DrSclafani answers some questions

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Re: DrSclafani answers some questions

Postby drsclafani » Sun Jan 06, 2013 11:38 pm

1eye wrote:Can the effect of the atlas on the jugular be seen from the inside, i.e., in situ, while moving the head and looking at the vein, either with a fluroscope and dye, or with IVUS, at the same time?


i have been looking and I am not seeing it. i have looked by asking patients to rotate, flex and extend the neck during venography and IVUS. Most of the obstructions in the upper jugular vein (not all of them) seem to be below the atlas
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Re: DrSclafani answers some questions

Postby drsclafani » Sun Jan 06, 2013 11:44 pm

Cece wrote:
EJC wrote:So the question is, is angioplasty the only way to achieve "pressure release"?
Diamox is used for glaucoma and idiopathic intracranial hypertension and chiari malformation. It may be useful for resistant CCSVI but no research has been done. I am not sure if pressure release means the same as relief from venous congestion in the muscles of the eye and iris. For venous congestion, there is leech therapy.... http://books.google.com/books?id=BXWqJT ... &q&f=false But the proposed venous congestion is secondary to the extracranial outflow obstructions. Treating the outflow obstructions should treat the venous congestion of the neck muscles or eye muscles.

Cece
you are thinking about emissary veins arent you?

we have noted improvement in skull based headaches when relief of valvular stenosis leads to reduced collateral flow through the emissary veins into the cervical veins. I might postulate, if i may, that venous congestion around the muscles of the eyes caused by collateral flow may make muscle function better. but i hate this postulation. It is the human trying to explain everything. Cece, et al, enjoy your better vision in your heart for a moment
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Re: DrSclafani answers some questions

Postby drsclafani » Sun Jan 06, 2013 11:50 pm

NZer1 wrote:Thanks Dr S.
What do you think is happening with the study of Dr Rosa and the Atlas adjustments?

Is it a case of method of testing is producing the outcome they want to find?

Is it more likely a muscular issue than a bone issue?

Is testing in various positions (as you do) going to show different findings to what Dr Rosa is seeing?

The Franz Schelling discussions on back jets talks about blood and or CSF flow that accelerates back to the brain because of fixed as well as positional stenosis plus a scenario of physically causing back flow such as Vasalva action.
My understanding of that is that the breach of the BBB occurs in some instances because of body position and self generated back pressure on the Veins or CSF and that can be very short lived, the damage occurring is brief and the issues of Grey and or White lesions are caused by inflammation and following Immune System activation and clean up causes the 'MS' symptomatology and disease processes. This happening in a relapse/remit fashion whereas the continuous progression form of 'MS' is more related to the ongoing effects of a fixed vascular stenosis and reflux process that as 'regularly' breaching the BBB and creating more continuous inflammation and white and grey matter damage.

I guess more time will be needed to scrutinise the Dr Rosa findings when more detail becomes available for critiquing ;)

Hope you made some head space and Family time over the end of the Year period Dr S!

Regards,
Nigel


Back Jets......I spent a long evening over quite a bit of beer discussing wth DrSchelling his theories of back jets. By my recollection backjets were explained by forceful compression of a dilated jugular vein by the neck muscles. As they get squeezed, that pressurized vefnous blood is front jetted normally down the jugular vein, through normal valves back to the heart. With valvular obstructions, these jets extend UP into the headcausing the trouble.

I do not see how backjets can result from obstruction of the jugular vein/dural sinus at the jugular foramen. I can understand collateralized flow but not backjets.
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Re: DrSclafani answers some questions

Postby drsclafani » Sun Jan 06, 2013 11:52 pm

magoo wrote:I am very interested in your opinions about Dr. Rosa's study too. Any information or observations would be greatly appreciated. :)

magoo
i am going to keep my opinions to myself because i have not seen any data that has undergone peer review or been published.
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Re: DrSclafani answers some questions

Postby drsclafani » Sun Jan 06, 2013 11:54 pm

HappyPoet wrote:Hi Dr. Sclafani,

CONGRATULATIONS--500 PAGES!


i never would have guessed that I would be speaking to patients on this forum for so long and been pushed to learn so much by so many patents

thanks
DrS
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Re: DrSclafani answers some questions

Postby drsclafani » Sun Jan 06, 2013 11:57 pm

Cece wrote:
drsclafani wrote:Left IJV

Image
image #1 shows tremendous reflux through numerous emissary veins that drain into the posterior cervical vein. A high grade stenosis at the second cervical vertebra narrowed the vein to less than 2 mm diameter. Flexion/extension, and rotation imaging with IVUS did not show any improvement in luminal area.
image #2 showed those cervical collaterals draining slowly and also showed reflux in pharyngeal veins. A typical valvulare stenosis was seen in the lower J1 segment on both ivus and catheter venography. . I was quite surprised that the apparently large diameter of he middle of the jugular vein actually was an early division into a facial vein and the internal jugular vein. This is important if you do not perform ivus because one could easilyil oversize the balloon based on the apperently large IJV on image #2

Without performing a catheterization of the dural sinus ()image 1), the interventionalist would have missed this upper jugular lesion.

Going from image 2 to image 3 is shocking! What looked like one vein was really two veins. Without the second image, it would easily be misinterpreted as a larger jugular than it was. I don't think you've shown us that before.


apropos of the current interests of the group, notice the stenosis of the high jugular vein. It is NOT at the skull base

of great significance to me is that failure to study the dural sinus drainage into the jugular vein might well have missed completely the stenosis at C2-3

all those patient whose studies included only the lower jugular vein and who did not see relief, should be concerned
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Re: DrSclafani answers some questions

Postby drsclafani » Sun Jan 06, 2013 11:59 pm

Cece wrote:
drsclafani wrote:Image

Angioplasty of the J1 segment was pretty good (see image 3). However in the same image one sees collaterals refluxing in image 3 (red arrow). Also look at the dilated subclavian vein to the right of the IJV on image 3, suggesting that there was obstruction in the brachiocephalic vein. Image 4 shows a narrowing in the brachiocephalic vein. We treated that with angioplasty too.

I think it's a compression and ballooning won't last. Am I wrong?

The patient's lasting improvements could be a result of the many other stenoses treated, so that can't serve as evidence one way or the other for durability of the brachiocephalic stenosis ballooning.


I completely agree. This is one area that I really worry about stenting
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Re: DrSclafani answers some questions

Postby NZer1 » Mon Jan 07, 2013 12:20 am

drsclafani wrote:
NZer1 wrote:Thanks Dr S.
What do you think is happening with the study of Dr Rosa and the Atlas adjustments?

Is it a case of method of testing is producing the outcome they want to find?

Is it more likely a muscular issue than a bone issue?

Is testing in various positions (as you do) going to show different findings to what Dr Rosa is seeing?

The Franz Schelling discussions on back jets talks about blood and or CSF flow that accelerates back to the brain because of fixed as well as positional stenosis plus a scenario of physically causing back flow such as Vasalva action.
My understanding of that is that the breach of the BBB occurs in some instances because of body position and self generated back pressure on the Veins or CSF and that can be very short lived, the damage occurring is brief and the issues of Grey and or White lesions are caused by inflammation and following Immune System activation and clean up causes the 'MS' symptomatology and disease processes. This happening in a relapse/remit fashion whereas the continuous progression form of 'MS' is more related to the ongoing effects of a fixed vascular stenosis and reflux process that as 'regularly' breaching the BBB and creating more continuous inflammation and white and grey matter damage.

I guess more time will be needed to scrutinise the Dr Rosa findings when more detail becomes available for critiquing ;)

Hope you made some head space and Family time over the end of the Year period Dr S!

Regards,
Nigel


Back Jets......I spent a long evening over quite a bit of beer discussing wth DrSchelling his theories of back jets. By my recollection backjets were explained by forceful compression of a dilated jugular vein by the neck muscles. As they get squeezed, that pressurized vefnous blood is front jetted normally down the jugular vein, through normal valves back to the heart. With valvular obstructions, these jets extend UP into the headcausing the trouble.

I do not see how backjets can result from obstruction of the jugular vein/dural sinus at the jugular foramen. I can understand collateralized flow but not backjets.



Too many beers then!

I have talked with Franz about this several times and I think that the location of the obstruction, stenosis, malformation, compression is not so much the point that Franz makes.

The incidence for instance of VV back jets linked to lesions at Autopsy is one example.

I think the process of what happens was Franz's point most of all.

He also talked about the volume of lesions that are too small to be seen on MRI and that Autopsy was the learning curve.

Just saying,
Nigel
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Re: DrSclafani answers some questions

Postby Robnl » Mon Jan 07, 2013 1:13 am

drsclafani wrote:
Robnl wrote:
drsclafani wrote:
I have been using the retrospectoscope and I have noted an increasing percentage of my patients are coming from Europe, including finland, denmark, germany, poland, england, scotland, ireland, italy, greece, switzerland and france.

I know that many of my patients, and presumably other Europeans, learned of me from reading on TIMS. Iam curious to hear there opinions about the state of CCSVI in Europe. What is the attitude of European neurologists regarding CCSVI? How many centers and doctors are currently operating in Europe? Is there governmenetal obstruction, interference, meddling in patient affairs? What are the reasons that patients would travel across the Atlantic to be treated in the USA? What obstacles exist to treatment in their own country? in neighboring European states? in the United States?

For those Northamericaners, similar questions: would you go back, if yes, why? if no, why not? what are the impediments? What are the benefits?

Any comments would be welcome. We North Americans always have a slanted opinion and in this international crisis, we need to understand each other

thanks

DrSclafani


So, what is happening in Holland?? ehh..nothing!!
First, it's forbidden by law to do medical prescanning a.k.a. scan 'healthy' persons.
Secondly, ccsvi is dismissed by neurology in Holland. Why? well, there are 2 major hospitals that are seen as the ms centers; VU amsterdam and EMC Rotterdam (there are other neuro's with ms as focus but not from 'university' point of view)

i contacted EMC in 2011, talked about ccsvi and my improvements after angioplasty...they were very happy for me, but veins are not the focus of the EMC MS research.
Now they have a study going on about fatigue and they called me to join. But my fatigue is more or less gone after treatment by dr. S. Again, they were very happy for me :mrgreen:

VU is very drug focussed and tries to find genes and cells that could trigger the immune system, they did a small CCSVI MRI study, but did not know what they were doing. Although results were 'mixed' there was no follow up..
There were also two scanning studies done by two other hospitals....and again there were 'some' results, but no follow up.

The missing word in the studies? Expertise.

So, Holland still follows the auto immune hypothesis and attacks the immune system with drugs...
There are still some private clinics in Europe, but the treatments in hospitals are stopped, why? I spoke to one of the hospitals...they stopped not because of the FDA warning (FDA cant warn europe), but for the possible consequences of the FDA warning.

Also, treatments are mostly (except dr Simka) done without any research, only jugs and some azygos. So results are doubtful, most (except 'simple' problems) improvements fade....

Concerning te current status of CCSVI i believe the opinion of dr.S:
CCSVI is not MS, but a seperate condition with similar symptoms; the lucky ones only have ccsvi. ccsvi occurs i most of MS patients. (correct me if i'm wrong Doc)
Does ccsvi lead to ms??? i dont know, but if neurology, IR's and vascular specialists would stick their heads together maybe the progress in knowledge would go much faster.

Lets hope the results of current trials will give a boost and eyes will open.

Why did i go to New York? Because it's the most complete treatment at this moment with the most CCSVI knowledge in an objective view.


My 2 cents,

Robert


It is all about expertise and point of view, Robert. I am a bit surprsed by the very strong objection to ccsvi. I think it is part ego, part finance, part corporate, part ignorance, part reaction to patient advocacy and poor politics. I dont think that you are going to get collaboration in the current environment of denial and a lack of impetus


Lets wait and see what trial results will bring....

Robert
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Re: DrSclafani answers some questions

Postby Robnl » Mon Jan 07, 2013 5:26 am

Have seen this doc?

http://www.facebook.com/note.php?note_i ... 1501877211
The specialists also stated that operators who are finding between 0-50% of CCSVI in people with MS are NOT utilizing correct doppler technique. They stated that the SAME problem happened 35 years ago, when technicians began analysing the carotid arteries. There is a very specific protocol that must be followed, or the results are inaccurate. A lack of knowledge of the venous return system from the brain is part of this problem.


and
The fact that neurologists continue to ignore this clarion call from vascular specialists, and proceed with badly designed studies, is disturbing. There have been millions of dollars of wasted money and years of wasted time, pursuing studies that are of no value.


:mrgreen:
:mrgreen: :mrgreen:
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Re: DrSclafani answers some questions

Postby EJC » Mon Jan 07, 2013 9:54 am

drsclafani wrote:
EJC wrote:Dr S,

I've spent the weekend thinking about the conversations on this thread and forum in general and I have a question specifically related to your understanding of the CCSVI procedure and improvements in eyesight. This is now the most debilitating symptom Emma has - double vision, poor ability to focus and eyes that at times seem to operate entirely independently of each other.

I know I've mentioned Emma's improvements before - her explanation was it was like switching from grainy old cable TV to the vibrance of HD TV at the flick of a switch.

I've read elsewhere on here that Cece also had a similar reaction.

How do you think this occurs? What is the mechanism that so instantly generates improvements?

On a related topic, my 78 year old father suffers from Myasthenia Gravis (one of the vast list of medical issues he has) for which he's prescribed Pyridostigmine tablets that pretty much deal with his issues (which interestingly are pretty similar to Emma's). He gave Emma one of tablets last week which after about a half hour straightened up her double vision and made things a whole world more comfortable. This last about 4 hours then receded - which we understand is about the operating window of that particular drug.

Any idea how this would be interacting with eyesight issues attributed to MS?


Vision is a very complicated thing, with involvement of the lens, optic nerve, brainstem and occipital cortex in perception and sight. cranial nerves are responsble for accomodation and pupillary reflexes in the iris , the extraocular muscles must work in synchronization. In other words, there is no one answer to the question and a detailed explanation would far exceed my expertise. Double vision often relates to the eyes not being in sync, the eyes are out of sync.Cranial Nerves 3, 4, and 6 are responsible for d extraocular muscle movement. Pyridostigmine bromide inhibits the destruction of acetylcholine by cholinesterase and thereby permits freer transmission of nerve impulses across the neuromuscular junction movements. This may reduce the imbalance for a while and allow better vision.

Why technicolor and high definition vision improvements occur during ccsvi is not clear to me. I can speciulate that venous congestion in the optic nerve may be reduced?

very tough question


Thanks for making an attempt to answer.

Emma's eyes are very clearly out of sync, her left eye has a mind of it's own, in fact her father had the same issue as a child, back then it was simply called a lazy eye! He had an operation to correct the issue back then.

As anytime we try to obtain help for Emma with eyesight issues it's always put down to "MS", I wondered of the fact that Pyridostigmine Bromide helped may in fact have pointed us somewhere other than "MS" for relief.
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Re: DrSclafani answers some questions

Postby Cece » Mon Jan 07, 2013 8:16 pm

drsclafani wrote: but i hate this postulation. It is the human trying to explain everything. Cece, et al, enjoy your better vision in your heart for a moment

Ok, yes, guilty of this...
I think we will have the answers someday but I am impatient.
drsclafani wrote:of great significance to me is that failure to study the dural sinus drainage into the jugular vein might well have missed completely the stenosis at C2-3

all those patient whose studies included only the lower jugular vein and who did not see relief, should be concerned
drsclafani wrote:here the focus is on the J3 segment stenosis. It is not located at the skull base, but more inferiorly. I didnt recognize any subluxations on my images. This stenosis is usually caused by a compression and treatment is usually not successful. I haven't put many stents in but I have treated several patients who have had problems with stents placed by others. Problems include migration, kinking, fracture, intimal hyperplasia.

If the treatment of the J3 area compression stenoses are typically unsuccessful, then maybe it is a good thing if this stenosis goes unseen and therefore untreated by other IRs. Although I agree with you about the importance of a top-to-bottom investigation of the jugular vein.
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Re: DrSclafani answers some questions

Postby Cece » Mon Jan 07, 2013 8:36 pm

drsclafani wrote:
Cece wrote:
drsclafani wrote:Image

Angioplasty of the J1 segment was pretty good (see image 3). However in the same image one sees collaterals refluxing in image 3 (red arrow). Also look at the dilated subclavian vein to the right of the IJV on image 3, suggesting that there was obstruction in the brachiocephalic vein. Image 4 shows a narrowing in the brachiocephalic vein. We treated that with angioplasty too.

I think it's a compression and ballooning won't last. Am I wrong?

The patient's lasting improvements could be a result of the many other stenoses treated, so that can't serve as evidence one way or the other for durability of the brachiocephalic stenosis ballooning.


I completely agree. This is one area that I really worry about stenting

I found a nice article on venous stent migration.
http://www.sciencedirect.com/science/ar ... 1498701429
Many authors described a high rate of serious complications due to the presence of intravascular foreign bodies. Fisher and Ferreyro6 reported a 71% incidence rate of significant complication or death directly attributable to the retained foreign body. They found that 29% of patients in whom the foreign body was not removed survived without serious complications, 33% had significant but nonfatal complications, and 38% died of causes directly related to the presence of the foreign body.

Consequences are high if a stent migration occurs.

Maybe it is the perfectionist in me that wants that brachiocephalic compression stented. We don't need perfect blood flow, we need good enough blood flow.
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Re: DrSclafani answers some questions

Postby NZer1 » Tue Jan 08, 2013 11:23 am

We all put allot of 'faith' in 'Peer Reviewed Publishings',

Does the Literature say that MS is an Auto-Immune disease?

Does the Literature show how that conclusion is supported?

I like to play the Atheist Advocate and ask who do we trust and why?

Money has decided the conclusion in many situations in Medicine and it has been very difficult to challenge and then correct information when necessary because it takes more money to do so.

Food for thought and direction finding,
Nigel

The eyes will see what the eyes are trained to see and the mind will therefore determine the vision.
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Re: DrSclafani answers some questions

Postby milesap » Tue Jan 08, 2013 12:45 pm

A good video the cause of MS and CCSVI worth a look
http://www.abc.net.au/catalyst/stories/3572695.htm
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