PATIENTS AND CAREGIVERS DISCUSS THE PHYSICIAN DISCUSSION

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

Postby eric593 » Tue Jan 25, 2011 9:55 am

DrCumming wrote: I do not know what they tried in terms of balloons or technique to get the vein open. Probably not much given the case was done in 30 minutes.


Did you not have the opportunity to review a clinical report or prior venogram images to know the history?

If not, was it not possible to contact the prior treating physician? I would think prior interventional history would be key information to have before going back in(?)
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Postby NZer1 » Tue Jan 25, 2011 11:46 am

Thanks Dr. Cumming, a very good warning to all watching.
Doesn't give the CCSVI treatment stats a fair go having this standard of work done! Sadly there will be allot of people wondering about their treatment!
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Postby Cece » Tue Jan 25, 2011 12:37 pm

Very disappointing indeed to see this. I hope the procedure goes well and you are successful at opening it up.
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ccsvi

Postby blossom » Tue Jan 25, 2011 9:11 pm

i hate it that some have gone for treatment praying that it helps and got the bam,slam thank you mam treatment. but, thankfully this is changing with more and more good doctors to choose from. plus they are learning more and soon i hope this all gets figured out.

even if it happened to only one person it is one too many that is put through additional misery. but, sadly we "can" learn from mistakes. and that is the price that is being paid by some especially the ones first in line.
but, somebody had to do it and i hope that at least it helps to make the future brighter for those of us that have symptoms they named ms.

dr. cummings, i pray you have success with this patient.
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Re: Case study #1

Postby Cece » Wed Jan 26, 2011 6:03 am

drsclafani wrote:Slam away, I can take it. After all, none of you detected the hypoplastic IJV in the first place
Cece wrote:The left jugular, is that hypoplastic? Or is the technical term 'a mess.' I'd balloon starting from the bottom, going up, after double-checking drsclafani's thread for what balloon sizes and pressures he's used in hypoplastic veins and repeat ballooning or adjusting sizes and pressures on whatever waisting is found, but with the issues near the skull base I'd leave alone. I would not expect too good of results with that one but perhaps would be surprised.

:wink:

(please note that I expect to be wrong and most definitely am not a doctor)

C'mon, a little credit? I've at least got Dr. Sclafani's methods memorized. :D
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Re: Case study #1

Postby L » Wed Jan 26, 2011 6:15 am

Cece wrote:C'mon, a little credit? I've at least got Dr. Sclafani's methods memorized. :D


How much is it to hire all the equipment? Can't be too expensive and if you set your rates to only cover costs for your first few procedures.. You need to put your skills to the test!
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Re: Case study #1

Postby drsclafani » Wed Jan 26, 2011 7:46 am

Cece wrote:
drsclafani wrote:Slam away, I can take it. After all, none of you detected the hypoplastic IJV in the first place
Cece wrote:The left jugular, is that hypoplastic? Or is the technical term 'a mess.' I'd balloon starting from the bottom, going up, after double-checking drsclafani's thread for what balloon sizes and pressures he's used in hypoplastic veins and repeat ballooning or adjusting sizes and pressures on whatever waisting is found, but with the issues near the skull base I'd leave alone. I would not expect too good of results with that one but perhaps would be surprised.

:wink:

(please note that I expect to be wrong and most definitely am not a doctor)

C'mon, a little credit? I've at least got Dr. Sclafani's methods memorized. :D


credit given

as i have said before when do you join my residency program :D

btw
PM please
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Postby NZer1 » Wed Jan 26, 2011 3:19 pm

Of to the Head Masters with you Cece.
Hey when are you and Dr S getting together?
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Postby Cece » Thu Jan 27, 2011 6:39 am

thanks everyone :D

NZer1, hopefully soon!
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Postby drsclafani » Thu Jan 27, 2011 9:34 pm

Cece wrote:The analogy has been that elastic recoil is like stretching a tight rubber band and then it re-takes its old shape. But that when you hear the pop, it's like tearing the rubber band.

For Dr. Sclafani's case, it's similar to another hypoplastic jugular that he posted in his thread a few weeks ago in which thrombus formed during the procedure. This might end up being among the expected complications of treating hypoplastic jugulars in that way. So far thrombectomy during the procedure seems to be working fine, but these clots could travel and cause a PE or be resistant to thrombectomy? I agree with what he said in his thread previously, that the vein is already hypoplastic so not much to lose, might as well try.


the volume of thrombus was quite small and is not likely to cause symptoms. we do this all the time when we treat clotted arteriovenous grafts for hemodialysis

i am not glib about this. thrombosis is a great disapointment. We are able to dilated the vesserl. it is from that point that thrombosis occurs. so we do have something to lose.

i thfnk we need to continue to think of solutions to hypoplasia
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Postby Algis » Thu Jan 27, 2011 9:40 pm

Sorry to intrude; but is Taxol ever used for clots?
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Whee do you start?

Postby Rosegirl » Fri Jan 28, 2011 5:36 am

Hi, Dr. S.

Some studies report that about half of the treated patients have problems with valves. How many valves are there, and where are they located?

Would it make sense to test and treat valves before treating problems in other areas? For example, if opening a stuck valve makes all the collateral veins above it go away, that would minimize any trauma that might otherwise have occurred if the doctor systematically treated any problems found as they occurred.
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Re: Whee do you start?

Postby DrCumming » Fri Jan 28, 2011 6:16 am

Rosegirl wrote:Hi, Dr. S.

Some studies report that about half of the treated patients have problems with valves. How many valves are there, and where are they located?

Would it make sense to test and treat valves before treating problems in other areas? For example, if opening a stuck valve makes all the collateral veins above it go away, that would minimize any trauma that might otherwise have occurred if the doctor systematically treated any problems found as they occurred.


The arrangement of valves in the body is quite variable. Typically there is 1 valve in the proximal IJ just before it joins the subclavian vein to form the inominate vein.

There has been discussion about only treating that area of the IJ first and (if I remember correctly) this is what Zamboni has advocated.

Again, this gets back to the discussion of doing enough versus doing to much. How big do we balloon and what areas do we balloon? And then trying to manage cost particullary for cash paying patients. So, its hard to only treat the proximal IJ when we see a distal IJ stenosis.

This is also one of the reasons Sal and I worry that we do not know enough to do a randomized study. We do not know the best way to do the procedure to get the best outcomes.
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Re: Whee do you start?

Postby Cece » Fri Jan 28, 2011 6:42 am

For that unexpanded stent, how is it that it hasn't clotted? Or is it not known if it has or hasn't. With turbulent flow there and a stent to clot against, it's hard to believe that jugular has a chance.

Picasa website wrote:"Oops... there's nothing to see here. Either you do not have access to these photos, or they don't exist at this web address. Please contact the owner directly to gain access."

Gotta fix that picture! :)
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Re: Taxol and clots

Postby NHE » Sat Jan 29, 2011 3:33 am

Algis wrote:Sorry to intrude; but is Taxol ever used for clots?


Hi Algis,
I would be interested in knowing what your thinking is here on Taxol. I know that it induces microtubules to polymerize into a highly stable form, but I'm not clear on what it would do for a clot.

Thanks, NHE
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