A discussion developed recently on the “Dr. Sclafani answers some questions” CCSVI thread page 520 through 522 among the Interventional Radiologist Dr. Sclafani, his patient dania, and vesta concerning the suggestion by dania and vesta that MS patients be examined and treated for Cerebrospinal Flow (CSF) problems before considering Angioplasty. They both recommended Dr. Michael Flanagan as a source of information. The exchanges ended June 22, 2013 as follows.
Sclafani June 21
i think you are missing my point. Angio and IVUS are quite good at showing stenoses, regardless of where they are located. Significant stenoses of all causes, including those caused by bone spurs, misalignments and so forth are best seen by angio and ivus, not xrays which can only show the bones. In addition, my experience indicates to me that these upper lesions are just not that common. The overwhelming percentage of patients have no problems with the jugular vein except where it enters the chest. I am not arguing that these other things do not occur, it is just that they are not common. and even if present, they are almost always going to be accompanied by valvular stenosis of inferior jugular bulb. No point in treating upper lesions without also addressing the lower lesions. In addition, xrays and scans are not going to help find the azygos vein stenosis present in about half of patients nor in showing the compression of the left renal vein that is present in 25%.
So my clinical judgment is that angiography and IVUS are the key and the starting point. If they fix the problems then great, end of story. if they don't then i would consider these other options but would prefer more and better data than i have seen so far.
Thanks for the discussion, Dana. »
Dania to Dr S June 21
“I agree that angio and IVUS are excellent at showing stenoses. All I am trying to convey is that for some stenosis might be caused by a problem with CSF flow. I also think that, perhaps, if angio is performed when the patient's disabilities are minor and they keep themselves healthy and exercise regularly they are more likely to keep their improvements. For me I did very well for 18 years. No meds. But I use to go to the gym 5 times a week and weight train. Heavy weights. I could leg press 400 pounds. I was 5'6" weighed 120 lbs. It was when I stopped going to the gym that my condition declined. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117722/http://link.springer.com/article/10.100
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Vesta June 22
I think you are missing our point. I believe it may be easier and less expensive to check out and treat CSF problems BEFORE angioplasty. See if such treatment works. A practical and financial question which may be medically advantageous as well. We have to live with and pay for the conséquences. This is not to doubt your dedication, expertise or competence. It's just survival.”
Dania June 22
“Thanks Vesta. That is my point of view, exactly. I guess I was not articulating it very well. It is not being argumentative. Just an opinion and my experiences. If my experiences helps anyone, so much the better. I completely drained my retirement funds. If I had known what is my particular problem I would have done everything differently.”
The entire discussion with relevant entries is shown on my site MS Cure Enigmas. net, Blog June 23, 2013 titled “Skeletal Diagnosis Before Angioplasty? An Exchange”
MS Cure Enigmas.net