marcstck wrote:
Dr. S, regarding Zamboni's very specialized sonogram protocols:
Since the abnormalities being found are far from subtle (malformed valves, anomalous membranes, mysterious septums, muscle bundles [good grief!] etc.) and the backflow of blood through the veins also being apparently quite out of the ordinary, shouldn't more generic procedures be able to detect these physical oddities?
Why does it take operators with highly specialized training using only very specific techniques to pick up signs of what amounts to gross venous dysfunction?
The knock against the recent German and Swedish studies that didn't find signs of venous reflux was that they weren't using the precise Zamboni protocols. Doesn't the fact that such precise protocols need to be followed throw up some question marks about the hypothesis?
This kind of reminds me of the MS researchers at Vanderbilt University who repeatedly (up until this day) find signs of chlamydia pneumonia in the serum and CSF of MS patients, when no other researchers or labs can replicate their claims.
Just playing devils advocate here, as you know that I'm a believer (I should be, with a big muscle bundle pinching my jugular closed), but I also believe in healthy skepticism. In a nutshell, shouldn't signs of CCSVI not require the arcane methods invented by Zamboni to detect them?
They
are quite out of the ordinary (these venous malformations), but they eluded detection for 150 years, so it is no surprise they were not straightforward to find. Doppler ultrasound is a screening tool, and one that may end up with its own specialized set of procedures for CCSVI testing. There is nothing arcane about it, rather it requires experience, since these malformations come in so many flavours.
They were not using the "Zamboni protocols", and limited themselves to screening only. If you decide you do not intend to treat CCSVI with venoplasty, firstly, you will never see the result of your screening 'live' on a fluoroscope screen, and secondly you will indeed find some false negative results, because of the azygous vein, operator error, etc.
That is why catheter venography is considered the gold standard. Until you do that I would not eliminate CCSVI, or May-Thurner's, or Budd-Chiari. Taking a course from Dr. Zamboni does not provide you with anything magical, mystical, or other-worldly. It provides you Dr. Zamboni's experiences with a very complex set of semi-random congenital malformations. There is nothing secret about it.
In fact I think the less uncommon this knowledge is, the easier and less expensive these procedures will be, and the better off everybody involved will be. The only question marks in these results are the conclusions. The denizens of this forum know, for instance, that the valsalva maneuver will invalidate your results. They know this not because of magickal initiation but because they have read public peer-reviewed documents.
Other researchers or labs can in a very straightforward manner replicate Dr. Zamboni's claims. They are doing this every day around the world. Just not in experiments looking to discredit. If you use a different recipe, the cake tastes different (sometimes more like a hotdog).
There have not been any generic procedures developed, partly because of FUD from what I call neigh-sayers. But they are in large part very generic. My local heart hospital does angioplasty almost on a production-line basis. Veins are different, I know, but not that different, and the procedures are done regularly elsewhere in the body.
The only thing specialized and hard to reproduce is the screening DUS. I would take whatever courses were offered, and buy the machine from the Italians, because they have been at this a while. Yes it is probably outside normal equipment and abilities, but big deal. Do we know everything there is to know about the human body, so Zamboni can teach us nothing? I think he and a lot of others, have results that say otherwise.
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