DrSclafani answers some questions

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

Re: DrSclafani answers some questions

Postby Robnl » Fri Nov 23, 2012 10:28 am

Hi Doc

What are your thoughts about vagues nerve compression and Dr. Arata;s findings???

Regards,

Robert
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Re: DrSclafani answers some questions

Postby aliki » Sat Nov 24, 2012 3:25 pm

Lety wrote:
aliki wrote:thank you very much for your answers . I restarted taking coumadin and I feel better . I will try to find a good acupuncture place to have some treatments . My left jugular vein that is clotted creates lots of problems ..



Nice to hear that you feel better, why Dr. Sclafani did not treated your left jugular vein ? Will he do this ?


Dr Sclafani could not treat my left jugulae vein because it was clotted and he couldn't do anything . The clot was very hard .
I feel a little better than before but I continue to have ccsvi problems , fatigue, cog fog , dizzyness and the worst thing is that now I cannot see well the colors and my ears have a tinning . These are new, before the procedure I didn't have that even after my last relapse 2 days before the procedure I was seeing good the colors and there was no tinning . Did this happen to anyone else ? I do patience but I really feel awful . I believe that something didn' t go well in my case but I don't know what is this ..
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Re: DrSclafani answers some questions

Postby dania » Sat Nov 24, 2012 5:59 pm

aliki wrote:
Lety wrote:
aliki wrote:thank you very much for your answers . I restarted taking coumadin and I feel better . I will try to find a good acupuncture place to have some treatments . My left jugular vein that is clotted creates lots of problems ..



Nice to hear that you feel better, why Dr. Sclafani did not treated your left jugular vein ? Will he do this ?


Dr Sclafani could not treat my left jugulae vein because it was clotted and he couldn't do anything . The clot was very hard .
I feel a little better than before but I continue to have ccsvi problems , fatigue, cog fog , dizzyness and the worst thing is that now I cannot see well the colors and my ears have a tinning . These are new, before the procedure I didn't have that even after my last relapse 2 days before the procedure I was seeing good the colors and there was no tinning . Did this happen to anyone else ? I do patience but I really feel awful . I believe that something didn' t go well in my case but I don't know what is this ..

You are not the only one. All my veins that had angioplasty died.They became stringy dried strands. Zero blood flow. It seems the less blood flow the more disabled one becomes.
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Re: DrSclafani answers some questions

Postby vesta » Sun Nov 25, 2012 4:07 am

I suggested acupuncture and/or TENS self acupressure to Aliki. Do please look up the Acupuncture subject on the blog at my site MS Cure Enigmas.net to see what meridiens should be used because acupuncturists themselves aren't aware of the CCSVI MS theory and are not focusing on the correct meridiens (Gall Bladder and Bladder/Kidney) The Gall Bladder 21 point on the upper back where the neck meets the shoulder literally opens the blood flow in my case, I can feel it. I treat myself every morning and evenings too if stressed (or ask for a neck massage forcing the blood down towards the heart.) It may be that many with CCSVI have "sticky" valves or the veins collapse, but the veins are not actually blocked and can be worked on. I would try that before angioplasty. Since I started 2 years ago, I no longer have brain fog and don't have the severe fatigue. (I also went back to the gluten free diet etc) It's worth a try I can't see the harm in trying (of course no massage if you have a blood clot.) Was the IVUS used in dania's angioplasty?
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Re: DrSclafani answers some questions

Postby aliki » Sun Nov 25, 2012 12:33 pm

Vesta , I am looking for a good acupuncturist , I am ready to try everything that could help me .
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Re: DrSclafani answers some questions

Postby vesta » Sun Nov 25, 2012 12:42 pm

Sounds good. I'm hoping the best for you.
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Re: DrSclafani answers some questions

Postby milesap » Thu Nov 29, 2012 7:22 am

Any thoughts on the NIH study blaming fibrinogen crossing brain barrier causing MS giving credence to Dr Zamboni theory

http://www.medicalnewstoday.com/releases/253312.php
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Re: DrSclafani answers some questions

Postby Robnl » Thu Dec 06, 2012 5:17 am

Where is the doc? Still (lost? :wink: ) in Cambodia?
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Re: DrSclafani answers some questions

Postby NZer1 » Thu Dec 06, 2012 11:57 am

Just had an email Folks,
Dr S is alive and well and focused on work. He is aware of what is happening around the Net and is observing and learning from what is happening and being said. :)
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Re: DrSclafani answers some questions

Postby Cece » Sun Dec 09, 2012 11:07 am

NZer1 wrote:Just had an email Folks,
Dr S is alive and well and focused on work. He is aware of what is happening around the Net and is observing and learning from what is happening and being said. :)

Alive and well and not lost in Cambodia is good. I had a college roommate who went on to be a diplomat at the US embassy in Cambodia. Textile industry, politics, poverty.

I miss Dr. Sclafani's case studies though!
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Re: DrSclafani answers some questions

Postby Algis » Wed Dec 12, 2012 3:37 am

Cambodia is not the country where you want to be if you want to have a reasonable internet connection... Maybe in 5* hotel they are better but I doubt Dr.Sclafani would spend his life there :/
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Re: DrSclafani answers some questions

Postby drsclafani » Fri Dec 14, 2012 11:55 pm

Algis wrote:Cambodia is not the country where you want to be if you want to have a reasonable internet connection... Maybe in 5* hotel they are better but I doubt Dr.Sclafani would spend his life there :/


In the past two months, i have visited western china where i saw the ruins of a 2000 year old kingdom and the 1000 year old khmer kingdom of angkor wat in cambodia. In between the two trips, i had an awful lot of catching up to do, patients to care for and person life to attend to. sorry that i havent been here. but to be honest , there hasnt been a lot of talk here in the past two months. If there is more discussion, it would make it easier for me to remain committed.

for those that want to see angkor wat, you are invited to look at a link to my photo album of the place

https://dl.dropbox.com/u/44806001/Cambo ... 20Wat.ppsx

DrS
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Re: DrSclafani answers some questions

Postby Robnl » Sat Dec 15, 2012 1:49 am

Hi Doc,

Well, it's a bit quiet concerning ccsvi itself...but all kinds of ' bloodstream' things happening ..

I asked a few questions via mail (monthly report) but suppose the amount of mails are way above you head after 2 months :mrgreen:


Maybe an interesting case would bring up some discussion??

rgds,

Robert
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Re: DrSclafani answers some questions

Postby drsclafani » Sat Dec 15, 2012 2:25 am

aliki wrote:thank you very much for your answers . I restarted taking coumadin and I feel better . I will try to find a good acupuncture place to have some treatments . My left jugular vein that is clotted creates lots of problems ..

Dr Sclafani could not treat my left jugulae vein because it was clotted and he couldn't do anything . The clot was very hard .
I feel a little better than before but I continue to have ccsvi problems , fatigue, cog fog , dizzyness and the worst thing is that now I cannot see well the colors and my ears have a tinning . These are new, before the procedure I didn't have that even after my last relapse 2 days before the procedure I was seeing good the colors and there was no tinning . Did this happen to anyone else ? I do patience but I really feel awful . I believe that something didn' t go well in my case but I don't know what is this ..

dania wrote:you are not the only one. All my veins that had angioplasty died.They became stringy dried strands. Zero blood flow. It seems the less blood flow the more disabled one becomes.


Sorry Dania, the loss of these jugular veins is very sad.

thrombosis is related to a variety of causes, inadequate flow or stasis, inciting material in the vessel, damage of the venous wall, the degree of coagulability of the patient

thrombosis is a complication of angioplasty. Angioplasty stretches the vascular wall and this results in exposure of the muscle in the venous wall to the circulating blood. the exposed muscle chemically signals the platelet cells to aggregate to each other and to the injured wall and initiates the clotting cascade. thus angioplasty increases risk of thrombosis.

I treat my patients with a thrombin antagonist and platelet inhibition to retard the natural reaction during the healing process. Unfortunately it doesnt always work and thrombus may still occur. It happens in my practice in about 1.5% of my patients.

To try to salvage such situations, treatment of thrombosis must be swift. Untreated thrombus quickly organizes into a dense fibrotic situation that can result in loss of the vein as in dania's experience.

at the completion of my prophylactic regimen, I recommend a sonogram to find thrombosis early.

the following example represents such a case.

this 54 year old man was treated previously by another interventionalist with short term clinical improvements. I retreated the patient.
Image

The upper images show reflux in the occipital emissary veins. There was a stenosis of the inferior jugular bulb shown on IVUS to be caused by an immobile valve (top right). The two lower left images show an inflated balloon with two annular constrictions. While the lower one was eliminated, the upper one did not resolve despite several dilatations up to 22 atmospheres. Nonetheless, the image on the far right seems show a good dilatation and improved flow.

He was treated by pradaxa 150 mg every 12 hours for thirty days, accompanied by a daily 81 mg aspirin. After treatment the neck was sore, but no improvements ensued. Nothing seemed to change clinically except three days before i saw him in followup he had a day of intense fatigue. on the day i saw him his assessment was unchanged from prior to the procedure five weeks ago. An ultrasound was performed as is our routine and he had thrombosis of the right internal jugular vein, manifested on ultrasound by an absence of color flow in the lower third of the vein and by a lack of compressibility of the jugular vein.

He returned to the procedure suite the following morning. The images of that event (yesterday) were as follows

Image

images show the following:
1&2. the tip of the catheter is in the tip of the occluded vein: a fine line of contrast media indicates the existing size of the lower internal jugular vein. some contrast fills the upper IJV, not thrombosed.
3. The stiff end of a fine wire was advanced very carefully up the channel. You see where the tip ended. it was impossible to push it further up the vein, probably because of fibrin plug is preventing that from occurring.
4. The catheter was advanced up that wire and contrast study shows that part of the vein is filled with liquid clot. However the appearance extending up to the patent vessel remains a thin track.
5. using a stiffer wire looped around was pushed through the upper plug into the vein that was patent.
6. Finally a catheter extends across the obstruction and now linking the brachiocephalic vein to the upper jugular vein.
7. A thin balloon catheter was extended up along the wire and inflated. This creates a channel that can accomodate the larger stent catheter.
8. The balloon is finally fully inflated.
9. a stent is deployed. Self expanding nitinol, it opens at body temperature at it is uncovered.
10. A balloon is inflated to open the stent.
11. The stent is completely expanded to 10 mm.
12. Flow has been restored.

Now we must resume anticoagulation as the vein attempts to heal itself.

Any questions.
4.
2.
Salvatore JA Sclafani MD
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Re: DrSclafani answers some questions

Postby dania » Sat Dec 15, 2012 3:24 am

Taking medication to prevent clotting is not a guarantee one will not produce clots. I did and was taking 10mg of Coumadin My INR was 2.6 and clotted in the vein that was stented. I did not have clots in the other 2 veins and they developed scarring and died as well.
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