DrSclafani answers some questions

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

Postby IKES » Tue Nov 30, 2010 4:20 pm

I have MS and have been avidly following this board and the development of CCSVI treatment, its promise and the current realities of treatment. Although in time the vascular intervention equipment and techniques will evolve and become standardized, the problem of restenosis needs to be better understood and prevented.

In furtherance of this, I have attached 4 research articles that point the way to better medication regimens for the prevention of restenosis. In addition to current post angioplasty medications of aspirin, clopedigrol, or blood thinners I believe that pretreatment and prolonged use of an angiotensin receptor blocker (ARB) alone or in combination with an ACE inhibitor can significantly reduce the incidence and severity of restenosis.

What are your thoughts about this Dr. Sclafani?

Thank you

<shortened url>

http://hyper.ahajournals.org/cgi/content/full/48/4/664

http://www.jlr.org/content/47/3/476.full

http://ats.ctsnetjournals.org/cgi/conte ... /79/3/1081
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Postby Johnson » Tue Nov 30, 2010 4:40 pm

drsclafani wrote:
Johnson wrote:...

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.

Thanks for your reply, Doc.

I might have mentioned; I had no pain or real discomfort during, or after the angioplasty, this just popped up suddenly 7 weeks later. It is almost resolved now, without treatment.
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Postby Johnson » Tue Nov 30, 2010 5:11 pm

IKES wrote:I have MS and have been avidly following this board and the development of CCSVI treatment, its promise and the current realities of treatment. Although in time the vascular intervention equipment and techniques will evolve and become standardized, the problem of restenosis needs to be better understood and prevented.

In furtherance of this, I have attached 4 research articles that point the way to better medication regimens for the prevention of restenosis. In addition to current post angioplasty medications of aspirin, clopedigrol, or blood thinners I believe that pretreatment and prolonged use of an angiotensin receptor blocker (ARB) alone or in combination with an ACE inhibitor can significantly reduce the incidence and severity of restenosis.

What are your thoughts about this Dr. Sclafani?

Thank you

<shortened url>

http://hyper.ahajournals.org/cgi/content/full/48/4/664

http://www.jlr.org/content/47/3/476.full

http://ats.ctsnetjournals.org/cgi/conte ... /79/3/1081


Pardon me for chiming in on a question to Dr. Sclafani, but I have some experience with ARBs - specifically: olmesartan (Benicar in the US, UK). Besides relaxing the vasculature and lowering BP (mine is a blissful 121/69), it up-regulates the immune system, cleans out VDRs, is renal protective, and has other beneficial actions that I do not remember at present. I was taking a low dose (10mg/day) before 2nd procedure, and went up to 20mg after, then 40mg. I feel that olmesartan does impart benefit to me.

Care does have to be taken when used with heparins, as it can cause hypokalemia, so it might be contra-indicated with after-procedure meds.. It can (and does) make one woozy, but I have been woozy for so long, it does not trouble me much.
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Postby MS_HOPE » Tue Nov 30, 2010 5:30 pm

drsclafani wrote:Ultrasound with compression is the best way to look for thrombosis of the vein.


Dr. Sclafani, does this mean that the ultrasound tech would press very hard on the vein when taking the images?

Another patient I know, who was treated by Dr. Sinan a few months ago, had significant symptom improvements, and then went for a two-month follow-up doppler where the tech pressed very hard against his neck. Three days later, his symptoms returned. He feels there's a connection between the two events.

Does this sound like a theoretical possibility? Could this type of examination contribute, perhaps, to elastic recoil of the vein, or a return of a valve problem? Are you aware of any other such reports?

Thank you!
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Postby Cece » Tue Nov 30, 2010 9:51 pm

IKES, what a great first post. Welcome!
drsclafani wrote:its reassuring that cece cleared that up! :wink:

thanks 8)
drsclafani wrote:moreover i wonder whether all patients with the clinical scenario of ms, have ccsvi .

If you listen to Wheelchair Kamikaze, he's reasonably convincing on this subject, that MS is a catch-all and different diseases lumped together.

Still, if every MS patient you see has CCSVI, that answers the question?
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Postby drsclafani » Tue Nov 30, 2010 10:22 pm

IKES wrote:I have MS and have been avidly following this board and the development of CCSVI treatment, its promise and the current realities of treatment. Although in time the vascular intervention equipment and techniques will evolve and become standardized, the problem of restenosis needs to be better understood and prevented.

In furtherance of this, I have attached 4 research articles that point the way to better medication regimens for the prevention of restenosis. In addition to current post angioplasty medications of aspirin, clopedigrol, or blood thinners I believe that pretreatment and prolonged use of an angiotensin receptor blocker (ARB) alone or in combination with an ACE inhibitor can significantly reduce the incidence and severity of restenosis.

What are your thoughts about this Dr. Sclafani?

Thank you

<shortened url>

http://hyper.ahajournals.org/cgi/content/full/48/4/664

http://www.jlr.org/content/47/3/476.full

http://ats.ctsnetjournals.org/cgi/conte ... /79/3/1081

ikes
it will take a while to go through these papers. I cant do them justice in the moment at after midnight

please understand that i do not believe that the primary cause of restenosis is intimal hyperplasia but elastic recoil resulting from inadequate dilatation of the primary stenosis. thus my efforts are at the moment focused on trying to get to optimum venoplasty without stenting

We will speak more after I have had a chance to review the papers you sent.
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Postby elliberato » Wed Dec 01, 2010 6:38 am

DR S,
do you have a list of locations for the centers? The Website doesnt. Also do you plant to travel to them to treat or will you only be in NYC?
Last edited by elliberato on Wed Dec 01, 2010 6:05 pm, edited 3 times in total.
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Postby Algis » Wed Dec 01, 2010 7:04 am

Pardon me to be hijacking again but: don't we under-estimate that the jugulars get both the feed of the thoracic lymph ducts? Those are feeding fat directly from the small intestine and it should not be discounted (lots of nutrients, hormones, sugar, whatever - just name it - is dumped in there).

Or am I sitting in the wrong car? Darn, it gets tougher by the day 8O :? :D
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Postby David1949 » Wed Dec 01, 2010 2:47 pm

Dr. Sclafani
Like everyone else here I am delighted to hear you will soon be back in business and that AAC clinics around the country will soon be offering treatment for CCSVI. Will the doctors doing the procedure at the AAC clinics be trained by you?
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Postby Cece » Wed Dec 01, 2010 3:09 pm

elliberato wrote:DR S,
do you have a list of locations for the Amerisource centers? The Website doesnt. Also do you plant to travel to them to treat or will you only be in NYC?

drsclafani on the locations:
http://www.thisisms.com/ftopicp-144012.html#144012

me on how to find them on the American Access Care website:
http://www.thisisms.com/ftopicp-144015.html#144015
Hope that is helpful.
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Postby elliberato » Wed Dec 01, 2010 6:01 pm

thanks Cece

Dr S,
I have had MS 4 years (who really knows) at least thats when diagnosed. n Secondary progressive. No fatigue issues, no cognitive issues, duh I think, seriously all my activity in my t,c,l spine. Spasticity and stiffness horrible to point where i am not walking without assistance. THink Liberation may help me or is it just to hypothetical?
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Postby drsclafani » Wed Dec 01, 2010 10:47 pm

MS_HOPE wrote:
drsclafani wrote:Ultrasound with compression is the best way to look for thrombosis of the vein.


Dr. Sclafani, does this mean that the ultrasound tech would press very hard on the vein when taking the images?

the ultrasound is done with light touch of the probe to the neck. if clot is suspected, then it is often necessary to press down to compress the vein. if there is clot in the vein it wont collapse.

Another patient I know, who was treated by Dr. Sinan a few months ago, had significant symptom improvements, and then went for a two-month follow-up doppler where the tech pressed very hard against his neck. Three days later, his symptoms returned. He feels there's a connection between the two events.

might be coincidence. i guess it is prossible that presing on the vein could have resulted in shutting of a valve. pure conjecture

Does this sound like a theoretical possibility? Could this type of examination contribute, perhaps, to elastic recoil of the vein, or a return of a valve problem? Are you aware of any other such reports?

Thank you!


elastic recoil is an inherent feature of elastic tissue. i do not think pressing on the vein is going to cause elastic recoil
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Postby drsclafani » Wed Dec 01, 2010 10:52 pm

Algis wrote:Pardon me to be hijacking again but: don't we under-estimate that the jugulars get both the feed of the thoracic lymph ducts? Those are feeding fat directly from the small intestine and it should not be discounted (lots of nutrients, hormones, sugar, whatever - just name it - is dumped in there).

Or am I sitting in the wrong car? Darn, it gets tougher by the day 8O :? :D


the lymphatic ducts drain into the subclavian veins adjacent to the jugular veins
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Postby drsclafani » Wed Dec 01, 2010 10:54 pm

David1949 wrote:Dr. Sclafani
Like everyone else here I am delighted to hear you will soon be back in business and that AAC clinics around the country will soon be offering treatment for CCSVI. Will the doctors doing the procedure at the AAC clinics be trained by you?


these are all highly experienced physicians. i have been training for some time. Many will be visiting with me when i do procedures.

all the procedures will be reviewed complications witll be analyzed. negative outcomes will be scrutinized. all patients will be be placed in our own internal registry
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Postby drsclafani » Wed Dec 01, 2010 10:56 pm

elliberato wrote:thanks Cece

Dr S,
I have had MS 4 years (who really knows) at least thats when diagnosed. n Secondary progressive. No fatigue issues, no cognitive issues, duh I think, seriously all my activity in my t,c,l spine. Spasticity and stiffness horrible to point where i am not walking without assistance. THink Liberation may help me or is it just to hypothetical?


unpredictable in SPMS
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