DrSclafani answers some questions

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

Postby Robnl » Thu Jun 02, 2011 4:50 am

Hi doc,

Question; some time ago yoiu mentioned that you find a lot more azygous problems when you look at this vein under different angles. You said '25% percent and rising'...how are the numbers at this moment?

Keep up the good work...Dr. S. the explorer :D :D

Robert
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Postby Kleiner » Thu Jun 02, 2011 4:57 am

To reiterate what the last few posters have said, I don't ask a lot of questions, as I do not have the in depth knowledge, but I have read all of the 5000+ posts on this thread and they have been more helpful than you can imagine. So helpful that I know I am making the right decision to visit you whenever I can get some support up here in Canada. You truly are an amazing person for everything that you are doing.

That being said, what would you say about strapping that IVUS machine to your back and opening up a few veins while you are visiting Canada?? :D Maybe a cross Canada Venoplasty Tour...
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Postby Kathryn333 » Thu Jun 02, 2011 6:49 am

bruce123 wrote:
drsclafani wrote:Thank you for your kind words of appreciation. It means a lot to me. Preparing those cases takes upward of two hours to do. When few questions arise, i wonder whether it is valuable to patients.
DrS


I don't post on this thread because I don't know enough to ask an intelligent question, but I ALWAYS read this thread. I continue to learn so much. Thank you Dr. S.

Good luck with you meeting in Toronto with the Canadian MS Society.

Bruce.



Dr. Sclafani, not all of us have the comprehension that others have on this thread, but we all read, and we try to learn and absorb. I've read all your postings, but I leave it to others to ask the intelligent questions. We all appreciate what you do for us. Thank you.
I'm disappointed that your meeting in Toronto is "closed door". I would have been there.
You are the best. :)

Dorothy
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Postby Nunzio » Thu Jun 02, 2011 12:28 pm

drsclafani wrote:
Cece wrote:
drsclafani wrote:
Dr. Siskin used the fact that iliac disease was not found in MS patients to any higher degree than the the incidence in the regular population as justification for not interrogating the iliac. (see ccsvi.org video for his discussion of this)

I imagine the same argument might be applied for whether or not to look at the renal vein, especially if something is only found about once every 75 - 100 patients. I'd disagree with such an argument, of course.


i think that dr siskin missed the point. We do not look for may thurner syndrome in ccsvi because it is more frequent in patients with ccsvi; we look for it because its presence is hemodynamically more significant in patients with ccsvi. This was the point that Robbie galeotti brought home to me.


I have to agree with you.
Below is a post I placed on April 27 in answer to Dr. Hewett presentation on the same subject.

Nunzio wrote:
joge wrote:In this video with dr. Hewett, he explains (stenting in) MTS. Also he shows MTS is found in 17% of his (160) ccsvi patients (at 8 min, 30 sec).

In a normal (asymptomatic) population it is found in 6 -24%.

So...

http://www.youtube.com/watch?v=A_R88CJT ... re=related

So.... Dr. Hewett is totally missing the point.
In CCSVI patients we are not treating May-Thurner to help the leg, we are treating it because it diverts the blood that should drain through the Inf Vena Cava, into the Azygous vein and overloading it.
I do not expect MTS to be any higher in MS than in normal population.
Still if I have CCSVI, specially with Azygous problem, I would not want to have an additional condition that would interfere with my Central Nervous System circulation
That is why Dr. Zamboni and Dr. Sclafani always enter on the left side and check the left Ilac and renal vein.
http://www.thisisms.com/ftopicp-162666-.html#162666
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Postby Nunzio » Thu Jun 02, 2011 1:36 pm

drsclafani wrote:I sometimes find the left renal vein catheterization very difficult. the vein has a very wide mouth and the vector of pushing the catheter makes it difficult to keep the catheter into the vein
I have not spent a lot of time getting into the vessel and have been too quick to stop.

I cannot agree with galeotti on this. I h ave done over 1000 inferior vena cava filters. In preparation for placing the filter, i have catheterized about 1000 renal veins and rarely seen this entity. Perhaps it is an association with ccsvi.

You might be right and there might be an association with renal vein problems and CCSVI. Dr. Galeotti mentioned 4.6% as the percentage of patients in his group with renal vein problems.
He also mentioned 86% of patients with Azygous problems which is more that I have seen mentioned by other groups.

Image
Now a question:
It seems to me that if the right Renal Vein is occluded the collaterals would still drain into the Azygous vein.
Do you check the right Renal Vein too?
Thanks a lot
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Postby Cece » Thu Jun 02, 2011 7:34 pm

drsclafani wrote:I have been looking at these IVUS for a long time. When i first saw those bright dots and blotches, i wondered whether they were real. I am now convinced that I can see webs. before i wasnt sure and i left them alone. Now i am considering angioplasty of the webs

Have other researchers in other diseases seen webs like this with IVUS?

We are also getting used to still images here, but with IVUS moving (and moving fast), it is impressive how much you're able to make out.

That might be flattery. I cannot help it. :D
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Postby Hockeydad » Fri Jun 03, 2011 7:36 am

Let me echo the same sentiments as above. I'm a simple hockeydad (with a university degree), so I'm intelligent enough to follow the diagrams and even , somewhat, understand what is being presented. It has helped me "get" what is happening in my own body. I just don't know enough to ask a meaningful question. Please continue with these patient files. It does "suck" as well, that your meeting in Toronto is closed as I would have come to hear you speak.
RRMS since Feb , 2010. No drugs, just vitamins and exercise.
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Postby Cece » Fri Jun 03, 2011 6:13 pm

Back on page one of this thread, I was asking if the high-up jugular stenoses were in the brain (they're not) and how the catheter is able to get to the jugulars from the femoral vein without going through the heart (umm, it goes through the heart).

Why settle for not knowing when there is someone here eager to teach?

Perhaps anyone who thinks they do not know enough to ask a good question might feel obligated to ask a question on the next case...let Dr. Sclafani judge whether it is good or not....
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Postby drsclafani » Fri Jun 03, 2011 6:32 pm

Cece wrote:Back on page one of this thread, I was asking if the high-up jugular stenoses were in the brain (they're not) and how the catheter is able to get to the jugulars from the femoral vein without going through the heart (umm, it goes through the heart).

Why settle for not knowing when there is someone here eager to teach?

Perhaps anyone who thinks they do not know enough to ask a good question might feel obligated to ask a question on the next case...let Dr. Sclafani judge whether it is good or not....


Let me say it again... ...

THE ONLY BAD QUESTION IS ONE THAT IS NEVER ASKED
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Postby PCakes » Fri Jun 03, 2011 6:54 pm

drsclafani wrote:Let me say it again... ...

THE ONLY BAD QUESTION IS ONE THAT IS NEVER ASKED


Okay, here goes.. Dr Sclafani do you think that thyroid issues, very common in MS, might be tied to CCSVI?

My oldest sister, not diagnosed with MS but with many many connective tissue disease issues, called today to tell me that she has tested positive for both Graves and Hashimoto's. Hypo and hyper thyroid? She is being told the only way to deal with this would be to pharmaceutically 'kill' the thyroid. I am very worried for her.

Thank you,
pc
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Postby pklittle » Fri Jun 03, 2011 7:39 pm

Dr. S,
I have a similar question to what Pcakes is asking. My younger sister has a history of thyroid problems and migraine headaches. She had a nodule on her thryroid I think, and she had her thyroid "zapped". Bouts of headaches come and go.
Might these problems be instigated by vascular disease/ccsvi?
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Postby drsclafani » Fri Jun 03, 2011 9:02 pm

PCakes wrote:
drsclafani wrote:Let me say it again... ...

THE ONLY BAD QUESTION IS ONE THAT IS NEVER ASKED


Okay, here goes.. Dr Sclafani do you think that thyroid issues, very common in MS, might be tied to CCSVI?

My oldest sister, not diagnosed with MS but with many many connective tissue disease issues, called today to tell me that she has tested positive for both Graves and Hashimoto's. Hypo and hyper thyroid? She is being told the only way to deal with this would be to pharmaceutically 'kill' the thyroid. I am very worried for her.

Thank you,
pc


Both hashimotos disease and graves disease occur with higher frequency in patients with MS. The explanation has been that autoimmune disease cluster and both hashimotos and graves are autoimmune and this fits nicely with an autoimmune explanation of ms.

however just as collateral circulation is suggested as a cause of inflammation in the brain, there are those who suggest that the collateral circulation of ccsvi going through the thyroid gland could cause these inflammatory thyroid diseases, sort of a chronic thyroid venous insufficiency.

I certainly see considerable collaterals in venous obstruction that run through the thyroid gland.

Food for thought, but unresolved opinions.
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Postby drsclafani » Fri Jun 03, 2011 9:05 pm

Kleiner wrote:To reiterate what the last few posters have said, I don't ask a lot of questions, as I do not have the in depth knowledge, but I have read all of the 5000+ posts on this thread and they have been more helpful than you can imagine. So helpful that I know I am making the right decision to visit you whenever I can get some support up here in Canada. You truly are an amazing person for everything that you are doing.

That being said, what would you say about strapping that IVUS machine to your back and opening up a few veins while you are visiting Canada?? :D Maybe a cross Canada Venoplasty Tour...


funny the rock star's IVUS tour
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Postby drsclafani » Fri Jun 03, 2011 9:06 pm

Robnl wrote:Hi doc,

Question; some time ago yoiu mentioned that you find a lot more azygous problems when you look at this vein under different angles. You said '25% percent and rising'...how are the numbers at this moment?

Keep up the good work...Dr. S. the explorer :D :D

Robert


i would say one in 20-33% of cases have some abnormality in azygous.
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Postby drsclafani » Fri Jun 03, 2011 9:10 pm

Thekla wrote:You mention not treating/placing a stent in the renal vein because the necessary tests hadn't been done. With a positive outcome when you do treat this patient, would anticipatory testing be a good idea across the board for patients, or perhaps repeat patients? Or is this too rare to warrant it?

I love reading the cases you post here even though I seldom post any questions---I'm glad Cece does! I too have trouble seeing the details on the ivus, but I never was any good at seeing whether those baby ultrasounds had a penis or not! I was surprised by both of my boys!


i think testing should be by venography at the time of the rest of the venogram. If stenoses are seen, then it is work the patient up for the cause and then treat the patient at a second treatment. There are many diagnostic patterns and i see no particular rush to treat this injury without full workup.

i think the incidence of these stenosis is low. so i would not prescreen patients for this problem. It would just waste a lot of health care dollars.
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