CCSVI and CCVBP

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

Re: CCSVI and CCVBP

Postby uprightdoc » Wed Sep 11, 2013 12:53 pm

Your welcome Nigel. Buldges invade and decrease the epidural space which contains the vertebral veins. Bending the neck forward further decreases the space. Disrupting venous flow can lead to chronic ischemia and edema. Buldges can also irritate local tissues and cause inflammation. Sometime the dura mater of the nerve roots become adherent to buldges and ostophytes due to chorinic inflammation resulting in local segmental tethering. Buldges also act as fulcrums when the the head bends forward. Fulcrums and tethering caused by buldges can increase tension and irritation of the cord and nerve roots.

The spinal cord has been studied as a co-axial cable with blood and CSF flowing through it at different rates. I further propose that the spinal canal is a tri-axial tube with veous blood surrounding the cord. Spondylosis, stenosis and scoliosis affect blood and CSF flow through the tri-axial tube.

It is interesting that the L'Hermitte's sign and the trigeminal neuralgia disappeared but everything else appears worse, including: fatigue, temperature, vision and cognition issues, as well as lower body weakness. Keep me posted on the one year assesment and suggested protocol changes.
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Re: CCSVI and CCVBP

Postby uprightdoc » Wed Sep 11, 2013 12:58 pm

It's 92 degrees. I going to head down to the Lake for a mid September swim, a rare event in the northcountry.
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Re: CCSVI and CCVBP

Postby Robnl » Wed Sep 11, 2013 1:19 pm

Hi doc,

What about this one?

Image

And have a Nice swim :-D
Last edited by Robnl on Wed Sep 11, 2013 1:54 pm, edited 1 time in total.
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Re: CCSVI and CCVBP

Postby NZer1 » Wed Sep 11, 2013 1:35 pm

uprightdoc wrote:Your welcome Nigel. Buldges invade and decrease the epidural space which contains the vertebral veins. Bending the neck forward further decreases the space. Disrupting venous flow can lead to chronic ischemia and edema. Buldges can also irritate local tissues and cause inflammation. Sometime the dura mater of the nerve roots become adherent to buldges and ostophytes due to chorinic inflammation resulting in local segmental tethering. Buldges also act as fulcrums when the the head bends forward. Fulcrums and tethering caused by buldges can increase tension and irritation of the cord and nerve roots.

The spinal cord has been studied as a co-axial cable with blood and CSF flowing through it at different rates. I further propose that the spinal canal is a tri-axial tube with veous blood surrounding the cord. Spondylosis, stenosis and scoliosis affect blood and CSF flow through the tri-axial tube.

It is interesting that the L'Hermitte's sign and the trigeminal neuralgia disappeared but everything else appears worse, including: fatigue, temperature, vision and cognition issues, as well as lower body weakness. Keep me posted on the one year assesment and suggested protocol changes.


Thanks Dr,
don'y worry you won't be able to avoid an update ;)

I also 'assume' that with bulges creating fluid segments or compartments in the cord when we flex the spine it will be a series of pressure gradients that will hydraulic the contained fluid in stages and in different directions in stages as the flex occurs?
Could this be localised reflux/back jets within the sections or back to the brain from the uppermost section?
It seems to be what Franz Schelling was referring to at C2 and the ligaments compressing fluids?

This would also be compressive moments in the flexing that 'could' be what the doppler test was finding in my exam. If the compression they skope of is changing from suprine to upright?
Now that I have noticed or understood what as originally written I intend to ask what can be done to isolate when and where this occurs. Another journey to Australia may be the only way to investigate?
It 'may' be very important investigating whether it can be improved or changed. I think originally if was planned to see if the CPn infection had any association and monitor in stages?

Especially important to identify and see who else has this scenario.

Hope the swim was beneficial rather than only bloody cold!

;)
Nigel
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Re: CCSVI and CCVBP

Postby uprightdoc » Wed Sep 11, 2013 3:21 pm

That's exactly right Nigel. I suspect that the spondylosis separates the canal into compartments and create hydraulic effects inside and outside the cord in the spinal canal. It also interferes with normal flow of blood and CSF between the cranial vault and spinal canal which can interfere with blood and CSF drainage from the brain. It can cause localized reflux. Flexion of the neck can further compress and pressurize the compartment.

The swim was terrific. Did a half mile or so of backstroke. I had to get it in between the electric storms. The water was - well- refreshing and good for singing falsetto. It was a pleasure just to get in, in mid September.
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Re: CCSVI and CCVBP

Postby Robnl » Thu Sep 12, 2013 11:48 pm

uprightdoc wrote:I would treat you according to what I find. I would consider cervical traction in your case with prepatory and follow up physioltherapy. If you do consider cervical traction you need to find a high quality piece of equipment that can control the angle, strength and duration of the pull, as well as length of treatment. Before considering traction, you need to be checked for possible local tethering of the cord such as L'Hermitte's sign as well as upper and lower extremity adverse mechanical tension tests. You should also be checked for upper motor nerve signs. In addition manual and mechanical types of traction, flexion-distraction and craniosacral I would also use different types of electrotherapy on your weak muscles and I would work on your sensory and proprioceptive nerves for balance.


Hi Doc,

I do have upper motor nerve signs...

Rgds,

Robert
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Re: CCSVI and CCVBP

Postby dania » Fri Sep 13, 2013 7:09 am

Dr Flanagan, feel free to post anything that has to due with my case. Knowledge is power.
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Re: CCSVI and CCVBP

Postby HappyPoet » Fri Sep 13, 2013 8:29 am

Hi dania,
Thanks again for sharing your case with us. Can't wait to hear what Dr. Flanagan has to say!

Hi Dr. Flanagan, an update:
I haven't been very lucky with doctor appts. Unfortunately, my AO chiro cancelled two of my appts, so I won't be adjusted until Monday. And Tuesday is my appt for the injections; my original appt was cancelled/rescheduled by the doctor's office. So, if you could see me next Sunday, Sept 22, I'd be most grateful. I just have to get back on track with all my doctors. My MS Hug pain is at its high point which I didn't want to happen because it's much harder and takes much longer to get back to baseline. BUT I'm hopeful my RSO will help get me through this rough patch until I can see you and Dr. Mulhallen. :)

Btw, did you accidentally miss robnl's latest post of his MRI, or did I miss your comments?

So happy you had an enjoyable swim this time of year (and then came all the rain). When young, we used to call hot weather in Sept and Oct in the Adirondacks an Indian Summer, but I wonder if it's acceptable to use this phrase--I hope so because it sounds so much nicer than Native American Summer.
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Re: CCSVI and CCVBP

Postby uprightdoc » Fri Sep 13, 2013 8:44 am

Dania,
You're right. Knowledge is power. Things didn't go smoothly yesterday. I was only able to do a limited seated only exam. I wasn't surprised, however. I was prepared before you got here from comments you made about barking out orders and that your ex-husband and I should be able to transfer and move you as long as we followed your directions. That made me suspcious of what you had in store for us. I told you I would give it a try but if it didn't work for me I would let you know and skip the parts of the exam that require positioning you on the table.

The number one problem I saw yesterday was the way you transfer and move. Your method of transferring and moving is hazardous. It poses a high risk for injury to providers trying to help you. What's worse is that you are also straining and making your muscles and joints worse. The second problem that was related to the way you transfer and move is the arrangement of the catheter bag. It should have been secured to your thigh. The setup for catheter made even more difficult to transfer and move you freely in and out of the car and on the treatment table while trying to control the long tube and bag and do it your way. The tube kept getting wound up in the glide board, car seat, office chair, stool to wheelchair system you use. The good news is that you are strong in the upper body and you are relatively light in weight. Transferring and moving you should be easy. Even with two bad shoulders, a badly injured right leg, bad discs in my neck and low back and fractured right wrist, I could easily transfer you with proper technique. You ex-husband and I could have moved you with ease. Getting the right equipment and transfer procedures will help a great deal and prevent needless injuries to you and your providers. You are going to have to learn to dance and let your partner lead.

Your pelvis and coccyx are not your primary problem. You obviously have a spastic scissors gait due to weakness in your abductors causing your adductors to pull your thighs inward. You were unable to raise your knees or straighten your lower leg to grade your muscles. I was unable to test the foot muscles due to obvious easily provoked clonus in both legs. Clonus is a sure sign of upper motor neuron problems. Oddly, you also have absent reflexes in your legs. Typically you would expect hyperreflexia with clonus in UMN problems. Your biceps, brachioradialis and triceps muscles were all 5/5. Your left hand wrist flexors and extensors were weak at 4/5. Your left hand fingers were weak at 3/5. Your deltoids, trapezius and SCM muscles of the shoulder and neck were 5/5. Your neck ranges of motion were limited and dyskinetic in left and right lateral flexion and extension. You have significant loss of motion in your upper cervical spine. You had significant hypertonicity of the suboccipital area on the left. You had knots and hypertoncity throughout the spine. Interestingly, I was able to stimulate the femoral nerve and produce muscle twitches in the legs. This is a good sign. If they were totally disconnected (denervated) there would be no twitches. I use Galvanic DC for dennervated muscles.

Your history and MRI reports indicate that you don't have the classic MS lesions seen in the brain. This means you don't have definite MS. Instead, you do have a lesion or lesions in the cord causing MS signs and symptoms. This means you have possible or probable MS. You also have a history of significant trauma and multiple fractures due to falls from horses and horses falling onto you. Your problems are clearly in your cervical spine and cord. You need an updated cervical MRI. Whether you have possible, probable or definite MS is irrelevant. You have very definite and obvious signs, symptoms and co-morbidity problems that need to be addressed to prevent further deterioration and disabilities. You need good physical medicine on a regular basis. You are a challenge but I have some suggestions.

Although it wasn't the best circumstances or exam, our meeting revealed a great deal of useful information.
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Re: CCSVI and CCVBP

Postby dania » Fri Sep 13, 2013 9:25 am

You may have thought it did not go smoothly but I was very happy that I was examined by you. The reason for a urine bag was not attached to my thigh was to lie face down on a table, it gets in the way. Especially with the anterior rotation of my left leg and my legs being clamped together. Plus the added weight. What test/scans etc do you think I should have? I will contact my neuro and ask for them.
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Re: CCSVI and CCVBP

Postby dania » Fri Sep 13, 2013 10:11 am

I just remembered that after a hot shower I am more flexible. Less clonus. I often, just run the blow dryer on my body for the heat. You mention infrared red yesterday, what do you recommend?
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Re: CCSVI and CCVBP

Postby uprightdoc » Fri Sep 13, 2013 10:46 am

I would have perferred to check your hips, knees, buttocks, thigh and leg muscles in much better positions for more specific information, especially the sacroiliac complex of ligaments which include the coccyx. I would have liked to try and stimulate and test more specific motor points in the thigh, leg and foot muscles. The little bit I saw showed that the lateral thigh muscles could be stimulated. We could have figured something out like strapping the bag to the outside the thigh so as not to interfere with supine and prone positions or scissored legs. Hindsight is 20/20.

I have a long wish list. In addition to neuro problems, you have orthopedic rheumatological type problems related to the entire spine. A brain scan would be nice. A cervical MRI is a must. You have significant problems in the cervical spine and cord. Your ex-husband said you were climbing stairs a year ago. We need to know what is going on. The absent reflexes in the legs is interesting.

Infrared is one suggestion. Your muscles and joints need regular therapy. I have other suggestions, including exercise to move blood and reduce the moderate swelling in your feet. First you need to work on improving the transfer problem. You have terrific strength in your upper body with some weakness developing in the left hand. I suspect it is from straining your arms and upper body. The last thing you need is to further strain your neck, shoulders and wrists due to transferring less efficiently, especially when someone is there to help you.
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Re: CCSVI and CCVBP

Postby NZer1 » Fri Sep 13, 2013 12:43 pm

Hi Dr and Dania,
as an observer with a bias to infection related links to 'MS' type symptoms I would like to add an observation.

Firstly that Dania using a Neurologist as a lead Doctor sounds inappropriate after hearing Dr F's comments. Dr F's findings are not going to be understood and agreed by a Neuro.

The next observation is regarding the injury history. I too have a history of various similar injuries and have found that I have problems because of intra-cellular bacterial infection of the areas of muscular tissue damage and that infection has migrated into the CNS. As well as the infection I have progressive symptoms that are lower body mostly. The injuries to my cervical spine appear to be the problem area that has caused lesions on MRI, and the tissues of disc and muscles of the spine are suspected to be infected as well. The infection issues that become symptomatic relate more to endo-toxins production related to the life cycle of the infection bacteria, as it does to the effect of porphyria and mitochondrial dysfunction caused directly by the bacteria and therefore low ATP (cellular energy) production by the mitochondria.

The dx of an intra-cellular infection is extremely challenging, and most Medical professionals are not appropriate for dx or treatments, whether the dx is Lyme and co-infections (co-infections are more problematic/symptomatic than the basic Borellia) or CPn or Mycoplasma or Babesia etc, etc.

I personally would seek a well known Lyme disease specialist who is able to direct having the best testing possible done at the same time as looking at improving the currant dysfunctions and rehab'ing as much as possible with Dr F guidance.

Transverse Myelitis appears to be a dx that fits the assessment of Dr F and that is why I would consider finding the best of the best to test for infection possibilities to the CNS/Spinal Cord.

Investigating the flows of blood and CSF related to the brain and cord would also give good indications if the Up Right MRI and Cine tests were performed by someone well versed with CCSVI issues. Long term infections will definitely effect the flows and the CCSVI findings.

This is all opinion of course and not based on training, rather it is based on listening and reading the research of the people searching for answers to the questions 'what is MS' and 'what is wrong with me'?

:)
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Re: CCSVI and CCVBP

Postby uprightdoc » Fri Sep 13, 2013 12:51 pm

Hello Robert,
In case I didn't previously reply in a PM, the last sagittal (side) cervical view is more of the same but better detail. The triangular tooth-like bone is the dens of C2 or axis. The vertebra below it is C3. The lower vertebra should look more square. Look at the deformity in your end plates (top and bottom of the vertebra). That type of deformation is from compression loads. The compression loads likewise caused the disc to buldge into the epidural space and compress the vertebral veins (VVP) from C3 through C6. Spondylosis changes the dimensions of the spinal canal and alters the hydraulics in the epidural space surrounding the cord. Those hydraulics are affected by posture, movement and respiration. The faulty hydraulics in the epidural space and veins of the spinal canal are transmitted to the spinal cord. That's a basic principle of physics. The impact of those faulty hydraulics in the epidural space on blood and CSF flow in the cord has yet to be determined. Further research needs to be done. My theory is, whatever it is, faulty hydraulics can't be good.
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Re: CCSVI and CCVBP

Postby uprightdoc » Fri Sep 13, 2013 1:48 pm

Hello Poet,
Late summer and Indian Summers are terrific with warm days and cool nights but as you know swimming in New York in September is dicey but in the Northcountry it's rare. Despite the warm days the extra-cool nights cooled the lake considerably. Swimming is supposed to be bad for rotator cuff problems but I find my long style stroke terrific for rehab. The backstroke is terrific for the latts and the stabilizer muscles of the shoulders. The recovery phase is more natural as it is simple shoulder elevation. David Armbruster and Jack Sigel were swimming coaches that developed the butterfly stroke. Their book on Swimming and Diving interested me in kinesiology before I started chiropractic school. It was great looking up the other day and seeing the white birch along the shore against the dark gray of the gathering storm clouds. I worked up a pretty good appetite as well. I will see you on 9/22.
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