DrSclafani answers some questions

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

Re: DrSclafani answers some questions

Postby dlynn » Wed Aug 15, 2012 8:38 am

Dr. Sclafani,
Do MS patients risk rejection (by ins. providers) of being treated for NCS if it is considered
part of or associated with CCSVI (CCSVI/MS)?
thank you
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Re: DrSclafani answers some questions

Postby drsclafani » Wed Aug 15, 2012 11:25 am

dlynn wrote:Dr. Sclafani,
Do MS patients risk rejection (by ins. providers) of being treated for NCS if it is considered
part of or associated with CCSVI (CCSVI/MS)?
thank you

That is a risk especially if done during ccsvi treatment. However there is no proven association between nutcracker in and ms. If symptoms of nutcracker are present, I might treat that first and see if the symptoms improved before treatment of ccsvi
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Patient contact: ccsviliberation@gmail.com
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Re: DrSclafani answers some questions

Postby Cece » Wed Aug 15, 2012 11:53 am

Sake wrote:Thanks for your response Dr Sclafani, when my azygos was first treated I had large improvements, in saying this my right IJV was also ballooned, this was in August last year, I had been fine for the year up until the last month. I had a Doppler indicating restenosis of my right IJV and it wasn't until yesterday that I found out that the azygos had occluded. I wouldn't even be too sure regarding how long it's been like that. My recent symptoms already seem to be improving from yesterday's ballooning of the right IJV.

Do you believe occlusion is being caused by a blood clot in most cases or scarring of the vein? I also would love to know your thoughts on using drug eluting balloons if scarring may be the cause of restenosis and/or occlusions? Do you think they have any benefit?

Thanks for your time, it is very much appreciated.

Sake

Dr. Sclafani, have you seen an occluded azygous vein in any of your CCSVI patients? Or have any other IRs shared images of an occluded azygous vein?
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Re: DrSclafani answers some questions

Postby Cece » Wed Aug 15, 2012 1:38 pm

Sake wrote:Hi Cece, this is the first I'm hearing about the renal vein, I'd have to look into it to find out some info.. Is it common that people are finding blockages there? If so is it safe to balloon?

Here's a thread Dr. Sclafani started some time back about nutcracker syndrome in the renal vein: chronic-cerebrospinal-venous-insufficiency-ccsvi-f40/topic19330.html
The most serious risk of this procedure is migration of the stent. Patency is high, more than 95% percent at two years. Many patients have flank pain that can last a week or two. This is due to stretch of the vein by the stent. Oversizing of the stent is commonly done to reduce risk of migration.
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Re: DrSclafani answers some questions

Postby drsclafani » Wed Aug 15, 2012 9:33 pm

Cece wrote:
Sake wrote:Thanks for your response Dr Sclafani, when my azygos was first treated I had large improvements, in saying this my right IJV was also ballooned, this was in August last year, I had been fine for the year up until the last month. I had a Doppler indicating restenosis of my right IJV and it wasn't until yesterday that I found out that the azygos had occluded. I wouldn't even be too sure regarding how long it's been like that. My recent symptoms already seem to be improving from yesterday's ballooning of the right IJV.

Do you believe occlusion is being caused by a blood clot in most cases or scarring of the vein? I also would love to know your thoughts on using drug eluting balloons if scarring may be the cause of restenosis and/or occlusions? Do you think they have any benefit?

Thanks for your time, it is very much appreciated.

Sake

Dr. Sclafani, have you seen an occluded azygous vein in any of your CCSVI patients? Or have any other IRs shared images of an occluded azygous vein?


Yes, i have seen this complication. It is mostly likely caused by thrombosis rather than scarring.

Drug eluding stents and balloons show promise in reducing intimal hyperplasia, but intimal hyperplasia is not common after jugular angioplasty.

There are no drug eluding balloons in the sizes currently used to treat jugular stenoses.
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Re: DrSclafani answers some questions

Postby NZer1 » Wed Aug 15, 2012 9:41 pm

Hi, Dr S,
a patient of yours recently had narrowed internal Jugulars that were very difficult to open.

In these cases do you think that the narrowed section of vein is part of another problem, such as a vascular disease?

The narrowed sections of vein seen in some cases appear to be caused by something as yet unknown?

Regards,
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Re: DrSclafani answers some questions

Postby drsclafani » Wed Aug 15, 2012 10:07 pm

Sake wrote:Hi Cece, this is the first I'm hearing about the renal vein, I'd have to look into it to find out some info.. Is it common that people are finding blockages there? If so is it safe to balloon?


Nutcracker compression obstruction of the left renal vein occurs in about 20% of humans, most of whom are not symptomatic. It is called nutcracker syndrome when it is symptomatic. symptoms of renal vein obstruction include fatigue and imbalance, common symptoms in PwMS
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Re: DrSclafani answers some questions

Postby drsclafani » Wed Aug 15, 2012 10:24 pm

NZer1 wrote:Hi, Dr S,
a patient of yours recently had narrowed internal Jugulars that were very difficult to open.

In these cases do you think that the narrowed section of vein is part of another problem, such as a vascular disease?

The narrowed sections of vein seen in some cases appear to be caused by something as yet unknown?

Regards,
Nigel


nigel, we have a semantic issue here. Narrowing of the vein is a vascular disease. i am sure you mean something more specific. what is it.

i think that the case in question was similar to the other cases of stenosis. Sometimes it just is a stronger stenosis in the malformation.
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Re: DrSclafani answers some questions

Postby NZer1 » Wed Aug 15, 2012 10:36 pm

I am going to see Dr Paul Thibault in Australia and have a Doppler check of my Veins in a week or two. He is the one who DXed the CPn Bacterial infection of my 'brain'.
I am looking forward to step one of the journey to your operating theatre.
I got the news about the other case and wondered if there is something happening in the Southern Hemisphere?
The Australians are set in their minds about the findings not all being valves etc and it interests me!
The talk some time back from Mike Arata was much the same but opposite, that everything was valves.

So as an observer, I am observing and wanting to get some thinking going and feed back.:)

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Re: DrSclafani answers some questions

Postby Sake » Wed Aug 15, 2012 11:49 pm

drsclafani wrote:
Cece wrote:
Sake wrote:Thanks for your response Dr Sclafani, when my azygos was first treated I had large improvements, in saying this my right IJV was also ballooned, this was in August last year, I had been fine for the year up until the last month. I had a Doppler indicating restenosis of my right IJV and it wasn't until yesterday that I found out that the azygos had occluded. I wouldn't even be too sure regarding how long it's been like that. My recent symptoms already seem to be improving from yesterday's ballooning of the right IJV.

Do you believe occlusion is being caused by a blood clot in most cases or scarring of the vein? I also would love to know your thoughts on using drug eluting balloons if scarring may be the cause of restenosis and/or occlusions? Do you think they have any benefit?

Thanks for your time, it is very much appreciated.

Sake

Dr. Sclafani, have you seen an occluded azygous vein in any of your CCSVI patients? Or have any other IRs shared images of an occluded azygous vein?


Yes, i have seen this complication. It is mostly likely caused by thrombosis rather than scarring.

Drug eluding stents and balloons show promise in reducing intimal hyperplasia, but intimal hyperplasia is not common after jugular angioplasty.

There are no drug eluding balloons in the sizes currently used to treat jugular stenoses.


Thanks once again for your response Dr Sclafani. I discussed your thoughts regarding this type of complication with my surgeon although he does not believe that my case is caused by thrombosis. He also advised that he would be very open to discuss with you the details of my recent procedure and complications regarding the occlusion, for your thoughts and comments. Would it be ok if I included you in an email to him via your ccsviliberation@gmail.com email address in order to initiate this contact?
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Re: DrSclafani answers some questions

Postby NZer1 » Thu Aug 16, 2012 12:39 am

Another piece of news from FaceBook;
Jenna Mach
Hi Dr. Arata, I am sure you had a chance to see the video and know the theory of Atlas Orthognal; does this have a merit, sounds very convincing and very logical but we have been "showered" with so much logic but nothing seems to be "IT" and yet we go after all what has been served from the "MS ALMOST CURE” Menu. Would appreciate your input, Jenna.
Mike Arata;
Stylocervical compression identified at venography is the most common cause of lack of response with CCSVI treatment. Atlas alignment therapies such as NUCCA seem to relieve stylocervical compression. This leads to conversion of non-responders in most cases. This is the case even if both jugulars are occluded.
https://www.facebook.com/Dr.Arata

Thoughts?

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Re: DrSclafani answers some questions

Postby CureOrBust » Thu Aug 16, 2012 4:33 am

NZer1 wrote:I am going to see Dr Paul Thibault in Australia and have a Doppler check of my Veins in a week or two. He is the one who DXed the CPn Bacterial infection of my 'brain'.
I am looking forward to step one of the journey to your operating theatre.
I have had two treatments in Australia. After these two, I went and saw Dr Thibault and his sonographer for a follow up, and they could not find any evidence of CCSVI. I was then treated by Dr S in Brooklyn, and he did find evidence using the ultrasound, and also more than one location to treat. NB I am a non responder. :sad:
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Re: DrSclafani answers some questions

Postby NZer1 » Thu Aug 16, 2012 11:38 am

CureOrBust wrote:
NZer1 wrote:I am going to see Dr Paul Thibault in Australia and have a Doppler check of my Veins in a week or two. He is the one who DXed the CPn Bacterial infection of my 'brain'.
I am looking forward to step one of the journey to your operating theatre.
I have had two treatments in Australia. After these two, I went and saw Dr Thibault and his sonographer for a follow up, and they could not find any evidence of CCSVI. I was then treated by Dr S in Brooklyn, and he did find evidence using the ultrasound, and also more than one location to treat. NB I am a non responder. :sad:


When I go to see Paul this is the sort of info I need to be telling him. He is in favour of IVUS and there isn't interest from the IR's, so its a problem for us all at the end of the day.
The areas that Sal found may not have been detectable with Doppler, eg azygos. Where were the areas Sal found using ultrasound Cure?

Sal are you able to help in this, I want to give Paul the benefit of your experience, even if he doesn't contact you for what ever reason to ask for help!

If Paul doesn't get this feed back nothing will change!

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Re: DrSclafani answers some questions

Postby NZer1 » Thu Aug 16, 2012 3:26 pm

Previously Unknown Cleaning System in Brain: Newer Imaging Technique Brings 'Glymphatic System' to Light

"Understanding how the brain copes with waste is critical. In every organ, waste clearance is as basic an issue as how nutrients are delivered. In the brain, it's an especially interesting subject, because in essentially all neurodegenerative diseases, including Alzheimer's disease, protein waste accumulates and eventually suffocates and kills the neuronal network of the brain," said Iliff.
"If the glymphatic system fails to cleanse the brain as it is meant to, either as a consequence of normal aging, or in response to brain injury, waste may begin to accumulate in the brain. This may be what is happening with amyloid deposits in Alzheimer's disease," said Iliff. "Perhaps increasing the activity of the glymphatic system might help prevent amyloid deposition from building up or could offer a new way to clean out buildups of the material in established Alzheimer's disease," he added.

http://www.sciencedaily.com/releases/20 ... 142042.htm
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Re: DrSclafani answers some questions

Postby NZer1 » Thu Aug 16, 2012 4:38 pm

http://stm.sciencemag.org/content/4/147/147ra111
ABSTRACT

Because it lacks a lymphatic circulation, the brain must clear extracellular proteins by an alternative mechanism. The cerebrospinal fluid (CSF) functions as a sink for brain extracellular solutes, but it is not clear how solutes from the brain interstitium move from the parenchyma to the CSF. We demonstrate that a substantial portion of subarachnoid CSF cycles through the brain interstitial space. On the basis of in vivo two-photon imaging of small fluorescent tracers, we showed that CSF enters the parenchyma along paravascular spaces that surround penetrating arteries and that brain interstitial fluid is cleared along paravenous drainage pathways. Animals lacking the water channel aquaporin-4 (AQP4) in astrocytes exhibit slowed CSF influx through this system and a ~70% reduction in interstitial solute clearance, suggesting that the bulk fluid flow between these anatomical influx and efflux routes is supported by astrocytic water transport. Fluorescent-tagged amyloid β, a peptide thought to be pathogenic in Alzheimer’s disease, was transported along this route, and deletion of the Aqp4 gene suppressed the clearance of soluble amyloid β, suggesting that this pathway may remove amyloid β from the central nervous system. Clearance through paravenous flow may also regulate extracellular levels of proteins involved with neurodegenerative conditions, its impairment perhaps contributing to the mis-accumulation of soluble proteins.
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