DrSclafani answers some questions

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Re: DrSclafani answers some questions

Postby drsclafani » Sat May 04, 2013 8:48 am

Robnl wrote:Hi doc,

I came across something that is called...Superior Vena Cavography and Azygography....

http://radiology.rsna.org/content/88/3/441.extract

What is it?

Rgds,

Robert

robert
"ography" is imaging of that particular part of the body. superior venacavography is imaging of the superior vena cava. Sometimes this is done in ccsvi assessment but usually it is dural sinography, internal jugular venography, and brachiocephalography, azygography, left renal venography, ascending lumbar venography and ilio-cavography.
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Re: DrSclafani answers some questions

Postby dlynn » Sat May 04, 2013 12:42 pm

Dr. Sclafani,
Is venogram the only way to check blood flow (or clotting) in the Azygous and Renal vein?
Is it known if certain M.S. or CCSVI symptoms are caused by specific location of stenosis or valve problems?

thank you
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Re: DrSclafani answers some questions

Postby drsclafani » Sat May 04, 2013 12:50 pm

dlynn wrote:Dr. Sclafani,
Is venogram the only way to check blood flow (or clotting) in the Azygous and Renal vein?
Is it known if certain M.S. or CCSVI symptoms are caused by specific location of stenosis or valve problems?

thank you

venography is pretty much the only way to assess blood in the azygos vein. in the renal vein it is also possible to look at the renal vein by CT or MR venography or by ultrasound doppler. However i generally look at the renal vein during CCSVI treatment by venography and IVUS.

i look at the venous circulation of the cerebrspinal venous system as one large body of fluid with multiple outlets. Everything is interconnected. So most symptoms of CCSVI are seen with any variety of venous abnormalities.

drS
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Re: DrSclafani answers some questions

Postby Cece » Sat May 04, 2013 1:15 pm

drsclafani wrote:
Cece wrote:
drsclafani wrote:i gave a talk on early restenosis and "non-responders" and how to address the many causes of these.

With nonresponders in quotations, I think this is probably not about true nonresponders who had the procedure done to perfection but didn't result in any change in their symptoms. Instead it would be patients who seem to be nonresponders but whose procedure wasn't thorough enough or the balloons not appropriately sized and so there is hope for a more optimized procedure to turn them into responders.


Cece: lets not assume what i mean. There are many patients who seem to have a response that is very short lived. Many consider this a placebo effect and consider these patients Nonresponders. Let me get this lecture into a form that clarifies such issues of semantics and then we can discuss it.

Patients who seem to be nonresponders but who actually had a very short-lived response, which could be misclassified (or correctly classified) as placebo.
Sorry CureOrBust I was kinda throwing cold water out, when you said you were interested, but I thought that there was nothing new here. But it sounds like there is.
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Re: DrSclafani answers some questions

Postby drsclafani » Sat May 04, 2013 1:22 pm

drsclafani wrote:
Cece wrote:
drsclafani wrote:i gave a talk on early restenosis and "non-responders" and how to address the many causes of these.

With nonresponders in quotations, I think this is probably not about true nonresponders who had the procedure done to perfection but didn't result in any change in their symptoms. Instead it would be patients who seem to be nonresponders but whose procedure wasn't thorough enough or the balloons not appropriately sized and so there is hope for a more optimized procedure to turn them into responders.


Cece: lets not assume what i mean. There are many patients who seem to have a response that is very short lived. Many consider this a placebo effect and consider these patients Nonresponders. Let me get this lecture into a form that clarifies such issues of semantics and then we can discuss it.

cece wrote:Patients who seem to be nonresponders but who actually had a very short-lived response, which could be misclassified (or correctly classified) as placebo.
Sorry CureOrBust I was kinda throwing cold water out, when you said you were interested, but I thought that there was nothing new here. But it sounds like there is.

it is very elaborate and is taking a long time to complete this lecture before i can film it for youtube.
much is familiar to some of you, but it is a synthesis of lots of experiential information
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Re: DrSclafani answers some questions

Postby Cece » Sat May 04, 2013 1:29 pm

Robnl wrote:I came across something that is called...Superior Vena Cavography and Azygography....

http://radiology.rsna.org/content/88/3/441.extract

That was looking at the azygous in patients with lung cancer?
Here's more from a different article:
Azygography is a useful technique for the pre-operative detection of unresectability of oesophageal malignancies. Invarison of the azygos vein by oesophageal carcinoma occurs because of the anatomic proximity of the thoracic oesophagus and the azygos vein. Azygography may be performed by either intraosseous injection of a rib or by direct retrograde catheterization. Complete obstruction of the azygos vein indicates that an oesophageal carcinoma is unresectable if no other intrathoracic disease is evident.

http://www.ncbi.nlm.nih.gov/pubmed/953385
That's old (1976) and it doesn't mention modern imaging methods (MRI) but it does mention catheterization venogram and curiously intraosseous injection of a rib. Also it explains why you'd want to look at the azygous vein in a lung cancer patient. edit: ok, that's espohageus cancer. In lung cancer, the cancer can invade or compress the superior vena cava which redirects flow to the azygous, making it enlargen, so maybe that is why they're looking at the azygous.
Last edited by Cece on Sat May 04, 2013 1:43 pm, edited 1 time in total.
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Re: DrSclafani answers some questions

Postby drsclafani » Sat May 04, 2013 1:33 pm

Cece wrote:
Robnl wrote:I came across something that is called...Superior Vena Cavography and Azygography....

http://radiology.rsna.org/content/88/3/441.extract

That was looking at the azygous in patients with lung cancer?
Here's more from a different article:
Azygography is a useful technique for the pre-operative detection of unresectability of oesophageal malignancies. Invarison of the azygos vein by oesophageal carcinoma occurs because of the anatomic proximity of the thoracic oesophagus and the azygos vein. Azygography may be performed by either intraosseous injection of a rib or by direct retrograde catheterization. Complete obstruction of the azygos vein indicates that an oesophageal carcinoma is unresectable if no other intrathoracic disease is evident.

http://www.ncbi.nlm.nih.gov/pubmed/953385
That's old (1976) and it doesn't mention modern imaging methods (MRI) but it does mention catheterization venogram and curiously intraosseous injection of a rib. Also it explains why you'd want to look at the azygous vein in a lung cancer patient.


got those purposes the azygography has been supplanted by MR and CT. But the resolution is insufficient to assess the azygos for ccsvi. i would not even consider it.
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Re: DrSclafani answers some questions

Postby Cece » Sat May 04, 2013 1:36 pm

drsclafani wrote:it is very elaborate and is taking a long time to complete this lecture before i can film it for youtube.
much is familiar to some of you, but it is a synthesis of lots of experiential information

It sounds very interesting!
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Re: DrSclafani answers some questions

Postby CureOrBust » Sat May 04, 2013 5:50 pm

Cece wrote:Sorry CureOrBust I was kinda throwing cold water out, when you said you were interested, but I thought that there was nothing new here.
That's OK.

The problem is that I am not even a "short-lived responder". I would of even been happy with a little placebo :sad:

However, I may of got some "placebo", but not for my MS. I had an issue with a randomly recurring (and worsening) superficial thrombosis in my left leg. When it happened, it was painful to the point of not being able to move, let alone stand or walk on it. After my first procedure (when I was going for my second) I mentioned it to my IR (an acquaintance of Dr S), and he said it was most likely a placebo. It started to come back just before the second procedure (under a year later). After the second procedure, I again had a "remission" (ie it didn't re-occur). When I saw Dr S, (around 1 year later) it had again started to "hint" of returning. When I told Dr S about this, he also thought it was most likely a placebo. Since Dr S procedure, there has been no return of the pain. Placebo or not, I like it. It truly left me incapacitated. The weird thing also was that I had my leg from crutch-to-ankle ultrasound'ed twice, and they found absolutely nothing. Even though the last time I could hardly walk because of it.
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Re: DrSclafani answers some questions

Postby Cece » Sat May 04, 2013 10:06 pm

CureOrBust wrote:The weird thing also was that I had my leg from crutch-to-ankle ultrasound'ed twice, and they found absolutely nothing.

But it was definitively diagnosed as a thrombosis? It wasn't neurological pain? Could the blood thinners after the procedure have helped it resolve?

I wish you'd have been a responder.

Dr. Beggs in one of the early symposium videos once speculated that nonresponders could have developed thickening of the capillaries of the brain as a result of CCSVI deranged hemodynamics, so that even when the extracranial obstruction was treated, the resistance was still there within the capillaries of the brain. I might not be getting that right, and it was only speculation, but if that is a factor, then maybe something can be done about it. Maybe the right pharmaceutical.

The other idea is that there is overlap between MS and CCSVI symptoms, and no one knows until the CCSVI has been treated if the symptom was from the MS or from the CCSVI, and nonresponders' symptoms were from the MS and not the CCSVI. But then what can be done? The neurologists have to take it from there and they've got next to nothing.
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Re: DrSclafani answers some questions

Postby NZer1 » Sat May 04, 2013 11:01 pm

Cece wrote:
CureOrBust wrote:The weird thing also was that I had my leg from crutch-to-ankle ultrasound'ed twice, and they found absolutely nothing.

But it was definitively diagnosed as a thrombosis? It wasn't neurological pain? Could the blood thinners after the procedure have helped it resolve?

I wish you'd have been a responder.

Dr. Beggs in one of the early symposium videos once speculated that nonresponders could have developed thickening of the capillaries of the brain as a result of CCSVI deranged hemodynamics, so that even when the extracranial obstruction was treated, the resistance was still there within the capillaries of the brain. I might not be getting that right, and it was only speculation, but if that is a factor, then maybe something can be done about it. Maybe the right pharmaceutical.

The other idea is that there is overlap between MS and CCSVI symptoms, and no one knows until the CCSVI has been treated if the symptom was from the MS or from the CCSVI, and nonresponders' symptoms were from the MS and not the CCSVI. But then what can be done? The neurologists have to take it from there and they've got next to nothing.



I wonder whether this is why Dr Simka and many others are talking about infections?
It could be an issue like the findings of infection involved in atherosclerosis wall adhesions, in the brain issues where there might be a sclerosis formed from the immune system attempts to repair an infection of the capillary, and there is also the issue of back jets effecting the small passages of the capillaries as well?
Some bacteria like CPn love endothelial walls and macrophages as host cells!

:)
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Re: DrSclafani answers some questions

Postby Robnl » Sun May 05, 2013 12:41 am

drsclafani wrote:
Cece wrote:
Robnl wrote:I came across something that is called...Superior Vena Cavography and Azygography....

http://radiology.rsna.org/content/88/3/441.extract

That was looking at the azygous in patients with lung cancer?
Here's more from a different article:
Azygography is a useful technique for the pre-operative detection of unresectability of oesophageal malignancies. Invarison of the azygos vein by oesophageal carcinoma occurs because of the anatomic proximity of the thoracic oesophagus and the azygos vein. Azygography may be performed by either intraosseous injection of a rib or by direct retrograde catheterization. Complete obstruction of the azygos vein indicates that an oesophageal carcinoma is unresectable if no other intrathoracic disease is evident.

http://www.ncbi.nlm.nih.gov/pubmed/953385
That's old (1976) and it doesn't mention modern imaging methods (MRI) but it does mention catheterization venogram and curiously intraosseous injection of a rib. Also it explains why you'd want to look at the azygous vein in a lung cancer patient.


got those purposes the azygography has been supplanted by MR and CT. But the resolution is insufficient to assess the azygos for ccsvi. i would not even consider it.[/quote

Ok.....methods/techniques from the past....i understand :smile:
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Re: DrSclafani answers some questions

Postby CureOrBust » Sun May 05, 2013 2:57 am

Cece wrote:But it was definitively diagnosed as a thrombosis? It wasn't neurological pain? Could the blood thinners after the procedure have helped it resolve?
On the first incident of the leg-vein-pain thing, the actual vein was swollen up visibly on the front of my shin (sort of midway between my shin and ankle). A few years later it stopped swelling up on the days it caused issues (ie pain with no visual clue); which worried me more.

As for the neuralgic pain (apart from the visible vein for the first few years it randomly appeared), my GP actually prescribed Tegretol CR 200 (Carbamazepine from Wiki "Carbamazepine is typically used for the treatment of seizure disorders and neuropathic pain."), which did nothing for the pain.

Also, I could avoid the pain and hasten a return to normal using a pressure bandage on the leg. If I slept with the pressure bandage on, it would not occur the following day.

Oh, and for the first two treatments I was not prescribed any blood thinners post op.
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Re: DrSclafani answers some questions

Postby CureOrBust » Sun May 05, 2013 2:59 am

NZer1 wrote:I wonder whether this is why Dr Simka and many others are talking about infections?
It could be an issue like the findings of infection involved in atherosclerosis wall adhesions, in the brain issues where there might be a sclerosis formed from the immune system attempts to repair an infection of the capillary, and there is also the issue of back jets effecting the small passages of the capillaries as well?
Some bacteria like CPn love endothelial walls and macrophages as host cells!
I was on the ABX's protocol for 12 months, and still have MS symptoms, and had the leg-pain-swelling thing, and had CCSVI.
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Re: DrSclafani answers some questions

Postby NZer1 » Sun May 05, 2013 1:31 pm

CureOrBust wrote:
NZer1 wrote:I wonder whether this is why Dr Simka and many others are talking about infections?
It could be an issue like the findings of infection involved in atherosclerosis wall adhesions, in the brain issues where there might be a sclerosis formed from the immune system attempts to repair an infection of the capillary, and there is also the issue of back jets effecting the small passages of the capillaries as well?
Some bacteria like CPn love endothelial walls and macrophages as host cells!
I was on the ABX's protocol for 12 months, and still have MS symptoms, and had the leg-pain-swelling thing, and had CCSVI.


Hi Cure,
from what I have heard there are many versions of the Protocol and different drugs used, there is also a time factor for treatment and some are requiring being on the protocol for a long time, as Sean T in Aust is finding at the moment with 22 months and still having herx reactions and no active MRI findings.
If we have been on DMD's then the bacteria will have modified and also hibernate when necessary to avoid treatments so we are assuming allot when we say that the protocol didn't work or I have no bacterial symptoms. Even a change of diet and stresses will have effects both positive and negative.
The combinations of stealth bacteria and the bio-films they live amongst is another problem with treatment.
The leg problems that you are having sound like it may be a separate yet similar issue regarding blood return, if both brain and leg are creating symptoms. I sometimes think that the Vascular search is to simplistic and the Dr's need to think outside the box more.
The tests that are done in a standard fashion will only find the standard issues and we with MS symptoms are not standard patients in the search for Vascular answers!

The placebo theory with PTA was also disproved by BNAC with their recent sham trial, both with those 50% treated and those not treated had NO symptom improvement and the 75% or better phase 1 arm HAD improvements, so imo that rules out PTA placebo!

Many people who have had MS PTA go on to have Leg vein PTA as well.

;)
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