DrSclafani answers some questions

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

Postby Cece » Tue Apr 12, 2011 6:20 pm

I am told drbart is quoting 'goodfellas' :)
I have to brush up on my mafia movie references!
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Postby vivavie » Tue Apr 12, 2011 6:31 pm

If my stents are occluded what are my options, I am already on coumadin and plavix? I have a stent within stents within stents (3 layers), Is there anything more that can be done? should I even bother to get that US?
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Postby Johnson » Tue Apr 12, 2011 7:40 pm

vivavie wrote:If my stents are occluded what are my options, I am already on coumadin and plavix? I have a stent within stents within stents (3 layers), Is there anything more that can be done? should I even bother to get that US?

Something that I have been thinking of as a "scarf", is a product called Farabloc (Google link with links to sales, NIH studies, etc.) - a product I bought for my old Grandma years ago. She swore by it, and would use it constantly for pain. I've been too lazy to unpack it from her stuff, but I have been curious of any possible effect on my own veins.

I have a wild thought that stents - being of a wire mesh - might be conducting electro-magnetic energy, which may have an undesired effect in the vein. My inspiration is that the Farabloc might act in a homeopathic way to remediate the issues with your stents. I would suggest, if you try it, to do so under supervision, as it might trigger the release of any clots you might have.

There is, at the link above; this link to an NIH study that looked at blood chemistry being positively affected by Farabloc related to muscle soreness in exercise. It's just interesting to me.

Hey! it's no crazier than a bee-sting!
My name is not really Johnson. MSed up since 1993
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Postby drsclafani » Tue Apr 12, 2011 7:47 pm

vivavie wrote:If my stents are occluded what are my options, I am already on coumadin and plavix? I have a stent within stents within stents (3 layers), Is there anything more that can be done? should I even bother to get that US?


could it be something other than thrombosis? an infection leading to swelling?

i think a simple ultrasound is valuable in excluding thrombus too.

vivavie
i am so sorry you had the stent in the first place.
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Postby Brainteaser » Tue Apr 12, 2011 9:23 pm

vivavie wrote:I have a stent within stents within stents (3 layers)

Huh? Did I miss something? This thread goes so fast! Three layers of stents sounds a first. How did that happen and for what purpose?
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Postby vivavie » Wed Apr 13, 2011 5:22 am

drsclafani wrote:
vivavie wrote:If my stents are occluded what are my options, I am already on coumadin and plavix? I have a stent within stents within stents (3 layers), Is there anything more that can be done? should I even bother to get that US?


could it be something other than thrombosis? an infection leading to swelling?

i think a simple ultrasound is valuable in excluding thrombus too.

vivavie
i am so sorry you had the stent in the first place.


If there is a thrombus, then what can be done?
I could never feel the presence of the stents, for 10 days it is getting more sore.
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Postby numbness23 » Wed Apr 13, 2011 7:48 am

Dr Sclafani,
On one of the forums here called 'improvements' there are some astonishing results to the Liberation. Every single one is amazing. Now that you are doing these full time are you seeing the same?
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Postby davmets2 » Wed Apr 13, 2011 11:19 am

Dr Sclafani,
I just had my 3 month ultrasound. My procedure was done in 2 stages, one week apart. While doing the second procedure for the RJV the venogram showed that the LJV that was done the week before with 18 mm balloon had restenosed and clotted. He attempted to re-balloon without any success. Had been on warifin since then (just stopped taking yesterday).
The ultrasound that I just had done yesterday showed flow in both jugulars. He couldn't tell me how much flow. He suggested another procedure with ballooning and probably a stent, but gave no guarantees that this would work or help. He told me to think about it, but the sooner I do it the better chances of success.
I guess my question would be, is there any test to show how much flow I'm getting and do you think that I should consider another procedure, possibly with a different Dr. such as yourself.
Thanks
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Postby Cece » Wed Apr 13, 2011 6:52 pm

vivavie wrote:If there is a thrombus, then what can be done?
I could never feel the presence of the stents, for 10 days it is getting more sore.

Mechanical clot removal? Thrombolysis?
Ballooning within the stent?

How have your coumadin INR levels been testing at? Some people have difficulty getting up to the right level.

Did you ever have testing to see how your dural sinuses look on that side?

Cece
not a doctor
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Postby bestadmom » Wed Apr 13, 2011 7:12 pm

Cece wrote:Cece
not a doctor


A doctor in the making :-)
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Postby drsclafani » Wed Apr 13, 2011 9:22 pm

vivavie wrote:If my stents are occluded what are my options, I am already on coumadin and plavix? I have a stent within stents within stents (3 layers), Is there anything more that can be done? should I even bother to get that US?


firstly, we must ask what was the intention behind the first intervention. Was it to eliminate some painful symptoms? to reverse some weakness or sensory mprove balance? to reverse fatigue ?
the ask whether that accomplished that. that is the first piece of the puzzle.

Secondly, if you had reversal of fortunte and symptoms returned, then was the original improvement of great value or a minor disappointing improvement.

Thirdly, what was the purpose of putting the first stent in? was it a regretful treatment plan or did it provide you with some worthwhile improvement

Fourthly, we know what the purpose of putting the last stents in. Did it provide what you were looking for.

After answering these questions, we can have a meaningful discussion of how much further to pursue this. Only you can answer these questions.

But, you are in pain, we do not know why. treatment, no treatment, i think it is important to understand what is going on because we cannot have a logical discussion with out knowing that.

drs
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Postby vivavie » Wed Apr 13, 2011 9:26 pm

Cece wrote:
vivavie wrote:If there is a thrombus, then what can be done?
I could never feel the presence of the stents, for 10 days it is getting more sore.

Mechanical clot removal? Thrombolysis?
Ballooning within the stent?

How have your coumadin INR levels been testing at? Some people have difficulty getting up to the right level.

Did you ever have testing to see how your dural sinuses look on that side?

Cece
not a doctor


Yes my IRN is at 2,4 - target is between 2 and3.
Dural sinuses? not that I now of, good question for Dr Sclafani: Did you look at it when I was on your table?
Ballooning within stents: yes in Dec, again in Feb that is when they added the 2 more stents. Now it is more like a solid tube to prevent the growth getting inside.
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Postby drsclafani » Wed Apr 13, 2011 9:45 pm

Brainteaser wrote:
vivavie wrote:I have a stent within stents within stents (3 layers)

Huh? Did I miss something? This thread goes so fast! Three layers of stents sounds a first. How did that happen and for what purpose?


i put in the third set of stents for intimal hyperplasia elicited by the first two stents. Sometimes more stents are required . but i want ti reiterate that the incidence should probably be very small

i have not yet put in a stent except for patients who already have stents.
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Postby vivavie » Wed Apr 13, 2011 10:26 pm

drsclafani wrote:
vivavie wrote:If my stents are occluded what are my options, I am already on coumadin and plavix? I have a stent within stents within stents (3 layers), Is there anything more that can be done? should I even bother to get that US?


firstly, we must ask what was the intention behind the first intervention. Was it to eliminate some painful symptoms? to reverse some weakness or sensory mprove balance? to reverse fatigue ?
the ask whether that accomplished that. that is the first piece of the puzzle.

Secondly, if you had reversal of fortunte and symptoms returned, then was the original improvement of great value or a minor disappointing improvement.

Thirdly, what was the purpose of putting the first stent in? was it a regretful treatment plan or did it provide you with some worthwhile improvement

Fourthly, we know what the purpose of putting the last stents in. Did it provide what you were looking for.

After answering these questions, we can have a meaningful discussion of how much further to pursue this. Only you can answer these questions.

But, you are in pain, we do not know why. treatment, no treatment, i think it is important to understand what is going on because we cannot have a logical discussion with out knowing that.

drs


Thank you Dr Sclafani, i will answer all your questions, have the US and get back to you for further disscussion.
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Postby CD » Fri Apr 15, 2011 1:18 pm

davmets2 wrote:Dr Sclafani,
I just had my 3 month ultrasound. My procedure was done in 2 stages, one week apart. While doing the second procedure for the RJV the venogram showed that the LJV that was done the week before with 18 mm balloon had restenosed and clotted. He attempted to re-balloon without any success. Had been on warifin since then (just stopped taking yesterday).
The ultrasound that I just had done yesterday showed flow in both jugulars. He couldn't tell me how much flow. He suggested another procedure with ballooning and probably a stent, but gave no guarantees that this would work or help. He told me to think about it, but the sooner I do it the better chances of success.
I guess my question would be, is there any test to show how much flow I'm getting and do you think that I should consider another procedure, possibly with a different Dr. such as yourself.
Thanks


Hi Dr. Sclafani,
I thought this was a good question. I, too, would be interested in your opinion on this question, whenever you have the time to answer. I know you are a very busy doctor.
Thanks,
CD
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