WHY WE NEED VALVES

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

Re: WHY WE NEED VALVES

Postby cheerleader » Mon Oct 10, 2011 7:27 am

daniel wrote:
What are the implications of this? If we've had our jugulars ballooned, should we be avoiding coughing and 'acute increases in intrathoracic pressure' (whatever that means)?


Hi Daniel-
Jugular ballooning where valves are functioning normally should be fine. I asked Dr. Dake about this, since Jeff is a trumpeter...he's still playing, no problem.

If you start from the beginning of this thread, I mention Dr. Schelling and his concern. He has always believed that it is intrathoracic reversal of flow and pressure which causes Dawson's Fingers type lesions. For a review of Dr. Schelling's work on MS lesions, please see his book:
http://www.ms-info.net/evo/msmanu/984
This is just a theory, and has not been clarified at this point. But the valves DO prevent throacic pressure from sending venous reflux up into the brain.
For an explanation of thoracic pressure changes and venous return:
http://www.cvphysiology.com/Cardiac%20F ... cic%20pump

I also mention Dr. Chung's work on internal jugular vein valve insufficiency (IJVVI) and transient global amnesia and LA in the aging. (His papers are on pub med) Other researchers are finding the connection of valve insufficiency.
My point is that we simply do not know enough about jugular vein valves at this point to say they are inconsequential or unnecessary. There is a reason why 97% of us have them. Certainly, those who do not have valves should try to avoid head down positional changes such as inversion poses in yoga, or upside down roller coaster rides....but no one can avoid valsalva manuevers forever...you're going to cough, or strain, or have sex. And thoracic pressure changes are autonomic.

I feel very responsible for making sure no one is harmed...it was terrible seeing the adverse outcomes at Stanford, and made me much more wary. I feel it is important to discuss what we do not know about CCSVI treatment going forward-
cheer
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http://ccsviinms.blogspot.com
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Re: WHY WE NEED VALVES

Postby 1eye » Mon Oct 10, 2011 8:53 am

I can see why one might be apprehensive, about things like roller coaster rides, yoga, blowing hard on a trumpet, or, for some, even airplanes. I was thinking it might be something that's neither infrequent or hard to do, but can be destructive over many years of repetition, to certain people: like lying down.

Then again, Dizzy wouldn't have got those cheeks if he'd only played one solo, we've only been airborne a century, and sex is a time-honoured activity.
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Re: WHY WE NEED VALVES

Postby NZer1 » Mon Oct 10, 2011 12:48 pm

Very interesting discussion.
I come away with the thought that this is all assumed. If we were able to measure the pressure or vacuum changes inside the veins of normals and MSers we would be moving ahead.
The statement that we have valves in our IJV's is true, the question that comes from that is how many of those valves are functioning as they were designed, what if there is only a percentage of function?
Many valves are simply not working and for 'how long' is also an important question. Until we can measure what is happening inside these veins we are guessing and assuming.
Has Dr. Zamboni an understanding if he is repairing or replacing valves?
Regards Nigel
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Re: WHY WE NEED VALVES

Postby 1eye » Mon Oct 10, 2011 1:26 pm

Sorry for the frequent intrusions but:
I come away with the thought that this is all assumed. If we were able to measure the pressure or vacuum changes inside the veins of normals and MSers we would be moving ahead.
Exactly so. Three major variables: pressure (potential energy), flow rate (kinetic energy) and resistance must be known, dynamically and steady-state. Of these, the most likely to affect the resulting flow, and be under direct control by the autonomic nervous system, is resistance, due to the diameter of the blood vessels and it's 4th power relationship to resistance, and consequently to the other two. If anything interferes with our ability to control it, via dilation/constriction of the diameters, we are, as Bob & Doug MacKenzie might say, hosed.
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Re: WHY WE NEED VALVES

Postby CindyCB » Wed Oct 12, 2011 11:55 am

Noticed this article today in one of the tabloids (from the UK)...

http://www.dailymail.co.uk/sciencetech/ ... emory.html

"Sex can be mind-blowing – but not always in a good way, as scientists have found it can wipe your memory.

They cite the case of a 54-year-old woman who arrived at a hospital in Washington DC in a state of panic because she’d just been intimate with her husband and immediately lost all recollection of the previous 24 hours.

This rare condition is called ‘transient global amnesia’ and is always temporary, but because it’s so severe, it can be very distressing, say researchers.

The brain doesn’t suffer any harm, though, according to one neurologist not involved in the case. Indeed, brains scans of the woman at Georgetown University Hospital showed no damage had occurred.

Very little is known about what triggers the condition, though some doctors believe that misfiring valves in the neck may be the cause.

Instead of closing shut, they are remaining open to allow pressure in the stomach to push oxygen-poor blood that should be seeping downwards to the heart, back up through the jugular veins and in to the part of the brain that controls memories.

Sebastian Ameriso, from the Institute for Neurological Research in Buenos Aires, told Livescience: ‘We don't know very much about the cause. It causes a lot of alarm, but this is not a stroke or an event that causes damage to the brain. It's almost always very benign.’

The 54-year-old woman, whose case was reported in The Journal of Emergency Medicine, will have been just one of three to five people per 100,000 a year affected by transient global amnesia.

In the majority of cases it takes just a few hours for the memory to return.

Exerting yourself in other ways - such as weight-lifting or even going to the loo - can also lead to transient global amnesia.

And it’s the older generation, those in their 50s and 60s, who are most at risk.

Ameriso urges anyone with sudden memory loss to seek medical help as it could be a symptom of something far more serious, such as a stroke."

Thought it was interesting anyway.
Thyroid disease, Vitamin D deficiency, hypermobility, 'ME/CFS', CCSVI (stenosis both sides and assymetric malformed valves), TMJ - No MS but many neuro symptoms.
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Re: WHY WE NEED VALVES

Postby cheerleader » Wed Oct 12, 2011 12:19 pm

Yes--extremely interesting, Cindy. This is exactly what the Chung research is finding, and why we need working valves.
Transient Global Amnesia (TGA) related to jugular venous reflux, due to valve insufficiency.
This happens during valsalva manuever, stress, or sex, and is a problem as the body ages.
I started linking the papers on here back in '09, because I wondered how it might tie in to CCSVI.

Transiant global amnesia happens after stressful situations-

Quote:
In many cases, an episode of transient global amnesia can be traced to a physically or emotionally stressful incident shortly before symptoms began. Among the triggering events commonly reported are:

Sudden immersion in cold or hot water
Strenuous physical activity
Sexual intercourse
Medical procedures, such as angiography or endoscopy
Acute emotional distress, as might be provoked by bad news, conflict or overwork
The underlying cause of transient global amnesia is unknown. There appears to be a link between transient global amnesia and a history of migraines, though the underlying factors that contribute to both conditions aren't fully understood.

from the Mayo Clinic page on TGA

A sudden, hyperacute ischemic change is very different than an ongoing problem. I reiterate, CCSVI and TGA may not be mutually exclusive. Tiny lesions are detected in some patients after TGA-

Quote:
Hakan et al demonstrated tiny increases in signal in the left parahippocampal gyrus and splenium of the corpus callosum on DWI in one patient. This method of imaging allows detection of hyperacute ischemic change. Liang et al and Yang et al have also recently used DWI to document tiny lesions in the hippocampus of patients with acute TGA.1,2 However, Eustache et al reported a PET study consistent with a spreading depression in the left lateral frontal cortex. This case also featured oligemia in the left occipital cortex.3 Strupp et al found mainly medial temporal changes on DWI in 7 of 10 patients with TGA. They suggested that cellular edema or spreading depression could be responsible, not just ischemia.4

http://emedicine.medscape.com/article/1160964-overview

The studies are ongoing. It appears there is substantial evidence that jugular valve malfunctions may play a part in TGA. But that does not nullify CCSVI studies. I think the Germans are wrong to discount CCSVI without researching it.
We have to be really careful about making comments regarding well-established, peer-reviewed research on here, just because it doesn't seem to fit our particular paradigm. We don't know enough about how TGA and CCSVI are different or how they are the same YET, but research will continue to help us understand.

Here is the Chung research I put on the big CCSVI forum last year, Marie has it linked in the research sticky. There is still more to learn regarding jugular venous reflux. Please read this paper-
http://health.elsevier.com/ajws_archive ... 3A4703.pdf
cheer
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dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: WHY WE NEED VALVES

Postby munchkin » Wed Oct 12, 2011 2:37 pm

had a funny thought, kind of fell flat
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Re: WHY WE NEED VALVES

Postby 1eye » Thu Oct 13, 2011 5:50 am

kind of fell flat


Hmmm. Too much straining? Or nymphomania followed by trumpet playing? "Either this man is dead or my watch has stopped."
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Re: WHY WE NEED VALVES

Postby cheerleader » Thu Oct 13, 2011 6:38 am

munchkin wrote:had a funny thought, kind of fell flat


as long as you, personally, remain upright, munchkin, no falling flat while being funny :)
I saw the sex joke which was cute, but was busy discussing valves on the Arata thread with Jugular.
Valves an important, they are not unnecessary, and this needs to be discussed with the IRs, and they need to be handed the research.
Dr. Chung will be speaking on his decades of valve research at the ISNVD conference next year, and some doctors are working on mechanical valvereplacements for veins.
I just want to make sure that the fallacy that "valves are not necessary" is dealt with and the actual recent science is read...
97% of people w/valves, preventing thoracic pressure increases and valsalva reflux to brain, TGA, TIA and LA. The papers are all this link.
cheer
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dx dual jugular vein stenosis (CCSVI) 4/09
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Re: WHY WE NEED VALVES

Postby munchkin » Thu Oct 13, 2011 7:53 am

So far, I'm still upright. Although I might add it's not always as much fun. :oops: :wink: (these were the smiles I meant to put with my original comment)
Thank you Cheer for sharing your time with us here. Even though your husband is doing well; you are still involved in this community and I know I appreciate the information. The need for shared information and unified thinking is needed. Dr.Zamboni did an amazing thing for people with MS. He started some in the medical/research community thinking. It shocks me at how little is known/accepted regarding the return venous system.
I'm all for valves, but, they also need to figure out how to help those of us who have had blockages from the experiments because valves are a moot point if your veins have been occluded.
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Re: WHY WE NEED VALVES

Postby Jugular » Thu Oct 13, 2011 9:32 am

Based upon what I learned in the other thread :), it would seem that valves with truncular malformations (stuck closed) are associated with CCSVI and MS, whereas valves that are insufficient (stuck open) are associated with TGA.

I'm still not sure that it is a "pick your poison" dichotomy. Firstly, trying to balloon veins upstream from valvular malformations seems to be at best a temporary fix (clinics focused on valves have markedly lower restenosis rates). Secondly, there have been no reported cases of TGA in the ever growing population of patients having undergone valvular angioplasty.

A few other things to keep in mind. TGA does not seem to cause any lasting damage, patiients who have experienced it once, tend not to again, and (as 1eye) points out, collaterals have no valves. So patients with valvular malformations have the worst of both worlds and patients having undergone valve "opening" have the best of one and an unproven risk of the other (which they had anyway).

In my case; I have noticed no ill effect from repeated valsalva maneuvering. Knock on wood.
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Re: WHY WE NEED VALVES

Postby cheerleader » Thu Oct 13, 2011 2:28 pm

Jugular wrote:Based upon what I learned in the other thread :), it would seem that valves with truncular malformations (stuck closed) are associated with CCSVI and MS, whereas valves that are insufficient (stuck open) are associated with TGA.


YES!!!!! YAY! We have a winner....I guess you've shown that I could have said that in less words, huh???

I'm still not sure that it is a "pick your poison" dichotomy. Firstly, trying to balloon veins upstream from valvular malformations seems to be at best a temporary fix (clinics focused on valves have markedly lower restenosis rates). Secondly, there have been no reported cases of TGA in the ever growing population of patients having undergone valvular angioplasty.

This type of internet rumor about restenosis rates is what got people going to Bulgaria to get LARGER Balloons....they thought it lead to lower restenosis rates, and now they have NO FLOW. People with valvupasty have just as many restenoses...here's a guy in Las Vegas who went to Arata's clinic NINE times, due to restenosis. He needed a vein transplant--
http://msmikejuices.blogspot.com/search ... results=29


I'm just going to throw this out there. What if increasing speed of flow thru the vein by opening the stenotic lesion, like what was done to my husband, relieved what looked like a "stuck" valve? Hydration, blood thinners, the endothelial health program can help keep that blood flowing. What if it is merely that enough flow isn't going thru the vein to keep the valve in an open position when lying down? We do not know how many strokes or TGA experiences have been related to valvuplasty, since there is no follow up. One Canadian did die in Orange County....but we do not know circumstances, because there was no follow up.

A few other things to keep in mind. TGA does not seem to cause any lasting damage, patiients who have experienced it once, tend not to again, and (as 1eye) points out, collaterals have no valves. So patients with valvular malformations have the worst of both worlds and patients having undergone valve "opening" have the best of one and an unproven risk of the other (which they had anyway).

That's not true about TGA....you can have repeats, and strokes, as well. It's not a benign thing...

28 patients with transient global amnesia (TGA) were followed for a mean period of 73 months. The patients fell into 3 diagnostic groups: a group where patients had associated symptoms and signs of transient focal cerebral ischemia (TIA), a migraine group and a miscellaneous group. 22 patients had evidence of cerebrovascular disease or risk factors for cerebrovascular disease, and a vascular basis for the amnesic attack was highly suggestive in 25 patients. During the follow-up period 2 patients died, 3 had recurrent TGA and 13 developed a completed stroke or suffered from further TIA's. Permanent memory impairment was encountered in 9 cases. An unfavourable course was related to the presence of other TIA manifestations and/or risk factors for cerebrovascular disease. The study indicates that TGA is probably due to transient ischemia in the vertebrobasilar arterial distribution area. TGA per se has a good prognosis, but the coexistence of risk factor or manifest cerebrovascular disease implies a high rate of a subsequent completed stroke or permanent memory impairment.

http://www.ncbi.nlm.nih.gov/pubmed/7211 ... t=Abstract

Repeated attacks of TGA are not rare and with each attack the likelihood increases of permanent memory deficits and progressive dementia. A rarer outcome is cerebral infarction in the territory of posterior cerebral arteries commonly referred to as "amnesic stroke."

http://stroke.ahajournals.org/content/5 ... f_ipsecsha

Collaterals do not have valves, you are right, but they are squirrly and more circuitous than the jugular veins, which are a straight shot from heart to head. Venous reflux in a collateral will not exert the same venous back pressure into the brain.

In my case; I have noticed no ill effect from repeated valsalva maneuvering. Knock on wood.

As I've stated, that's all that matters in your case, Jugular. My husband is fine with stents, as well. But other patients need to go in with all of the peer-reviewed and published research. That's why I stick around :-) Anecdotal evidence is great, but we need to stick to what's been documented...and that shows that valves are important.
cheer
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dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: WHY WE NEED VALVES

Postby NZer1 » Thu Oct 13, 2011 2:49 pm

The sooner a device or method of measuring flows in various positions and during various actions is done to compare and understand what is actually happening and what is risk we are all guessing. To compare before and after PTA is also going to a must to answer all of these questions.
Mri is unable to give the answers in the current forms and I don't think US is going to help accurately answer these questions either.
Maybe Trev Tucker and others that are more experienced with flow dynamics will be able to give some options.
The valves at are dysfunctional will need to be understood as well, there may not be a fix for them if they hardened, stuck etc.
Will be interesting to hear how Dr. Zamboni gets on with his replacement valves.
Regards Nigel
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Re: WHY WE NEED VALVES

Postby Jugular » Thu Oct 13, 2011 3:50 pm

cheerleader wrote:This type of internet rumor about restenosis rates is what got people going to Bulgaria to get LARGER Balloons....they thought it lead to lower restenosis rates, and now they have NO FLOW. People with valvupasty have just as many restenoses...here's a guy in Las Vegas who went to Arata's clinic NINE times, due to restenosis. He needed a vein transplant--
http://msmikejuices.blogspot.com/search ... results=29

I think it goes beyond internet rumor and can comfortably be called "Kool-Aid" since the low restenosis rate is something pitched by Synergy Health (former Pacific Interventionalists). You can believe them or not - they seemed honest enough to me. In any case, they are now conducting two IRB studies which include follow-up monitoring, so they should be able to take the step from Kool-Aid to published results soon.

Interesting story though by the chap from Las Vegas. Since he's been cleared for bungee jumping, did the transplant include a valve?

Which leads me to question - a large portion of truncular venous malformations implicated in CCSVI from what I've read (so major caveat there) are congenital in origin. After the faulty valves are busted up, could you regenerate new working ones? In other words, if the body can grow a collateral, maybe it can sprout a valve.
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Re: WHY WE NEED VALVES

Postby 1eye » Thu Oct 13, 2011 3:57 pm

I must admit to having not read up much on TGA, but:
The study indicates that TGA is probably due to transient ischemia in the vertebrobasilar arterial distribution area. TGA per se has a good prognosis, but the coexistence of risk factor or manifest cerebrovascular disease implies a high rate of a subsequent completed stroke or permanent memory impairment.

This gives no indication of valve problems in TGA. It talks instead about arterial distribution.
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