DrSclafani answers some questions

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Re: DrSclafani answers some questions

Postby drsclafani » Wed Jul 18, 2012 3:28 pm

NZer1 wrote:Sounds to me like Pathology studies to show what does physically happen with PTA will be needed to take the guess work out of the equation.

If I understand correctly there isn't a way to measure the flows before, during and after PTA, and there is no way of knowing what is popping or tearing under pressure.


I WOUND NOT AGREE WITH THAT. i AM FAIRLY SURE THAT FOR THE MOST PART THE VALVES AND TISSUES CONNECTED TO MALFORMED VALVES ARE WHAT ARE STRETCHED AND TORN

I am guessing that until it is understood what re-stenosis looks like we are in the dark.


actually, i do not feel like i am in the dark anymore. i am fairly confident that I know what i am doing and how things are opened.

my problem is mostly in predicting who will respond to that treatment


** Pathology studies would have happened in the past to evaluate Angio in other areas of the Body for other reasons, is it something that crosses over to be accurate when working on Juggs and Azy?


pathology studies require either surgery or autopsy to get the tissue to do pathological studies. The good thing is that most patients with MS do not die at an early age.

I have always believed that the MS disease is too loose a term and that there are many, many subtypes of the disease and that the Progressive disease is the truest form. Studies on the Vascular involvement on this form in my humble opinion are where the greatest knowledge gain will be. If Pathology studies are used with the focus on the restrictions and pathways back to white and grey matter lesions that will be the inroad to knowledge. The methods of changing the flow issues will again be based on Pathology insights.


nigel, i am sure you are not a willing volunteer for such pathological studies. we want you to keep on living!!!
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Re: DrSclafani answers some questions

Postby drsclafani » Wed Jul 18, 2012 3:53 pm

NZer1 wrote:Dr. S does having Ultrasound testing give any sort of flow indications in cases like the one above?

It seems it could be to do with the flow improvement by making the valves slightly more open and in still in one piece as opposed to being fully against the wall and then returning/healing to original configuration and symptoms returned prior to seeing you?

Yet the end result was a situation of the valves partial function or total dyfunction destroyed and the residual remains attempting to reattach/heal and recreating a stenosis?


Nigel, thank you for this discussion. It leads me to discuss what i think it sreally going on with the valves.

Integrating what i see by coppler ultrasound, venography and IVUS, I am of the opinion that there are many variable possibilities. I say possibilities because our imaging is still imperfect, even with IVUS. Perhaps the next iteration of IVUS, the so called high resolution IVUS, will expand our understanding. For the most part i now think that the abnormalities at the valves include stenoses valves of thickened tissue that does not open, thick valves that are scarred together, thick valves with septums attaching to the vein wall preventing opening and closing, valves associated with webs that are tissue bands and cells that restrict flow. true full septums that divide the lumen of the vein into segments and each segment has less flow that their total area. I am sure there are other variations. I agree that pathology studies will provide new insights, but these are are not perfect either because what they show is not identical to what is seen in a living beating flowing vein.

Is there reflux more pronounced and regular now?


Again, Negel, there are two kninds of reflux, reflux of blood flowing up from the heart and refluxifrom blood flowing down from the brain. Very different ideas.

The flow speed and volume in each treatment before and after might be of interest?


probably, blut this is not all about flow

It would be interesting to be able to identify what the improvement is from the first treatment, it almost sounds like the recovery in some Stroke Treatments?


only in a general sense. Stroke is so very different from this

Is there a problem remaining with CSF flow that hasn't returned to normal or first treatment quality. The CSF flow and symptoms are very similar to CCSVI and MS symptoms?

Problems such as Chiari Malformation issues which are often related to the slowing of CSF because of restricted flow in the region of the Brain Stem (have or share symptoms with MS and CCSVI)?


yes, in some way, i think that venous outflow obstruction impedes CSF drainage. Dont the ventricles drain through the pacchionian granulations into the veins?

Changing the vascular flow also changes the CSF and the Arterial flow and all three are interlinked and dependent on each other, change one and you change them all?


i agree


Adjustments to the Atlas/C1 are giving in some cases the same benefit as PTA and the flows improvements have been measured, (before and after the adjustment). Results are published by the way. This change in symptoms was attributed to CSF flow changes measured by MR, they occurred as quickly as on table improvements with some PTA? Co-incidence or part of the puzzle?


interesting, can you send me the references

Having enough information detail with the PTA treatments so that observations can be made and understood with any change in symptoms, BUT which detail, there's a missing piece, what is it, HELP?

Regards,
Nigel


yo no se, mon
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Re: DrSclafani answers some questions

Postby drsclafani » Wed Jul 18, 2012 4:03 pm

NZer1 wrote:Question for Dr. S and all watchers,

** Do people with RRMS also have a RR symptom experience with PTA?


yes, if i understand your question correctly

** Do people who have only had progression MS ever experience a relapse of symptoms after PTA?

absolutely

** Question for Dr. S are you interested in doing a inspection with IVUS and not ballooning, purely to map any all veins for me?

Thought fodder,
Nigel


what a waste that would be. most of the risk and none of the benefits.

Nigel, you have to explain to m e the rationale for that one. But we should do it in person.

as the Firesign Theater said: You have to stick it out if you want to get a head
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Re: DrSclafani answers some questions

Postby drsclafani » Wed Jul 18, 2012 4:04 pm

Cece wrote:
NZer1 wrote:** Question for Dr. S are you interested in doing a inspection with IVUS and not ballooning, purely to map any all veins for me?

I can't think why you would want this? In my experience, the ballooning is the best part....
I think the B-mode findings are more revealing after treatment.

If I'd been paying attention for the last two years, I'd remember what b-mode findings were. :sigh:

I experience l'Hermittes very early on, pre-MS diagnosis, and not since 2001.


cece

when ultrasound echos are put through a computer they created images. These are B-mode
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Re: DrSclafani answers some questions

Postby drsclafani » Wed Jul 18, 2012 4:15 pm

NZer1 wrote:Now that I am getting closer to having some form of treatment my mind has re-engaged with the unknowns in this picture.

** Is there any difference in outcome for people who have active lesions (Gadolinium Injection) on MRI at the time of PTA?

** I have not had active lesions on MRI over a 5 year period yet the lesions appeared in a 6 month space between MRI's and one on my cord was not seen two months ago. Is there a difference in outcomes if a person has stable MRI results at the time of PTA?

** Is a person with RRMS having a difference in the symptom outcome due to the timing of relapses and the PTA Treatment?

** Does the re-stenosis effect after PTA happen across at disease forms, RRMS, SPMS, PPMS and Benign?

** Has there been any symptom outcome that has co-in-sided with an accident, physical stress or any other high pressure cause on the vascular system after PTA?

Regards,
Nigel

# Just saw your comment as I was posting this Cece,
I don't have the access to regular treatment and I don't have the finance for multiple treatments. My disease is not confirmed as MS after 6+ years and I am a slow progressive in what ever is happening (life story, lol). My symptoms started after excessive physical stress on my upper spine and at this stage there is no guarantee of length of benefit from PTA. So I am one to keep a level head and evaluate the options as I see them. If I have IVUS inspection/assessment and down the track there is another option to PTA I still have untouched vein contents and a map of them to look at options at some time! And also Sal will want to retire one day, when will that be, I will feel at a great loss at that time.
Nigel



nigel two commends.


I DO NOT TREAT MS; I TREAT CCSVI. IF YOU HAVE SYMPTOMS THAT M IGHT BE CCSVI THEN I WILL TREAT YOU. lET THE CARDS FALL WHERE THEY MAY.


YOU ARE HIGHLY LIKELY TO HAVE VALVULAR ABNORMALITIES IF YOU HAVE MS. DOING A SIMPLE VENOPLASTY WILL DETERMINE WHETHER AND HOW MUCH BENEFIT YOU DERIVE. THIS IS NOT THAT COMPLICATED, ALTHOUGH THE UNDERSTANDING IS PRETTY COMPLICATED. bUT IN GENERAL, M OST OF THIS IS PRETTY STRAIGHTFORWARD. DERRICK HAD SOME STENOSES, THEY WERE TREATED, HE GOT BETTER. HOORAH!

OTHERS DONT DERIVE A BENEFIT: SO TRAGIC, BUT SITTING ON THE SIDELINE NEVER GETS YOU A DANCE.

WITH REGARD TO THE LAST POINT: I AM 65 YEARS OLD. THE ONLY WAY I WILL STOP DOING THIS IS IF THERE IS INSUFFICIENT PATIENT INTEREST TO CONTINUE. IF I GET TOO OLD, I WILL TRAIN SOMEONE TO TAKE OVER M Y PRACTICE.

WHAT IS THE ISSUE? I LOOK AT LIFE AS A SIMPLE PROPOSITION, MADE COMPLICATED BY HUMAN THINKING
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Re: DrSclafani answers some questions

Postby drsclafani » Wed Jul 18, 2012 4:18 pm

1eye wrote:
NZer1 wrote:** Is there any difference in outcome for people who have active lesions (Gadolinium Injection) on MRI at the time of PTA?

** I have not had active lesions on MRI over a 5 year period yet the lesions appeared in a 6 month space between MRI's and one on my cord was not seen two months ago. Is there a difference in outcomes if a person has stable MRI results at the time of PTA?
vascular system after PTA?

...

And also Sal will want to retire one day, when will that be, I will feel at a great loss at that time.
Nigel

Are you thinking there are Heizenberg effecta that cause as many problems as they solve, due to Gadolinium use or PTA?

And about retirement: perish the thought!! He does want to retire eventually. My father in law drives a truck, puts up and takes down tents and display cases, is on his feet all day, and carries heavy boxes in his "job" twice a week, at age 82. (He also smokes, so no recommendations here.) I would not trust my father-in-law with an IVUS, though. I will feel a loss too, but he has already done so much, that I am grateful anyway.


ONE EYE

ITS NOT WORKING OR RETIREMENT THAT FRIGHTENS ME, ITS THE ALTERNATIVE

IF THERE WERE ENOUGH PATIENTS, I WOULD HIRE A PROTOGE AND CONTINUE THIS INTO THE FUTURE.

IN THE MEANTIME, ENJOY ME!
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Re: DrSclafani answers some questions

Postby drsclafani » Wed Jul 18, 2012 4:26 pm

1eye wrote:It's still early to declare a victory, but do you think ballooning twice over this short a time could turn out to make the thing last longer? I realize you would only do it for restenosis.

just a hunch based upon an educated guess, but YES, i do think second procedures will play a role. we just have to get them funded because who can afford them!
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Re: DrSclafani answers some questions

Postby drsclafani » Wed Jul 18, 2012 4:28 pm

dlb wrote:Dr. Sclafani,
Regarding your last case study and other patients whose veins don't remain patent..... Is something like Ehlers Danlos at play, where collagen is not typical? Is that a possibility for veins not holding up after venoplasty? Just thoughts I have.... We are all so different!


my assessment was that the patient i described did not have EDS.

but have no doubt the veins of PwMS are different, thicker, denser collagen in the wall,
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Re: DrSclafani answers some questions

Postby Cece » Wed Jul 18, 2012 9:04 pm

drsclafani wrote:I think the B-mode findings are more revealing after treatment.

I looked up the ultrasound criteria from Dr. Zamboni that specifically mentions b-mode:
3. B-mode abnormalities or stenoses in IJVs. IJV stenosis was defined as a cross-sectional area of this vein less than or equal to 0.3 cm2. Flaps, webs, septums, etc., in the lumen of IJVs were considered B-mode abnormalities.
http://www.fondazionehilarescere.org/pd ... 5-ANGY.pdf

When I had a follow-up doppler this spring, my local IR thought it was good that he could not see any sign of the previously treated valves in either jugular vein. If he had seen a valve, would that have been a b-mode finding?
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Re: DrSclafani answers some questions

Postby NZer1 » Wed Jul 18, 2012 10:50 pm

Thanks Dr S for all your replies I have been brewing a few more for you but in the mean time I'll put a copy of a question to Dr F that was sparked by one of your answers to me Dr S.

Quote
"Hi everyone,
I have a question that has sparked from reading another thread.

** When the Dr Rosa team do there imaging do they check in several positions of rotation and forward or backward tilt of the head to get the readings regarding CSF flow and hopefully artery and vein flow?
Happy Poet are yo able to help with this please?

I am going to look for the earlier studies on blood pressure if any one has a link please could you let me know. What I recall is that the BP for people with high BP changed when they had an Altas adjustment.

My understanding from watching Dr S thread is that the flow readings will change with head rotation and neck position, which is natural and makes perfect sense. I am wondering if this is taken into account and publicised in the Dr Rosa and the other study on BP changes.

If Dr S is finding positive and negative readings purely because of rotation and position in the jugulars for instance with position and rotation then it will correspond with readings in the flows of all fluids in and out and CSF higher up. Its simply a case of where the hose is crimped, it won't matter where down stream for the testing only up stream position and finding it to check for pressure before and after so that you find the pressure point and the same corresponding zero pressure on the other side of the 'crimp'.

The Fonar study on CSF flow changes because of an AO adjustment;
http://www.fonar.com/pdf/PCP41_damadian.pdf"
Quote
"The first important observation of this study of eight MS patients was that every MS
patient exhibited obstructions to their CSF flow when examined by phase coded CSF
cinematography (ciné) in the upright position (Table 2A, col. 10 & 13). All MS patients
exhibited CSF flow abnormalities that were manifest on MR cinematography as interruptions to flow or outright flow obstructions somewhere in the cervical spinal canal,
depending on the location and extent of their cervical spine pathology (Table 2A, col.
10, 11 & 13). Normal examinees did not display these flow obstructions (Table 2B, col.
10 & 11)."
And from Dr CHU in the same publishing
"If trauma induced “leakage” of CSF proteins into the surrounding brain parenchyma,
and particularly “leakage” of antigenic proteins, is contributing to the formation of MS
plaques, then the vascular expansion stenting of the Azygous and Internal Jugular Veins
recommended by Zamboni et al. (16) could be monitored after installation by UPRIGHT
®
phase coded MRI measurements of CSF flow. Upright phase coded imaging of
CSF flow would assure that installed expansion stents are achieving the corrections of
CSF flow dynamics and intracranial pressure (ICP) that are needed to terminate plaque
generating CSF “leaks”.

Regards Nigel
ps Dr S did you get my questionnaire back?
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Re: DrSclafani answers some questions

Postby NZer1 » Thu Jul 19, 2012 12:36 am

Found the article that imo goes hand in hand with the jig saw, Dr Zamboni, Dr Schelling, Dr Flanagan, Dr Damadian, Dr Rosa, Dr Zivadinov et tal , in relationship of all flows Blood in/out and CSF. And the crossing of the BBB and CSF is being pumped into the white matter.

http://www.nucalispinalcare.com/pdf/1.pdf
Quote;
"Secondary efficacy end points
A summary of the X-ray changes both pre- and postprocedure throughout the study is noted in Table 3.
It is noteworthy that the difference in both rotational
and lateral positioning persisted for 8 weeks, as did
the reduction in BP, Table 3."

Thought fodder,
Nigel
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Re: DrSclafani answers some questions

Postby NZer1 » Thu Jul 19, 2012 12:40 am

Cece wrote:
drsclafani wrote:I think the B-mode findings are more revealing after treatment.

I looked up the ultrasound criteria from Dr. Zamboni that specifically mentions b-mode:
3. B-mode abnormalities or stenoses in IJVs. IJV stenosis was defined as a cross-sectional area of this vein less than or equal to 0.3 cm2. Flaps, webs, septums, etc., in the lumen of IJVs were considered B-mode abnormalities.
http://www.fondazionehilarescere.org/pd ... 5-ANGY.pdf

When I had a follow-up doppler this spring, my local IR thought it was good that he could not see any sign of the previously treated valves in either jugular vein. If he had seen a valve, would that have been a b-mode finding?


Dr S this radiology finding where the valve or other issue is no longer visible seems to be important?
Is this what you are finding? and the rest of the IR's of course

If the vein is repairing and not leaving obstructions that could impede flow then there is an amazing positive in the jig saw picture?

Regards
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Re: DrSclafani answers some questions

Postby drsclafani » Thu Jul 19, 2012 1:05 am

NZer1 wrote:Found the article that imo goes hand in hand with the jig saw, Dr Zamboni, Dr Schelling, Dr Flanagan, Dr Damadian, Dr Rosa, Dr Zivadinov et tal , in relationship of all flows Blood in/out and CSF. And the crossing of the BBB and CSF is being pumped into the white matter.

http://www.nucalispinalcare.com/pdf/1.pdf
Quote;
"Secondary efficacy end points
A summary of the X-ray changes both pre- and postprocedure throughout the study is noted in Table 3.
It is noteworthy that the difference in both rotational
and lateral positioning persisted for 8 weeks, as did
the reduction in BP, Table 3."

Thought fodder,
Nigel

Nigel
thank you for this interesting paper. But I do not see the relevance of hypertension to ms or to ccsvi. Not to disparage the theories regarding venous obstruction and atlas malalignment, this paper does not address this issue. It will be interesting to see if realignment of the atlas in PwMS will lower their blood pressures. I find that most of my patients have lowish bp. I am realy curious about atlas realignment's effect upon emissary vein flow.
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Re: DrSclafani answers some questions

Postby NZer1 » Thu Jul 19, 2012 1:35 am

From conversations with Dr F the BP effect may also be altered by the contact of the Brain stem where the BP is sensed from. If the contact is relieved the BP is effected.
I think that the low BP in MS is more of a clue than we have taken notice of. The balance issues also can be derived from alignment issues because of the disruption to the ear canals. So it seems to me that some more symptoms may be packaged with alignment, some with CCSVI and a combination of alignment and vascular malformation or function tips people into various disease categories/ or dx's.
Parkinson's, Alzheimers, MS, Irritable Bowel, and many more are being drawn into this picture of dx's of these causes (alignment and vascular combined).

**Dr S how long does the research give for internal vascular healing as an average? Double treatment time frames? Broken nose healings are all I know about, lol.

Nigel
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Re: DrSclafani answers some questions

Postby Robnl » Thu Jul 19, 2012 3:53 am

Doc,

You wrote:
I find that most of my patients have lowish bp


The bp is measured in the arteries, isn't it strange that the bp is lowish? Taking in regard that the outflow is 'disturbed' so the inflow gets more difficult =>> higher bp??

For me personally; i used to have a firm heartbeat...nowadays i almost cannot feel my heartbeat (yeah i'm still alive i suppose :mrgreen: )
Ofcourse i used to play football and now only some exercises...
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