Nihao, welcome back, how was your trip? You have missed exciting things....
* Dr. Hubbard found & treated CCSVI in a Parkinson's patient! What does it mean, we do not know.
* The SIRS find-a-doctor website has added 'Endovascular treatment/CCSVI in MS' to its searchable list of areas of expertise.
vivavie wrote:drsclafani wrote:vivavie wrote:Hello DrS, I finally got my stent unblock (candy wrap stenosis) AND:
70% left jug stenosis: balloon twice 8/10X40mm
50% right jug: balloon 3X (8/10/12X40 mm)
both in the area of prior radiation+ curietherapy and neck dissection from previous tongue cancer.
can you tell us whether your MS symptoms started before or after the radical neck surgery. If you and the group may recall, one of the arguments brought up to refute ccsvi is that patients with neck cancers have both their jugular veins tied off during surgery and they do not develop any symptoms. However it is known that sometimes these patients develop symptoms such as headaches, cog fog, balance problems and fatigue too.
Please let us knowHe ALSO found a kink/irregularity in my Azygos 8X40mm (not checked in Poland)
It cracked - it poped - it hurt. (He also check MT and lombar =fine)
I was this doc 1st, he was pretty thorough (2 1/2hr) and he felt he did an aggressive job. Nice, competent, entousiast IR.
I was sure this time I was Fully Liberated but NO! Nothing:Pain -fatigue- brain fog are the same. headache increase.
What eludes me is my stent is now clear, how come I don't have the previous improvements I had for 6 weeks (bladder, saliva, bowel, no headache, sleep)? During the 1st procedure they only found a faulty valva.
of course, i havent seen your pictures so it is hard to say much. but the diameter of the balloons used may have been too small. I cannot tell without knowing the measurements of your veins. While Dr sinan is moving toward 18 and 20 mm balloons, your doctor seems to have stayed on the side of smaller balloons, perhaps for safety.What should be my next step? Is it possible that the veins did not hold their new shape? How about balloon size? lenght? Would it be a good time to use cutting balloon because those veins must be hardened by radiation?
I am not ready to give up yet! help!
it is really difficult to answer you without seeing the picture. if your veins are narrowed by radiation, it is likely that stents will be needed. however, remember, i am just a bystander hearing about the work of another plumber
Tongue cancer was 5 years before ms. I was 30yo. Normally it is 60+ yo man who have smoke and DRINK all their life. That is probably why they never face CCVSI as complication for playing in their neck....
Yes, the Dr said my left jug was pretty small 6mm
How about stent stenosis while on Plavix?
Why did I not get my previous improvements back??
You already have all my CD from Poland and I shipped you this one yesterday with the details. Even the Doppler in July when I was told my veins were 100% NORMAL.
Did you wrestle with the bears or the Indians to be so tired after vacation?!?
I hope you enjoy your rice!
girlgeek33 wrote:Dr. S, can you talk about what issues can arise from a balloon breaking during angioplasty?
Do they design them to factor in this possibility?
Does this happen often? Rarely?
What should be watched for after a balloon has broken in a patient during angioplasty?
And what precautions can be taken to avoid any potential issues that a balloon break can cause?
Wow! Don't know if Ive ever had so many questions at once!
Rest now, enjoy being upside down! Look forward to hearing news from the trip...
Athena wrote:Dr. Sclafani,
1. How high up in the neck/ head /brain venous system can be assessed with US? with a real time venography?[Generally one can do ultrasound and doppler from the clavicle up to the mandible. so the upper quarter and the lower 1/6th are not well seen. but we are not looking at anatomy except in the lower vein near the clavicle. We are actually lookking at direction of flow. it is not uncommon to look at three spots on each vein on ultrasound in sitting and upright positions.
venography is an anatomical study that can see the dural sinuses in the skuil down to the junction of the jugular vein with the subclavian vein2. During venography, can one see reflux into the deep cerebral veins when dye is released high up in the internal jugular veins?
no one does not see the deep cerebral veins3. Could problems high up in the internal jugulars (i.e. my flat morphology of my right internal jugular at the level of C1) cause the reflux in the deep cerebral veins or is my problem more central in the brain??
of course, i can only generalize. i believe the flattening is relatively normal at the skull base in many patients. i do not think that reflux into the deep cerebral veins is caused by a problem in the brain4. What are your thoughts on treating with venoplasty high up in the jugular vein? How high up can the venoplasty balloon reach? What are the safely issues?
i do not want to dilate the high jugular vein before exploring the area of the valves. i believe that most high jugular narrowing is resolved by treating the low jugular problems.5. I have heard that some interventional radiologists have treated high up stenoses of the internal jugulars by ballooning lower in a safer part of the internal jugular, which appears to fix the problem higher up. Can you explain why this can improves blood flow in a narrowing above the part that was venoplastied? Could do so in layperson's terms as well as with fluid dynamics terms?
we havent discussed this in a while......
veins can distend greatly depending upon the amount of flow in them. if there is a low obstruction, the venous blood will seek an easier route of drainage, through collateral veins or through the vertebral veins. thus the jugular vein has little flow and collapses. in fact, while i sit here typing this email, my brains veins are draining through my vertebral vein and it is very likely that my upper jugular vein (as well as the rest of it) are collapsed. I am pleased that someone is not doing venoplasty on me at this minute!6. Do you believe that I should be assessed with a venogram?[quote/]
athena, there are many components that go into making a recommendation for a patient. the history of disease, the physical exam, the MRI, the ultrasound all play a role in advising a patient. it would be not be a wise decision for me to give advice to a particular patient.
however i believe that venography can identify things that are not seen on ultrasound. however it is slightly invasive and therefore ultrasound is the most cost effective method of screening. Dr. Zamboni showed that having more than one of the five ultrasound findings does not occur in a normal patient and thus would warrant venography.
Please, all your thoughts are welcomed. I appreciate you replying to this message.
Cece wrote:drsclafani wrote:i wanted to catch up here as much as possible because once i am in china everything will be upside down.
It must be easy to find CCSVI there, you just look for the people with purple faces....
Have a great vacation#2.
Johnson wrote:drsclafani wrote:kaboodah wrote:Dr. S,
Would blocked or very narrowed veins be the potential cause of high blood pressure? If so, how would someone have normal blood pressure but also have substantially blocked veins? Thanks!
i do not think that that narrowed veins results in hypertension
But could hypertension result in narrowing of veins? I am thinking more specifically about angiotensin. It is interesting that Putnam tried blood thinners. Of course there are different varieties of blood thinners, but what about angiotensin receptor inhibition? Could some of the benefits of the procedure be related to the blood thinners afterward; be it Fraxiparine, coumadin, what-not? I think that Fraxiparine is anti-thrombotic, which would indicate anti-fibrin? And back to collagen abnormalities in "MS".
I'm lost in thought in a deep fog.
NHE wrote:Here's a question... I have read that the thoracic pump effect operates on inhalation to create negative pressure in the thoracic cavity to help draw blood down through the cerebrospinal veins and vena cava. With this knowledge, I have tried a little experiment. When laying down, I will take several deep diaphragmatic breaths in an attempt to maximize my blood return through my jugular veins. I should state that I have not been tested yet for CCSVI. The result of the experimental breathing so far is that I typically feel a pressure in my ears and in my neck (the latter is hard to describe but it is similar to what I get when I walk a couple of blocks). Can you offer an explanation for this result? Is it a sign that I might have a stenosis of some sort or is it a normal effect? If someone has cerebrospinal stenosis, would this type of deliberate breathing create more reflux and ultimately have a negative impact?
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