DrSclafani answers some questions

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Re: DrSclafani answers some questions

Postby EJC » Fri Dec 21, 2012 2:02 pm

Cece wrote:
EJC wrote:I follow this thread, despite not understand a reasonably large amount if it, I do try.

The fact you're here and spend the time discussing this subject in such detail with your patients and anyone else wanting to ask questions is simply outstanding, like you haven't got enough on your plate already.

Outstanding is a good word for it. Remarkable, surprising, appreciated? I would not have the knowledge I have if it weren't for what has been taught here.

EJC, you and someone else made a comment recently about not understanding everything here. I couldn't find the other comment. I was wondering what parts aren't being understood?


I get lost with some of the medical speak, I don't have a full grasp of the anatomy of the area and as I jump in and out of this thread I also miss developments.

It's why I thought it would be a good idea to ask Dr S for an overview of where he is but dumbed down as much as possible so I (and others) can grasp it a little better.

I would love to have the time to do a basic anatomy course so I could understand this a little more, sadly I don't.
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Re: DrSclafani answers some questions

Postby EJC » Fri Dec 21, 2012 2:20 pm

dlynn wrote:EJC,
I found your question #3 to be curious. Never having been diagnosed with TMJ,(I have seen a specialist) I seemed to have symptoms.
My jaw had been locked for approx. 4yrs. causing (right side) inner ear , jaw, and neck pain. I had embolization done and the following day, my jaw unclenched and there is no more pain. I did have CCSVI procedures, but they never improved my jaw. I don't know if it's a coincidence, but it is interesting.
I believe changes/improvements should be noted.


Some of my questions may well be curious as they are often middle of the night ramblings of my mind when I can't sleep.

We're all here trying to get to grips with what any of this is, sometimes I find it helpful just to throw out thoughts, some can be discounted immediately, others may make us think.

It was only last week that it dawned on me CCSVI treatment and Jaw/Skeletal misalignment treatment provided relief of two completely different sets of symptoms. Up until now my mind has been concentrating on "MS" not breaking down the symptoms into their component parts.

If we diagnose a mechanical/electrical problem with a car, we start with symptom and try and follow it back to it's root cause in the hope solve it.

Over the years MS seems to have missed out on this logic by the powers that be simply addressing one thing (immune system) and providing products to deal with symptom relief. A patient would sit in front of their specialist describe a list of symptoms and they would all be attributed to "brain lesions" or "MS".

There is a part of mind that says things like this:-

Your hands and feet are cold? Then your circulation is clearly an issue.

Neuralgic pain? Then I think of trapped nerves like a sciatica problem.

Eyesight issues like Optic Neuritis ? Is there excess pressure around the back of the eyeball (cranial pressure).

etc etc.
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Re: DrSclafani answers some questions

Postby Cece » Fri Dec 21, 2012 3:01 pm

If the case today involved the renal and azygous, this is a good image for the anatomy and whereabouts of relevant veins:
Image
This was already in my photobucket account, so it's no trouble to post this sort of thing if anyone finds it helpful.

You can see the left renal vein where it's labelled. Also notice the much smaller vein coming off the top of the left renal vein that leads up into the hemiazygous vein. If the left renal vein is compressed, then the flow is diverted into the hemiazygous vein. It looks like the hemiazygous vein then crosses over and drains into the azygous vein.
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Re: DrSclafani answers some questions

Postby Cece » Fri Dec 21, 2012 3:11 pm

http://en.wikipedia.org/wiki/Azygos_vein
Image
This might be a better image. See the red artery running behind the left renal vein?

My own hemiazygous and renal vein anatomy is in some way a variant but I do not know how! At the end of my July 2011 procedure, Dr. Sclafani mentioned that it was a variant, and that instead of going from x vein to x vein to get to the renal vein, he went from x vein to y vein to z vein. He spoke fast when he shared this, and I with less knowledge did not catch the exact variant. But I don't think it matters, as the salient point was that it was a variant route but not in any way a damaging route.
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Re: DrSclafani answers some questions

Postby drsclafani » Fri Dec 21, 2012 8:13 pm

Cece wrote:
drsclafani wrote:
pelopidas wrote:I had a terrible chronic neck pain and occipital headache (in the back of my head) for the past 7-8 years.
MRI showed some mildly prolapsed cervical disk, so i thought i would live with it forever. I was having physiotherapy and i was taking pain killers almost every second day.
Then, 6 months ago (6/10/2011) i had my angioplasty procedure.
One month later i was talking to Dr Sclafani about the great improvements i already had. I mentioned that my neck pain was unexpectedly disappeared. He replied only "Ah, it was the spasm!"

I found what he meant:

Image
this is the anatomy and the vessels of the sternocleidomastoid muscle (only the arteries here, the veins were of no importance until recently)

Image
almost 90% of this pair of muscles has venous outflow through the jugulars
Maybe the spasm was some symptom of venous congestion of the muscles.
I am relieved of the neck pain and i can turn and flex my head so easily now.
I hope that this will last forever and so will all my other improvements.
Maybe other people have experienced the same thing.
Muscles have veins, too!

Thank you again Dr Sclafani (and this one is a special 6 months post-op thank you)!
-and thank you Cece for the image uploading advice!


glad you are a poster child for ccsvi. you are a lucky one. not everyone has such great responses. but it could not happen to a nicer woman.

a hint on sharing images on TIMS: dont use URL, use [img]type_out_url[/img]. This command will push the image directly into your email. your audience will not have to press on the link. see your image by my technique. They show directly in the post.

very interesting hypothesis regarding reduction of neck pain.what about this consideration: patients with MS often havfe very large condylar emissary veins that connect to the veins in the posterior neck. Could relieving the resistance in the IJV, reduce flow through the emissary vein and thus reduce venous congestion in the neck muscles?


Sal

this is what you're looking for, pelopidas?

In infants, stenosis in the internal jugular vein can lead to congestion and clotting in the small veins of the neck muscles which leads to scar tissue in the neck muscle which leads to torticollis. So what Dr. Sclafani says about internal jugular stenosis potentially leading to congestion of the neck muscles is plausible and supported in torticollis research.


the most common reflux I see during venography is from the dural sinus to the occipital emissary and the condylar emissary veins These veins drain into the posterior cervicals veins. Many headaches patients have that improve involve the skull base in the back of the neck. This is what suggested to me that some of these headaches might be vascular congestion of the muscles of the back of the neck
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Re: DrSclafani answers some questions

Postby drsclafani » Fri Dec 21, 2012 8:18 pm

EJC wrote:
drsclafani wrote:It is unclear whether one procedure supersedes the other. I fail to see how realignment does anything to manage a stenosis of a vein that results in venous obstruction of the inferior jugular bulb. Moreover, i fail to see how treating venous obstruction does anything for CSF obstructions at the skull base.


Yup, that's why we're all here throwing suggestions around, trying to understand how all these things interact, or even if they interact at all.

I have a feeling (and that's all it is as I have no medical training whatsoever) the Emma was under treated for CCSVI in Scotland, simply because more is now understood. The Canadian lady discussed above is an example of what I think occurred, fortunately we decided to have no stents in the original procedure.

However, as Emma is now undergoing skeletal and jaw misalignment treatments it would be logical to complete that before considering anything else. There's also the small matter of finding another $10,000 or so for another procedure.

Would we do it differently in hindsight? Probably, we'd do the skeletal stuff first. That may simply be due to hindsight, or the realisation that CCSVI is still (or was) in it's infancy in 2010 when Emma was treated.

Does one come before the other? I have no idea, if there's a correct order of treatment that assumes the two "conditions" actually interact, that's another big assumption.


Are you saying that the reason to do skeletal manipulations before the ccsvi treatment is related the fact that relates to the fact that ccsvi techniques are in evolution?
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Re: DrSclafani answers some questions

Postby drsclafani » Fri Dec 21, 2012 8:20 pm

dlynn wrote:EJC,
I found your question #3 to be curious. Never having been diagnosed with TMJ,(I have seen a specialist) I seemed to have symptoms.
My jaw had been locked for approx. 4yrs. causing (right side) inner ear , jaw, and neck pain. I had embolization done and the following day, my jaw unclenched and there is no more pain. I did have CCSVI procedures, but they never improved my jaw. I don't know if it's a coincidence, but it is interesting.
I believe changes/improvements should be noted.


dlynn
i think this should be clarified because the reference to embolization many not be familiar to many readers.
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Re: DrSclafani answers some questions

Postby EJC » Sat Dec 22, 2012 4:28 am

drsclafani wrote:
EJC wrote:
drsclafani wrote:It is unclear whether one procedure supersedes the other. I fail to see how realignment does anything to manage a stenosis of a vein that results in venous obstruction of the inferior jugular bulb. Moreover, i fail to see how treating venous obstruction does anything for CSF obstructions at the skull base.


Yup, that's why we're all here throwing suggestions around, trying to understand how all these things interact, or even if they interact at all.

I have a feeling (and that's all it is as I have no medical training whatsoever) the Emma was under treated for CCSVI in Scotland, simply because more is now understood. The Canadian lady discussed above is an example of what I think occurred, fortunately we decided to have no stents in the original procedure.

However, as Emma is now undergoing skeletal and jaw misalignment treatments it would be logical to complete that before considering anything else. There's also the small matter of finding another $10,000 or so for another procedure.

Would we do it differently in hindsight? Probably, we'd do the skeletal stuff first. That may simply be due to hindsight, or the realisation that CCSVI is still (or was) in it's infancy in 2010 when Emma was treated.

Does one come before the other? I have no idea, if there's a correct order of treatment that assumes the two "conditions" actually interact, that's another big assumption.


Are you saying that the reason to do skeletal manipulations before the ccsvi treatment is related the fact that relates to the fact that ccsvi techniques are in evolution?


I don't think it would be reasonable to consider that the single defining factor but it is certainly a consideration when taking everything as a whole.

However, it's a conclusion in hindsight simply based on how far CCSVI has come in the two years since my wife had a procedure.

Where will CCSVI be in two years from now?

It's one of those conundrums that you're faced with in life. Do I get it done now or wait?

That was the thought process that lead me to ask the guestion of you a few posts back - "Where do you think you are with CCSVI right now?"
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Re: DrSclafani answers some questions

Postby EJC » Sat Dec 22, 2012 4:34 am

Cece wrote:http://en.wikipedia.org/wiki/Azygos_vein
Image
This might be a better image. See the red artery running behind the left renal vein?

My own hemiazygous and renal vein anatomy is in some way a variant but I do not know how! At the end of my July 2011 procedure, Dr. Sclafani mentioned that it was a variant, and that instead of going from x vein to x vein to get to the renal vein, he went from x vein to y vein to z vein. He spoke fast when he shared this, and I with less knowledge did not catch the exact variant. But I don't think it matters, as the salient point was that it was a variant route but not in any way a damaging route.


Thanks for posting these Cece.

I have a basic grasp of what the procedure is and where everything is. In so much as I understand what the procedure does and what it's treating.

Where I get lost is the mechanics of the flow and when the discussions start to get detailed. A good example is the post above by Dr S.


drsclafani wrote:
the most common reflux I see during venography is from the dural sinus to the occipital emissary and the condylar emissary veins These veins drain into the posterior cervicals veins. Many headaches patients have that improve involve the skull base in the back of the neck. This is what suggested to me that some of these headaches might be vascular congestion of the muscles of the back of the neck


I can look at an anatomical diagram which will explain to me where each item referred to above is sited. However understanding where they are and understanding the relevance of reflux in these areas are two different conversations entirely.
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Re: DrSclafani answers some questions

Postby EJC » Sat Dec 22, 2012 4:36 am

drsclafani wrote:
dlynn wrote:EJC,
I found your question #3 to be curious. Never having been diagnosed with TMJ,(I have seen a specialist) I seemed to have symptoms.
My jaw had been locked for approx. 4yrs. causing (right side) inner ear , jaw, and neck pain. I had embolization done and the following day, my jaw unclenched and there is no more pain. I did have CCSVI procedures, but they never improved my jaw. I don't know if it's a coincidence, but it is interesting.
I believe changes/improvements should be noted.


dlynn
i think this should be clarified because the reference to embolization many not be familiar to many readers.


Yes please, I've read this a couple of times and looked up "embolization" but I'm none the wiser.
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Re: DrSclafani answers some questions

Postby drsclafani » Sat Dec 22, 2012 5:04 am

EJC wrote:
drsclafani wrote:
dlynn wrote:EJC,
I found your question #3 to be curious. Never having been diagnosed with TMJ,(I have seen a specialist) I seemed to have symptoms.
My jaw had been locked for approx. 4yrs. causing (right side) inner ear , jaw, and neck pain. I had embolization done and the following day, my jaw unclenched and there is no more pain. I did have CCSVI procedures, but they never improved my jaw. I don't know if it's a coincidence, but it is interesting.
I believe changes/improvements should be noted.


dlynn
i think this should be clarified because the reference to embolization many not be familiar to many readers.


Yes please, I've read this a couple of times and looked up "embolization" but I'm none the wiser.

I have to go to work now but will review embolization and its relevance as soon as I hae the time. It is, in this circumstance , a very important and relevant concept
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Re: DrSclafani answers some questions

Postby Cece » Sat Dec 22, 2012 10:06 am

EJC wrote:
drsclafani wrote:
the most common reflux I see during venography is from the dural sinus to the occipital emissary and the condylar emissary veins These veins drain into the posterior cervicals veins. Many headaches patients have that improve involve the skull base in the back of the neck. This is what suggested to me that some of these headaches might be vascular congestion of the muscles of the back of the neck


I can look at an anatomical diagram which will explain to me where each item referred to above is sited. However understanding where they are and understanding the relevance of reflux in these areas are two different conversations entirely.

The sinuses are at the base of the brain, within the skull. Flow collects in the sinuses and flows out through the jugulars. A blockage in the jugulars can affect the flow through the sinuses so that some blood flow is diverted out through the usually tiny emissary veins that travel through the skull itself. In some CCSVI patients, these emissary veins are unusually large, allowing a fair amount of flow to exit the skull this way. If too much flow is diverted through these emissary veins and to the posterior cervical veins, then there ends up being venous congestion. These veins were not meant to serve as drainage for the blood coming from the brain but instead meant to drain the blood flow from the neck muscles.

If the jugular blockages are opened, then the flow travels smoothly out the jugulars and there is no diverting to smaller blood vessels and the veins of the neck muscles can do a better job of draining the neck muscles. I don't understand exactly how venous congestion of the neck muscles would lead to headaches but it would mean slow-moving flow and dilated veins and capillaries and reduced oxygen available for the veins themselves and the neck muscles.
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Re: DrSclafani answers some questions

Postby EJC » Sat Dec 22, 2012 10:34 am

So the emissary veins have over developed to compensate in some way for the blockage in the jugulars but these veins still don't have enough capacity to compensate completely?

So that is the reflux and a symptom of that is headaches?
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Re: DrSclafani answers some questions

Postby NZer1 » Sat Dec 22, 2012 11:41 am

Hi Team,
I think that Dr F has more info on the functions of the various outlet flows that will explain the situation with headaches and other issues.
The 'chambers' of the Skull require the CSF to support the brain and decrease the contact points of the brain against skull, and also to keep the flow passages open.
In my understanding for example if the brain is not supported in the cavities of the Skull by CSF then there will be many issues such as the brain 'sitting' too low in the Foraman Magnum and causing Chiari Malformation (Brain Stem) issues etc, etc.
The blood flows impact other aspects of the system, CSF flow is created by Blood flow, CSF flow and functions are diverse, from cooling to support and then there is nutrient and waste transport. If the CSF is impeded by low flow then parts of the brain will suffer, such as the Thalamus and so on.

The whole system of Bloods and CSF is very complex and interdependent.

If there are also Alignment issues, scar tissues from injury, inflammation from infections, malformed bones and many other issues the fluid flows will be effected, that imo has to be addressed first and when the best is achieved then the flow issues will be simpler to address.
Upright MRI is now showing the complexity of the Atlas base of Skull region regarding alignments and flows which could not be imaged previously and therefore was misunderstood.

Each part of the system has to be assessed and optimised and a sequence approach has some logic I think.
Each Specialist has to link with the other Specialists to confront the complexity of CCSVI imo. :)

On with Flow as they say ;)
Regards,
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Re: DrSclafani answers some questions

Postby EJC » Sat Dec 22, 2012 12:18 pm

^ So, theoretically at least, it's not beyond the realms of possibility that CCSVI and skeletal misalignments/injury/malformations at least react or have a cause and effect relationship.

You've just described a similar thought process to mine - in so much as it's logical to straighten up known physical issues (alignments etc) before addressing vascular issues. On my part this is based on nothing more than "Man logic" rather than anything medical whatsoever.

It's also logical that "MS" is not one thing, how would you explain the huge disparity in symptoms? How would you explain recovery from symptoms after CCSVI for some patients and not others or indeed the vast range of recovery differences and regression rates.

So this gives you potentially three categories of patient with two possible symptoms:-

1 CCSVI only
2 Misalginments only
3 CCSVI + misalginments.

There's scope there for a massive range in symptoms between the three permutations.
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