DrSclafani answers some questions

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

Postby drsclafani » Thu Jun 16, 2011 9:10 pm

pklittle wrote:
registration is below projections


Any speculation as to why?


perhaps the notices have not reached them yet or they are thinking about whether to come or they just want to be in front of the barbie on the weekend

i think the word was spread around a bit more quickly by patient advocates last year.
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Postby drsclafani » Thu Jun 16, 2011 9:11 pm

Nola wrote:Dr Sclafani, thank you for the brilliant case studies. You could write a whole book just from this thread. Can I ask why are arachnoid granulations nothing to treat? If they are a physical structure, it seems like they would have an impact on drainage and flow. How often do you see them? Do you ever do anything at all with them?


The hotel 800 number said the patient rooms were all sold out weeks ago when I called to try to come. This must mean the professional numbers are the only area that is below expectation. I sent the information to more doctors. I hope this adds a few professionals.


nola, these are normal structures. they are necessary. what was noteworthy about this one was its size.
they are usually smaller but they are essential to drain the CSF
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Re: Easy question?

Postby drsclafani » Thu Jun 16, 2011 9:12 pm

bonzo1986 wrote:Dr Sclafani,


Is it possible to have an MRV, venography done on the spine?

Reason I ask... Wife had an MRI (brain, spine) done recently and the radialogist has found either a tumor or "vasular malformation" in the spine itself. We are scheduled to see a neurosurgen end of the month.

If it is vascular, is that somthing that could be repaired by an IR? Or is surgery they only way to repair something like that?

Thank you for any opinion you have


vascular malformation of the spine is a common problem. It can cause venous problems and neurological effects if they are high flow. They are not treated by surgery. If treatment is necessary, embolization makes the most sense.
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Postby drsclafani » Thu Jun 16, 2011 9:15 pm

Cece wrote:
drsclafani wrote:
Selective catheterization of the right internal jugular vein was performed first. I knew i was in the jugular vein because of the guidewire went into the dural sinuses.

Did you get the jugular vein on your first try?


yup :D

Impressive
drsclafani wrote:I have not yet seen an occlusion since i have redefined the angioplasty endpoints by using IVUS and dilating to a balloon diameter that has a cross sectional area that is 1.5-2 times the cross sectional area of the vein surrounding the stenosis and better standardized my anticoagulation regimen.

And also impressive.
:wink:


just had an occlusion. anticoagulation stopped prematurely because of allergic reaction. delay in getting on another one. :(

setting up to try to get it open now. I dont think i should speak further on this until the case is resolved.
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Postby pklittle » Thu Jun 16, 2011 9:39 pm

DrSclafani
sorry i have been aaway so long. been ill and too busy


I am sorry to read you have been ill. What's that saying?... You have been burning the candle at both ends.

Please take care of yourself Dr. <3. Take a breather now and then.
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Postby jgalt2009 » Fri Jun 17, 2011 5:27 am

Dr. Sclafani, I have two questions.

1. You state that, when you have a chance, you look in the vertebral veins, and you also stated that you now routinely check the dural sinuses. Do you have a "basic" playbook for the procedure, and adjust it based on circumstances or available time or other criteria?

2. My understanding is that the azygous vein serves to exfiltrate blood from the vertebral plexuses on the right side, and the hemiazygous and accessory hemiazygous exfiltrates blood from the left side of the v-plex. If this is correct, why not catheterize the hemiazygous and accessory hemiazygous while you are down in the azygous?

I'm thinking that when you get two flat tires, if you only fix one flat, the car will still perform poorly.
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Postby Rompers » Fri Jun 17, 2011 7:56 am

Dear Dr. Sclafani,

Your Canadian friends especially, will be looking forward to your impressions of how receptive the Canadian MS Society is today in Toronto.

"Dr. Hubbard will be addressing CCSVI in MS on a panel with Drs. Sclafani, Rubin, and Selchen on June 17th" (hubbardfoundation,blogspot.com)

I have every confidence that if any one can help "get the message" through, ...you will have an impact!

Rhonda
Procedure by DrS 5/3/11 SI
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Postby Cece » Fri Jun 17, 2011 1:58 pm

drsclafani wrote:just had an occlusion. anticoagulation stopped prematurely because of allergic reaction. delay in getting on another one. :(

setting up to try to get it open now. I dont think i should speak further on this until the case is resolved.

Dangit.
I hope it can be fixed for this patient.
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Postby drsclafani » Fri Jun 17, 2011 6:27 pm

Rompers wrote:Dear Dr. Sclafani,

Your Canadian friends especially, will be looking forward to your impressions of how receptive the Canadian MS Society is today in Toronto.

"Dr. Hubbard will be addressing CCSVI in MS on a panel with Drs. Sclafani, Rubin, and Selchen on June 17th" (hubbardfoundation,blogspot.com)

I have every confidence that if any one can help "get the message" through, ...you will have an impact!

Rhonda


regretfully, i was stranded at the airport in new york this afternoon because of severe lightning and thunderstorms. My flight was postponed and i could not find a plane available to get me to toronto in time. i am very disappointed. i had a few things to say that needed blunt saying. hopefully another time
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Postby WeWillBeatMS » Fri Jun 17, 2011 6:44 pm

Sorry you couldn't make it to Toronto. Take it as an opportunity to get some rest this weekend and recuperate.

So are you up to sharing what you found out about the positive CCSVI ultrasound last Friday morning and then no CCSVI on Saturday?

I was able to find out that none of the three neuros who slapped the MS label on me did a Lyme test. Wonderful! So I am going to be looking into that thanks to your suggestion.

WeWillBeatMS
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Postby drsclafani » Fri Jun 17, 2011 7:19 pm

jgalt2009 wrote:Dr. Sclafani, I have two questions.

1. You state that, when you have a chance, you look in the vertebral veins, and you also stated that you now routinely check the dural sinuses. Do you have a "basic" playbook for the procedure, and adjust it based on circumstances or available time or other criteria?


time never really is a criteria for what i do. i take as much time as necessary to get the job done.

the basic playbook keeps being enhanced.

it is as follows
1 consent
2 time out
3 prep
4 lidocaine anesthesia
5 ultrasound detection of the saphenous vein at the saphenofemoral junction
6 micropuncture access
7 sequential dilatation to 10 French
8 introduction of 80 cm 10 French sheath and placement in the superior vena cava
9 selective catheterization in whatever sequence makes sense of the right internal jugular vein, the left internal jugular vein and the azygous vein over a 0.014 inch platinum tipped guidewire.
10 after fentanyl analgesia, in each jugular first advance catheter into the transverse sinus and do Frontal and Lateral views of the dural sinuses into the jugular bulb
11 then do jugular venogram
12 then do ivus
13 then if appropriate measure cross sectional area of IJV above and below stenosis
14 then select balloon 50-100% larger in cross sectional area than vein balloon using ivus images depending upon location and size of the vein
15 give more fentanyl
16 inflate balloon to nominal pressure and identify 'waist"
17 position balloon shoulder at the waist
18 inflate to 10 Atmospheres.
19 if waist still present, inflate balloon up to 20 atmospheres slowly and incrementally to pressure that effaces the waist, moving shoulder of balloon to effect most stretching .
20 keep inflated for 15 second
21 check for elastic recoil, if none remove balloon
22 repeat venography and IVUS
23 if ok, move on to next vessel

24 azygous same basic principles but techniques and views different

25 after these three vessels are completed, move into abdomen,
26 catheterize and venogram of left renal vein
27 if stenosis, angioplasty and stenting

28 then IVC gram.
29 if may thurner angioplasty and stenting

30 then ascending lumbar venogram.
31 after everything completed remove catheter
32 manual compression of puncture site
33 pressure bandage
34 recovery for one hour
35 write report
26 discharge patient


it is my understanding is that the azygous vein serves to exfiltrate blood from the vertebral plexuses on the right side, and the hemiazygous and accessory hemiazygous exfiltrates blood from the left side of the v-plex. If this is correct, why not catheterize the hemiazygous and accessory hemiazygous while you are down in the azygous?

these veins are all one system and they can be assess quite nicely by injections of the azygous.

i dont quite agree with your assessment though, there are branches that interconnect all the way through the system.

DrS

I'm thinking that when you get two flat tires, if you only fix one flat, the car will still perform poorly.


These veins are progressively smaller. there comes a time when angioplasty is only going to get you in trouble.
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Postby drsclafani » Fri Jun 17, 2011 7:24 pm

WeWillBeatMS wrote:Sorry you couldn't make it to Toronto. Take it as an opportunity to get some rest this weekend and recuperate.

So are you up to sharing what you found out about the positive CCSVI ultrasound last Friday morning and then no CCSVI on Saturday?

I was able to find out that none of the three neuros who slapped the MS label on me did a Lyme test. Wonderful! So I am going to be looking into that thanks to your suggestion.

WeWillBeatMS


now wouldnt that be a kick in the ass

llike everyone is telling me, i need to recuperate.

there are few procedures scheduled for the next couple of weeks for reasons i cannot explain. i will have some time to wonder why. perhaps everyone thinks that my waiting time is greater than it is.

i will use that time to put together your case for presentation.

DrS
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Postby Icechick » Fri Jun 17, 2011 7:32 pm

Hi Dr. Sclafani - Christine R here. I just booked my room for July 14th. The bad news (for me) is - the block rate is no longer available because all those rooms are booked!! The good news is - that means people are attending!! I look forward to seeing you there! Perhaps AAC can try to negotiate a few more rooms for others that still want to attend. (hint hint).
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Postby 1eye » Sat Jun 18, 2011 5:14 am

drsclafani wrote:
Rompers wrote:Dear Dr. Sclafani,

Your Canadian friends especially, will be looking forward to your impressions of how receptive the Canadian MS Society is today in Toronto.

"Dr. Hubbard will be addressing CCSVI in MS on a panel with Drs. Sclafani, Rubin, and Selchen on June 17th" (hubbardfoundation,blogspot.com)

I have every confidence that if any one can help "get the message" through, ...you will have an impact!

Rhonda


regretfully, i was stranded at the airport in new york this afternoon because of severe lightning and thunderstorms. My flight was postponed and i could not find a plane available to get me to toronto in time. i am very disappointed. i had a few things to say that needed blunt saying. hopefully another time


Maybe after today's vote it will be to a different gang of people.
"Try - Just A Little Bit Harder" - Janis Joplin
CCSVI procedure Albany Aug 2010
'MS' is over - if you want it
Patients sans/without patience
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Postby Nola » Sat Jun 18, 2011 5:56 am

Likewise to Icechick, the Crowne Plaza said to me back in May that all patient rooms were sold out for July 14 & 15. I did ask again, yesterday, and they confirmed this. If more rooms were available at a lower rate I think there would be happy people.

More important, I think if Dr. Sclafani took as much care of himself as he did of his lucky patients there would also be happy people. How can we help you be healthy?
</div><div>Every moment of light and dark is a miracle. -- Walt Whitman</div><div>
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