DrSclafani answers some questions

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

Postby drsclafani » Mon Nov 29, 2010 10:22 pm

fogdweller wrote:
dania wrote:Dr Sclafani is there any way of preventing Intimal Hyperplasia? I have had the procedure done twice, Got some great improvements that disappeared after 1 week. With the third attempt all 3 veins are now 100% blocked. It seems usless to keep trying without addressing this problem first.


Dr. S., this is concerning. It seems to suggest that angioplasty might triggers hyperplasia which might totally clog up the veins.

I, too had improvements for a short time, 3 days or so, that faded. I am probably not worse now, but certainly not better. I had reason to believe that I had restenosed fairly quickly, perhaps with thrombosis ( does that happen?

yes, thrombosis can occur, especially without anticoagulation for protection in the short term. i think however, that elastic recoil is more likely. elastic recoili is the same as stretching a rubber band and then it recoils and forms its own size and shape.

Does thrombosis cause long term restenosis of sorts?). Is it possible that retreatment makes the problem worse?


thrombosis may cause complete obstruction of the vein.the body not only trys to clot, it tries to dissolve. So there are naturally occuring lytic agents that dissolve clot ad this disolved channel can become the interior of the vessel.
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Postby drsclafani » Mon Nov 29, 2010 10:23 pm

dania wrote:
fogdweller wrote:
dania wrote:Dr Sclafani is there any way of preventing Intimal Hyperplasia? I have had the procedure done twice, Got some great improvements that disappeared after 1 week. With the third attempt all 3 veins are now 100% blocked. It seems usless to keep trying without addressing this problem first.


Dr. S., this is concerning. It seems to suggest that angioplasty might triggers hyperplasia which might totally clog up the veins.

I, too had improvements for a short time, 3 days or so, that faded. I am probably not worse now, but certainly not better. I had reason to believe that I had restenosed fairly quickly, perhaps with thrombosis ( does that happen? Does thrombosis cause long term restenosis of sorts?). Is it possible that retreatment makes the problem worse?

I developed clots in the 1 stent I had but the other 2 veins had only been angioplastied and there were no clots in those 2. But they were now closed completely.


dania
one has to wonder whether clot in all three
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Postby drsclafani » Mon Nov 29, 2010 10:26 pm

mlrm wrote:Dear Sal,

Thanks for your reply! It was a great help for me on my trip to Poland!

It was a very though trip but my veins are open, so thats great:-)

If you are interested in reading my story you can go to my webpage:

mariesflowoflife.dk

PLEASE come to Denmark soon! I hear that you have a good friend in the danish hospital Rigshospitalet. Can't you guys put your heads together on how to convince the stiff neurologists of our country? You are greatly needed!

And you can stay with us if you like -no cost;-)

Sincerely

Marie Louise


marie louise
i looked at your site. it radiates your charm, grace and inner beauty (except for those ugly veins!)
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Postby drsclafani » Mon Nov 29, 2010 10:30 pm

Algis wrote:Doctor: another quick question, if I may:

Could stenoses be dynamics? I mean be there in some circumstances (position, muscle pressure, even metabolic, or...?) and absent in others. With time they could evolute in "permanent" stenoses.
This and the endothelial health of the veins would regulate the onset, RR, SP and so on of the MS.

Thinking loud and brain's boiling; I need a cold beer :D


have one on me algis.
a brooklyn lager or brooklyn pennant ale would hit the spot

i think all stenoses are dynamic. whether there is intimal hyperplasia, elastic recoil or stuck valves, the problems are not eradicated that simply.
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Re: Azygous Vein

Postby drsclafani » Mon Nov 29, 2010 10:33 pm

Opera wrote:Dear Dr Sclafani,
My very sincere thanks for starting a network of clinics for CCSVI treatment.

I have a question with no one who can provide an answer. I hope you can help me.

I underwent ballon angioplasty for bilateral jugular stenosis with no improvements to symptoms. At that time, I was told that my azygous vein is normal with a pressure of 12 mm. In the superior azygous vein the pressure was 9 mm.

I was surprised that my azygous was normal because an MRI of the Cervical Spine showed demyelination plaques at C 2/3, C5, C6 and T2/3.

My understanding is that there are lesions in the spinal cord only if there are problems with the azygous vein.

I would appreciate any feedback you can give me on this issue.

Thank you for everything you are doing for us and kind regards.


i think that the flow is redirected in all cases when more than one vein is abnormal.
I do not think that spinal leasions indicates azygos disease only. one can also have other problems such as vertebral vein stenoses, lumbar vein hypoplasia to name just two. moreover i wonder whether all patients with the clinical scenario of ms, have ccsvi .

sorry i dont have a great answer for you
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Postby drsclafani » Mon Nov 29, 2010 10:37 pm

Cece wrote:Important links, for safe-keeping:

Dr. Sclafani's Happy Thanksgiving announcement that he will be treating full time in January:
http://www.thisisms.com/ftopicp-143965.html#143965

Michelle's announcement on the nationwide network of clinics:
http://www.thisisms.com/ftopicp-143967.html#143967

Holly's announcement on the waiting list application:
http://www.thisisms.com/ftopicp-144029.html#144029

fogdweller wrote:Thank-you, Cece. As always, very helpful. I guess the answer is yes. The original stenosis is probably structural, maybe congential formation. After angioplasty the patient (me) may experience hyperplasia, which could result in a stenosis worse than the original structural blockage. bummer. Makes follow-up even more important, and as yet I have had no luck in getting that and it has been almost 2 months. I am still trying to get an itemized bill out of Pacific Interventionalists so I can bill my insurance company. I guess once they got payment, I wasn't much of a priority.

Okay that makes me :evil: , you still haven't been re-checked.

As I understand it, you've been turned away for follow-up from your original clinic and turned away by at least one other clinic because they don't want to treat someone who was treated elsewhere.

Dr. Sclafani, one of your AAC sites is in California, as is fogdweller. Do they have rules against seeing someone who was treated elsewhere? Fogdweller, would you travel within California if you could get in?

the site in california was up and running while i was still on the sideline. we are just beginning. we expect to have our first face to face meeting together in january. this will be a long term project.
I cannot speak for my colleagues, but fogdweller should give them a call at the del mar vein center

Have you been on any anticoagulation at all since the procedure? If I'm remembering right, was it aspirin only? If a clot becomes permanent in three months, you're at two months post-procedure. I don't mean to say you have a clot, but if it hasn't been checked, it hasn't been ruled out.

(Dr. Sclafani, does a clot becomes permanent in three months? I'm not actually sure about that.)[/quote]
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Postby drsclafani » Mon Nov 29, 2010 10:39 pm

(Dr. Sclafani, does a clot becomes permanent in three months? I'm not actually sure about that.)


clots become permanent fairly early. they can partially dissolve and contract leaving an irregular lumen where blood can flow, we call this recanalization.but many times the vessel just shrivels up and dies.
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Postby drsclafani » Mon Nov 29, 2010 10:40 pm

belsadie wrote:Dr. S. I had angioplasty in Aug. two jugs and azygos ballooned and remain patent after 3 months [acc. to an ultrasound of jugs., the azygos not visualized] However, two Zamboni criteria are positive, still. Will you discuss this kind of situation with an appointment to review all the results? What's your advice?
Happy Holidays! :roll: :?: :roll: :?:


1. was it an expert ultrasound?
2. which two findings were positive
3. i might look forward to the six month followup to see whatsup
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Postby drsclafani » Mon Nov 29, 2010 10:47 pm

HappyPoet wrote:CONGRATULATIONS
400,000 VIEWS ! ! !


Dear Dr. Sclafani,

Wishing you the best of success doesn't seem like nearly enough for all you've done for so many people. You stuck with us through thick and thin, and I'm sure you never thought you'd face the challenges and frustrations that define CCSVI.

We would have understood if you had stopped posting at anytime; after all, Internet message boards are not always the most hospitable of places. Yet, you stayed and created a safe haven filled with interactive learning for everyone. You ease our fears by answering question after question after question... thousands of our questions.

You changed your life for us when your retirement and the "good life" were just around the corner waiting for you. Only a very compassionate and deeply committed person could start off on this new, unchartered path that's guaranteed to be full of complex problems and many unknowns. Perhaps you will never be able to retire because now that we have you, we will not let go of you easily.

Your posts are like beacons of light (usually appearing in the middle of the night when you should be sleeping) that guide everyone through the foreign land of CCSVI. Every one of the 400,000 views on "drsclafani answers some questions" represents a gift, a priceless gift of knowledge, hope, and friendship from you to each of us.

How can we ever repay you for everything you've given us, Dr. Sclafani?
.


very touching happy poet

i would be repaid in full if we could all dance an evening away on a cruise around manhattan island with a stop in front of miss liberty to share a liberation jig and a liberation jug
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Postby Johnson » Tue Nov 30, 2010 12:25 am

Dear Dr. Sclafani,

I had my second procedure in Poland at he beginning of October. (~ 8 weeks ago) I had not too much benefit, but about 10 days ago, started feeling pain in LIJV (where the more aggressive ballooning took place). The pain is a warm, bruised feeling that seems aggravated when sleeping on my left side + point tenderness. There is no visual indication (swelling, redness, etc.)

I went to ER with the concern that I might be clotting. Full blood panel - d-Dimer, creatinine, etc., and a bedside ultrasound was done - "no evidence of a clot". Three days later, I was recalled for a more intensive Doppler US, which also revealed no clotting (there was an MD consultation with a vascular surgeon too). Do you feel (as) confident (as you can be from afar), that any clotting would reveal itself with such an investigation? The pain has subsided significantly since, I just get hung up on the 3 month window, and the idea that my jug might become irreversibly occluded.

Thank you for any insight that you might have. (I do have a disc of the Doppler US exam, if that would be informative in any way.)
My name is not really Johnson. MSed up since 1993
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Postby fogdweller » Tue Nov 30, 2010 11:18 am

drsclafani wrote:Have you been on any anticoagulation at all since the procedure? If I'm remembering right, was it aspirin only? If a clot becomes permanent in three months, you're at two months post-procedure. I don't mean to say you have a clot, but if it hasn't been checked, it hasn't been ruled out.
]


No, not even aspirin. The only post procedure instructions I got was to keep the bandage dry.

How is the best way to rule out a clot? Can any doppler center check this out, and could Dr. Harris in Del Mar order that for me in Northern CA?
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Postby Cece » Tue Nov 30, 2010 11:48 am

fogdweller, what's attributed to drsclafani there was actually something I'd written. :oops:

It's reassuring that he thought elastic recoil was more likely.
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Postby drsclafani » Tue Nov 30, 2010 2:29 pm

Johnson wrote:Dear Dr. Sclafani,

I had my second procedure in Poland at he beginning of October. (~ 8 weeks ago) I had not too much benefit, but about 10 days ago, started feeling pain in LIJV (where the more aggressive ballooning took place). The pain is a warm, bruised feeling that seems aggravated when sleeping on my left side + point tenderness. There is no visual indication (swelling, redness, etc.)

I went to ER with the concern that I might be clotting. Full blood panel - d-Dimer, creatinine, etc., and a bedside ultrasound was done - "no evidence of a clot". Three days later, I was recalled for a more intensive Doppler US, which also revealed no clotting (there was an MD consultation with a vascular surgeon too). Do you feel (as) confident (as you can be from afar), that any clotting would reveal itself with such an investigation? The pain has subsided significantly since, I just get hung up on the 3 month window, and the idea that my jug might become irreversibly occluded.

Thank you for any insight that you might have. (I do have a disc of the Doppler US exam, if that would be informative in any way.)


its an interesting question: what causes the pain. there is stretching of the tissue, the vein and the tissue surrounding the vein. that stretching can cause injury to any of that tissue, in the absence of rupture or thrombosis.
i am confident that two ultrasound examinations that do not show thrombosis are indicative that there is no thrombosis at that time. i am not saying that thrombosis cannot occur, just that thrombosis has not happened.
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Postby drsclafani » Tue Nov 30, 2010 2:33 pm

fogdweller wrote:
drsclafani wrote:Have you been on any anticoagulation at all since the procedure? If I'm remembering right, was it aspirin only? If a clot becomes permanent in three months, you're at two months post-procedure. I don't mean to say you have a clot, but if it hasn't been checked, it hasn't been ruled out.
]


No, not even aspirin. The only post procedure instructions I got was to keep the bandage dry.

How is the best way to rule out a clot? Can any doppler center check this out, and could Dr. Harris in Del Mar order that for me in Northern CA?

Ultrasound with compression is the best way to look for thrombosis of the vein.
i dont want to answer for dr harris. Ask him
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Postby drsclafani » Tue Nov 30, 2010 2:35 pm

Cece wrote:fogdweller, what's attributed to drsclafani there was actually something I'd written. :oops:

It's reassuring that he thought elastic recoil was more likely.

its reassuring that cece cleared that up! :wink:
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