This Is MS Multiple Sclerosis Community: Knowledge & Support

I can only answer in general terms questions posed on the forum, for record keeping and medicolegal reasons.

if you seek personal consultation, please use my patient email, ccsviliberation@gmail.com

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Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

I was asking for our friend with the sphenopalatine attacks just in case something that simple might have a positive effect. She can try flexion and extension and see if she gets any benefit pending future treatment. She's having an awful time now that they have returned with increasing frequency.

LOL

Did you also have a vision of Dr S doing the bird dance to the music of the same name? I did. ROFL.

tilt

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...and I for one, welcome our new Neurologist overlords!

My before and after CCSVI treatment video http://www.youtube.com/watch?v=RhosV4_DvWw
Visit my Lego Amusement Rides website http://www.brickshelf.com/cgi-bin/gallery.cgi?m=Bolliger

Flexing my neck used to trigger Lhermitte's sign, could there be a connection?

I found that odd shaped pillow in the Fall. I find it more comfortable. Here in Germany, they are called 'side-sleeper' pillows but they don't fit in any of the normal pillowcases!

From the Forums FAQ thread...

Q: How do I post a picture to the forum?
site-support-f2/topic5284.html#p40760

Posting Pictures, Part 2
site-support-f2/topic5284-15.html#p161827


NHE

hee
Walking around, our jugulars are shrunk down to 10%, so that would just be silly...
But lying down, Tilt has got it covered by using a towel for a pillow. I double-up my pillows by folding them in half and using the folded side, which brings my chin down toward my neck. Tilt's way would be extension, my way would be flexion. Not endorsed by Dr. Sclafani.

With the new Sclafani Maneuver® and Sclafani Venous Flow Pillows®, I'm betting there will be a line of t-shirts and posters next.

tilt

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...and I for one, welcome our new Neurologist overlords!

My before and after CCSVI treatment video http://www.youtube.com/watch?v=RhosV4_DvWw
Visit my Lego Amusement Rides website http://www.brickshelf.com/cgi-bin/gallery.cgi?m=Bolliger

Thanks tilt. The laughter is good. As therapeutic as the SM.

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Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

Good Humor this morning!

Dr. S the Australian TV article on Crissy has aired here on National TV and my phone has been running hot.
http://au.news.yahoo.com/sunday-night/f ... treatment/

Some opinions and stories are flowing on FB as you can imagine.

*The main interest that has been asked of me is "what is happening when ballooning, does the damaged material remain against the vein wall, does it reabsorb or is it removed by the healing processes".
**Can you give some sort of answer please?

Easy question as always,
Nigel

Nigel, this is a good question and i can only give an educated theory as there is little autopsy material after treatment.


when angioplasty is performed, the vein is stretched. Adjacent to the vein, within the vessel, the valve stretches. The leaflets of the valve appear to be fused or adherent to each other. So the leaflets are stretched as well and in being stretched, the valve is opened. it is likely still attached to the wall of the vein and is either compressed against the wall and then comes back into the flow of things with time, perhaps to restenose in the future.

I do not think that tissue is absorbed. Some of it may be torn off the vein wall. in such cases it would likely travel and lodge in the small blood vessels of the lung, obviously doing to no hemodynamic harm.

this is my best case conceptualization of what happens.

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Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

thekla, i think flexing the neck causes stretch on the spinal cord resulting in the sign. i do not think there is any connection to the flexion causes change in the vein size

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Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

Thanks Dr.S
In my mind we are hoping for the obstruction to stay against the wall, in reality of course we are open to every possibility imaginable.

**When there are other findings such as webs, septums and membrane is there any guesses/experiences there?

I am guessing also that retreating is a mine field knowing if there is an old or previously unseen issue.

*When I read some of your comments I get the impression that using IVUS in re-treat situations you are looking for original issues, treated issues and 'new' issues?

**Is there an actual situation we might call a new issue. Something that has happened as a result of flow improvement elsewhere in the vein or elsewhere in the collective system? Not caused by treatment in the past rather something that develops now the flow is increased where there has previously been low or less flow?

**Have you recovered, and are you looking after your self?

Regards Nigel

In my mind, i am hoping that the valve is opened up and will function again. But the primary goal is to keep the flow so that reflux above the valve no longer occurs. i am hoping over the years for a better solution, such as a percutaneously deployable synthetic valve replacement.


webs are lacy tissue that divides the vein drainage into smaller channels. Balloon should tear them open
septums are very challenging structures. their nature makes balloon angioplasty less effective than against valves. I think greater balloon diameter may be an answer. we shall see.



I don't look at it in that way.
I look at retreatment of patients previously treated by others as if my treatment was their first. So IVUS is very important to me. We know that venography can miss 25% of abnormalities. So why would i trust venography performed by others without IVUS?


yes, of course. I am trying to avoid using IVUS on my own retreatments. I reload the images from the first IVUS back into the IVUS unit and work from that. Hoping to save patients $2000 on retreatments.


I cannot think of any


very kind, Nigel, thank you. I am recovering nicely. I didnt miss or reschedule any patients. I have had some delay in addressing some patient email inquiries and questions but no patient was delayed! I feel very lucky to be alive and have a renewed sense of urgency to perfect my techniques

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Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com