Subject: Subject: In Support of the Victoria Radiologist Facing Repercussions
Subject: In Support of the Victoria Radiologist Facing Repercussions
Date: Sun, 9 May 2010
It was with great dismay that I read the article in the Victoria Times Colonist and discovered that the Interventional Radiologist who treated my sister, BC#2, may face repercussions for doing his job: treating a vascular patient with a diagnosed vascular pathology.
When my sister developed a sinus infection, she was afforded antibiotics even though no research has been done to prove relieving the sinus infection would alleviate her MS symptoms. When my sister developed nystagmus she was afforded gabapentin even though no research has been done to prove gabapentin can affect MS disease progression. When she developed urinary incontinence, well, there was no medication that afforded her any reprieve from the embarassment of this new symptom.
She was referred to the IR in Victoria because in November of 2009 my sister developed persistent, severe, debilitating headaches. From this point on we began to notice that her face and neck appeared and felt edemic and her eyesight was on a rapid decline. If you've ever noticed how swelling can come and go in a pregnant woman, you can appreciate what we began to notice in the face of my very non-pregnant sister. As a Vodder trained manual lymph drainage and complete decongestive therapist, I performed MLD on the face, neck, soft palate and spine of my sister. Each treatment achieved a reduction in swelling and headache intensity and a surprising improvement in visual clarity, but the results were always short lived.
Immediately after the venoplasty on April 12, 2010, the tremors in my sisters hands that previously caused her to make excuses to go home so we wouldn't see her spill her coffee, all but stopped. Her head cleared, the 'brain fog' was gone. The persistant headaches that had plagued her for 5 months finally disappeared. The persistant neck pain that plagued her for as long as she could remember, stopped. Her hands and feet became warm and sensation returned.
In the 3 weeks since she's had the venoplasty, her vision has improved from not being able to tell if a traffic light is green or red to being able to read the license plate in front of her. She can read small print off of a piece of paper, a task she's been unable to do for over a year and a half. She can walk through her house without hanging on to the walls. Her physical stamina and muscular strength continue to improve. And the best part of all, she has regained control of her bladder, something no one ever expected to be possible.
Endovascular balloon venoplasty was never touted as a cure for multiple sclerosis. Dr. Zamboni has never called it a cure, Dr. Godley has never called it a cure, and my sister never for a moment thought it would be a cure.
But she did believe that in light of the symptoms associated with internal jugular vein thrombosis being so very similar to MS relapse symptoms she had experienced, and that the 'MS hugs' she had experienced were remarkably similar to symptoms of pulmonary embolism which are known to be a complication of internal jugular vein thrombosis, that perhaps by improving venous blood flow she would find some relief of the headaches, pain and swelling.
The Interventional Radiologist was only doing his job, and he performed his duty beautifully. My sister is a patient. As a person with a uterus, tubal ligation and intact cervix she is a gynecological patient. As a person with myopia and now nystagmus, she is an opthamological patient. As a victim of multiple sclerosis, she is a neurological patient. And as a person with a pathologically narrow internal jugular vein compounded by 2 stenoses, she is a vascular patient.
Like every other human being, my sister is a person with a body that encloses all of the body's many vital systems. I must have missed the memo that declared if disease is found in one system all other systems are ignored until rigorous blinded research proves the association of one system to another. Forgive me doctors, as I truly mean no disrespect, but doesn't the fact that we are born with all of our systems contained within our integumentary system prove that one is associated with all? Doctors, isn't it documented fact that by removing any single system one compromises the health of those that remain? Does this not prove that each system is intimately associated?
The Vascular Disease Foundation documents that chronic venous insufficiency (CVI) is a common cause of leg pain and swelling and that on occasion, the cause of the problem isnt even in the legs, but is in the pelvis. It is also documented that one type of congenital venous defect involves the large deep or central veins and often interferes with their function. Segments of major veins may be absent or narrowed. Or segments may be greatly widened and expanded (dilated), called a venous aneurysm.
All of these malformations have been discovered in the over 750 multiple sclerosis patients who have already undergone venoplasty.
To deny multiple sclerosis patients access to ultrasound testing and venoplasty treatment for diagnosed venous insufficiency is to blatantly claim willful ignorance of a documented medical fact: vein occlusion or malformation can seriously damage the tissues that are affected by said compromised drainage.
To reprimand a doctor for honoring the Hippocratic Oath is unconscionable.
Gwen Valentic-Morrison RMT CDT
http://www.ncbi.nlm.nih.gov/pmc/article ... p00142.pdf
http://www.timescolonist.com/health/Vic ... rocedure/2
http://healthblog.ctv.ca/post/Treating- ... lasty.aspx
Dr Haacke Letter:
You are preaching to the converted. I have seen so many anomalous venous problems in the cases we have reviewed to date, it is hard not to believe that this poses a serious problem to the MS patient. First and foremost, if it is a severe vascular problem it should be treated. This procedure has been approved by 47 countries and is now being performed across the world with some success. Your sister is one good case in point where it has clearly made a difference in her life.
Yes research and double blinded studies still need to be done, but there is nothing wrong with having an open clinical arm where patients are followed afterwards similar to a full double blinded research arm. When a drug like penicillin works, would you withhold it from seriously infected patients who need it in a double blinded study. I think not. If an MS patient has a 70% carotid artery stenosis would you with hold treatment there similar to the venoplasty? No of course not. This is a vascular problem, treat it. As a final case in point, it is believed that vertebroplasty is very helpful to a certain class of patients suffering from spinal problems. But despite the fact that it works for some people, years later people are still arguing about double blinded studies, and yet 200,000 people per year receive this treatment and it is supported by the Society of Interventional Radiology despite recent negative double blinded studies.
When something is this complicated and yet treatment clearly works in at least some sub-population you cannot rely on or wait for supposed double blinded results to verify what might be contentious if the experimental procedures themselves end up being flawed. In any case, I have no doubt that will not be the case here, the evidence is just too overwhelming to argue about. Even the conservative, and likely too conservative, results of Robert Zivadinov who shows that 22% of normals (about 1/5) versus at least 1/2 (and possibly 2/3) MS patients show the CCSVI signs. To differentiate these two populations to a 97% power takes only 30 people. (These statistics are easily checked.)
However, proving that treatment works is another issue. And a much more complicated one because CCSVI can manifest itself from a dozen different causes, and it varies as we know widely from person to person. So in fact are the resulting treatments likely to vary widely. So designing a clean and clear study is likely to take some time, and will likely require quite a few different studies. In the meantime, there is enough evidence to at least treat those people who have severely compromised vascular systems. And to quote Gwen:
"To reprimand a doctor for honoring the Hippocratic Oath is unconscionable."
In fact one might go so far as to say, not to deal with a clear vascular problem is a violation of the Hippocratic Oath and is unconscionable. We need to find a dual solution to this that lets the research move forward to deal with this complicated issue while still dealing with the clinical needs.
If I can help in any way please let me know.
E. Mark Haacke, PhD