from evidence refuting such a link.

My intent in bringing this up is to plant a seed of an idea regarding possible study of the use of Statins, or other cholesterol reducing agents - IE niacin, as a possible after liberation treatment therapy for reducing RE stenosis.

Forgive me if I'm out of line.

Roger


thanks roger. that is food for thought.

and asking questions is the reason i am here. so ask away.....you are not out of line...in fact i think people with MS are able to think and contribute to the dialogue wuite well
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Postby drsclafani » Fri Aug 20, 2010 10:31 pm

suzq77 wrote:Does anyone know who I can contact to get videos from the fundraiser to share with my IR?

I sent him a youtube link that has a privacy block on it now...

thanks!


that will have to go to dr haacke
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Postby drsclafani » Fri Aug 20, 2010 10:35 pm

Cece wrote:
welshman wrote:You may well have already answered or opined on this, in which case CeCe will be able to give me the info (thanks in advance CeCe :) )

:oops: :)


To be thoroughly thorough, here is what DrS said a few weeks ago:
drsclafani wrote:
Cece wrote:
PCakes wrote:The azygos vein has not been investigated because, according to the physician, the azygos can not suffer from stenosis if the jugulars are normal.

8O


That is incorrect. the azygous can suffer from malformation in the presence of normal jugulars. however it is thought that two venous outflow obstructions are necessary in order to have problems


yes, i feel comfortable with that statement of mine.
le
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Postby drsclafani » Fri Aug 20, 2010 10:37 pm

Cece wrote:
welshman wrote:You may well have already answered or opined on this, in which case CeCe will be able to give me the info (thanks in advance CeCe :) )

:oops: :)
I believe his response to a similar question was that you can have a normal IJV and an abnormal azygous, one does not preclude the other. But that you do need 2 out of 5 of Zamboni's criteria and that this is not possible without involvement outside of the azygous IIRC.


lets not get things mixed up here. Zamboni criteria are signs of hemodynamic alteration that is consistent with CCSVI. It is not the same as azygos vs jugular etc.
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Postby drsclafani » Fri Aug 20, 2010 10:39 pm

fogdweller wrote:
drsclafani wrote:
Cece wrote:
PCakes wrote:The azygos vein has not been investigated because, according to the physician, the azygos can not suffer from stenosis if the jugulars are normal.

8O


That is incorrect. the azygous can suffer from malformation in the presence of normal jugulars. however it is thought that two venous outflow obstructions are necessary in order to have problems


If reflux is essentially creating the problem, wouldn't a single refluxing vein create problems? Is it possible to have reflux with a single stenosis? Maybe some of us who have had very mild and very slowly progressing disease have only a single obstruction?

We have so much to learn about this condition and there seem to be so many obstructions to moving forward with research.[/quote]

yes, i stand by my statement: we are in an age of discovery.

i think that one of the three major veins obstructed plus an outflow problem like the lumbar veins, may thurner sydrome and other obstructions that force the blood to find alternative vicarious pathways can cause problems.
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Re: one or two?

Postby drsclafani » Fri Aug 20, 2010 10:41 pm

hwebb wrote:Hi Fogdweller,

thought I'd chip in with my personal experience. When I had my initial venogram, I was diagnosed with two areas of stenosis (pencil stenosis in left jugular, and stenosis in azygos).

The first procedure successfully treated my azygos. A number of symptoms stopped (in particular, my hands/arms no longer went dead when I slept, and I know longer woke through the night with nausea...which could only be relieved by sitting up in bed). My jugular rapidly restenosed, and I continued to have many MS symptoms (specifically brain-fog, short-term memory problems, fatigue, and MS relapses).

I have had the jugular treated a second time, and this has addressed the brain fog, memory problems, fatigue and regular relapses (for the time being at least).

It seems many people are in a similar position, one of their treated areas restenoses, and they redevelop symptoms. Thus - I am of the opinion that you can still suffer from MS with only one stenosis.


i remind you that we are not treating ms. we are treating obstructed veins that restrict venous outflow
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Re: NIVL

Postby drsclafani » Fri Aug 20, 2010 10:45 pm

Nunzio wrote:
drsclafani wrote:
Nunzio wrote:Now a question: do you need to have the renal vein restricted for May-Thurner to affect the Azygous vein?
Thanks for your dedication.


i think that they are additive. what do you think?

Yes they are definitely additive or even synergistic, but if the iliac vein collaterals drain into the renal vein directly or through the connection between the renal vein and the lumbar vein, than the flow would return to the IVC and not affect the azygous flow unless the renal vein was also stenosed.
I noticed in the Zamboni paper that 4.6% of patient had the iliac vein dilated and 4.6% had the renal vein dilated.
I was wondering if those were the same patients.
Obviously the venography will tell you which way the blood is flowing.


there are so many variants regarding drainage. Thus sometimes there is lumbar vein hypoplasia or the renal vein is multiple, blood then traverses toward the heart however it needs to be done.
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Postby drsclafani » Fri Aug 20, 2010 10:48 pm

Nunzio wrote:
fogdweller wrote:
drsclafani wrote:
Cece wrote:
PCakes wrote:The azygos vein has not been investigated because, according to the physician, the azygos can not suffer from stenosis if the jugulars are normal.

8O


That is incorrect. the azygous can suffer from malformation in the presence of normal jugulars. however it is thought that two venous outflow obstructions are necessary in order to have problems


If reflux is essentially creating the problem, wouldn't a single refluxing vein create problems? Is it possible to have reflux with a single stenosis? Maybe some of us who have had very mild and very slowly progressing disease have only a single obstruction?

We have so much to learn about this condition and there seem to be so many obstructions to moving forward with research.

In fact this is Zamboni type D pattern present in 18% of MS patients and 75% of PPMS. 50% could have an associated obstruction in the IJV but that leave 9% of MS patients with a purely Azygous obstruction.


nunzio
i relooked at his drawinsg of his classification. you can see he illustrated lumbar vein hypoplasia very clearly in associations with type 4
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Postby drsclafani » Fri Aug 20, 2010 10:54 pm

Drury wrote:Dr. S,

Forgive me if this is a stupid question.

If the veins bulge as you said when you scream etc., is it possible that when very stressed they might also bulge? Point is stress is thought to be a common cause of MS flare-up so could stress play a part in blood flow which in turn could cause flare-up? Hope that makes sense.

Drury


i am surprised that cece did not already kick this saying in: the only stupid question is the one that is not asked

if you express your stress by screaming, then i suppose. But i cannot see the connection per say. Not to say that stress does not affect ms, it is just that its not probably the reason for ccsvi
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Postby drsclafani » Fri Aug 20, 2010 10:57 pm

Cece wrote:
fogdweller wrote:Is it possible to have reflux with a single stenosis? Maybe some of us who have had very mild and very slowly progressing disease have only a single obstruction?

If you only have one stenosis, you might have the reflux but I don't think you'd have the overall slow flow.

And without the slow flow, you wouldn't have the hypoxia. Without hypoxia, no MS?

Or with the reflux, you'd have endothelium weakening near the reflux but not everywhere else. Maybe when there are two stenoses, the slow flow contributes to weakening of the endothelium more overall?

Dr. Sclafani, will you be saying 'good-bye' (zai jien) before you head off to China? Or will we just at some point notice we are talking to ourselves? :)


cece you will be talking to yourself after i answer the last question i can. i will not be reachable except by a bear ,i guess) for the next week
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Postby drsclafani » Fri Aug 20, 2010 10:59 pm

1eye wrote:Maybe it has been asked and answered, and I should probably get better at using that index, but are venous thromboses more common than arterial? after this type of operation? with/without stents?
Early thrombosis can be avoided in most situation by anticoagulation after the procedure. Once veins start to clot, they are more difficult to keep open

stents are foreign materials so they can thrombose if one is not careful.
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Postby drsclafani » Fri Aug 20, 2010 11:07 pm

L wrote:An IR who performs two separate interventions, one for each jugular vein, was mentioned earlier in the thread. I just spoke to a spokesman for the privatescan clinic in Dusseldorf, it is Dr Beythian who does this (he works with Dr Kraus.) The rationale behind it is to avoid the unlikely event of both veins collapsing he said.


i still think this is nonesense. I have been told that dr mehta does the same thing.
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Postby drsclafani » Fri Aug 20, 2010 11:09 pm

1eye wrote:
fogdweller wrote:...with the reflux, you'd have endothelium weakening near the reflux but not everywhere else. Maybe when there are two stenoses, the slow flow contributes to weakening of the endothelium more overall?

...there is definitely some kind of inflamatory/immune reaction going on, and if you weaken the endothelium you let in inappropriate immune cells over the compromised blood brain barrier. Even if only one weakend spot, this seems to me to be problematic.


Foist of all, I don't understand as I haven't watched enough Gray's Anatomy.

How does reflux weaken the endothelium (or other Latin word to that effect)? Are we talking ballooning here?

Second how many veins drain the poetic brain? I have heard of internal jugulars, external jugulars, and vertebrals, as well as a lot of collaterals. I count 6.


1I:
actually there are four, the externals do not contribute very much except in obstruction. there are also venous plexuses that provide drainage but they also cause problems
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