ballooning of nonobstructed jugulars

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

ballooning of nonobstructed jugulars

Postby Cece » Wed Nov 07, 2012 11:02 am

http://blog.synergyhealthconcepts.com/d ... -magazine/
My initial experience with CCSVI was based on the assumption that it was for MS. It wasn’t exactly clear how but in some manner dilating the jugular veins had an impact on MS. As I gained more experience it became evident that the procedure helped patients with neurologic diseases other than MS, such as Parkinson’s. Logically it follows that CCSVI could not then be a treatment for MS. The degree of venous obstruction did not seem to have any bearing on the impact of the procedure. This observation lead to treating less obstructed jugulars and noting no difference. Ultimately non obstructed jugulars were dilated and the typical CCSVI response ensued. Clearly something else had to be going on.

Am I reading this correctly? Is he saying that he dilated nonobstructed jugulars in isolation (meaning nothing else was treated at that time) and the patients had improvements such as what is seen after an obstructed CCSVI jugular is dilated?

Possibilities suggest themselves
1 - placebo effect
2 - unseen stenosis was dilated, thus leading to improvements
3 - blood thinners used during the procedure led to symptomatic improvements
4 - pwMS have abnormal collagen throughout their jugulars, as shown in Dr. Zamboni's autopsy research, and if ballooning the jugulars softens the collagen in the vein wall, then this may allow greater distensibility thus leading to improvements in flow
5 - Dr. Arata's explanation - ballooning the jugular mechanically stimulates the vagus nerve running alongside the jugular, thus leading to improvements

If the balloon mechanically stimulated the vagus nerve and it was what lead to the response to treatment it would solve the mystery of how a patient with a normal jugular vein could respond to jugular ballooning.

I think the finding that patients have improvements after ballooning of an unobstructed vein is a new finding, but what does it mean? I am not convinced by Dr. Arata's explanation, although it is plausible, as are the other four possibilities listed. It opens him to criticism that he would take the step of ballooning unobstructed veins, but if a patient is paying out-of-pocket, then is the doctor free to do whatever is in his power that he thinks will help, and his finding was that ballooning these unobstructed veins was helpful?

It's a new idea to consider: does ballooning an unobstructed jugular vein offer the same results as ballooning an obstructed jugular?
We would need data to support this idea. Replication, publication, controlled trial, etc.
How often do patients turn up for CCSVI treatment that are then seen to have no obstructions whatsoever? He's treating patients that are not MS patients, was this exclusively in those patients? Or was it in patients that had been previously treated?
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Re: ballooning of nonobstructed jugulars

Postby Cece » Wed Nov 07, 2012 11:13 am

ok, beyond the rather shocking notion that ballooning unobstructed jugulars could lead to improvements, Dr. Arata's post contained this nugget:
The implications were so compelling that we changed our protocol and now focus on autonomic dysfunction. Treatment rests on definitive testing for it with HRV analysis rather than venous studies. Interestingly enough we are now able to objectively document response to therapy. Conjecture of a placebo effect has been nullified. I firmly believe that jugular ballooning treats autonomic dysfunction. Any impact on MS is mediated by alteration of the autonomic system not by changes in blood flow. Future investigations need to include a means of measuring autonomic function for patient screening and assessment of treatment response.

Heart rate variability analysis!
http://en.wikipedia.org/wiki/Heart_rate_variability
This can be measured before and after treatment, and objective improvement can be seen?
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Re: ballooning of nonobstructed jugulars

Postby MrSuccess » Wed Nov 07, 2012 12:57 pm

..... in this blog of Dr.Arata's .... is a golden gem . And that is ..... the comments he makes about treatment outcomes in OTHER neurological situations.

MrSuccess puts forth the novel idea :idea: of having the grass roots supporters and [ hopefully their medical experts ].... join together with CCSVI advocates and put additional pressure on those refusing to at least explore the possibilities that the CCSVI procedure can bring some help to those in need.

Has anyone such as CCSVI Alliance reached out yet for their support ?


There is indeed ..... Strength in Numbers .... :idea:


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Re: ballooning of nonobstructed jugulars

Postby cheerleader » Wed Nov 07, 2012 6:32 pm

There are currently approved medical practices in which the vagus nerve can be stimulated to help patients with epilepsy and seizures. And it is not a one time zap, like ballooning, but an implanted stimulating device, which gives ongoing stimulation to the nerve.

The vagus nerve, or cranial nerve X, is a part of the autonomic nervous system, which controls functions of the body that are not under voluntary control, such as heart rate and digestion. In the neck, the vagus nerve travels near the carotid artery and jugular vein. Interestingly, neurologists in the 19th century noted that applying pressure on the carotid artery in the neck, and thus the vagus nerve, could stop seizures. Recent research found that stimulation of the vagus nerve in animals decreases both epileptic activity in the EEG and the frequency and severity of seizures. After proven seizure reduction in animals using VNS, several controlled human trials demonstrated a significant reduction in seizures with minimal side effects. In 1997, the FDA approved vagus nerve stimulation in patients older than 12 with refractory partial epilepsy. Mounting clinical experience also demonstrates efficacy and safety in children and in patients with generalized epilepsies
.
http://epilepsy.med.nyu.edu/diagnosis-t ... lation-vns
http://www.healthcommunities.com/vagus- ... view.shtml


And treating a non-stenotic vein, simply based on this theory, is concerning. Especially when there is an already approved method of treating the vagus nerve.
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Re: ballooning of nonobstructed jugulars

Postby PointsNorth » Wed Nov 07, 2012 6:41 pm

Albany 2010. Brooklyn 2011
Calcitriol+D3 2013-
Hurry up and wait.
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Re: ballooning of nonobstructed jugulars

Postby Cece » Thu Nov 08, 2012 9:43 am

Has vagus nerve stimulation been tried in MS? (I'll check.)

http://msj.sagepub.com/content/13/9/1200.short
Vagus nerve stimulation (VNS), an adjunctive approach for the treatment of epilepsy, was performed in three multiple sclerosis (MS) patients displaying postural cerebellar tremor (PCT) and dysphagia. Following VNS, improvement of PCT and dysphagia was manifested over a period of two and three months, respectively. In view of the involvement of the main brainstem visceral component of the vagus, the nucleus tractus solitarius (NTS), in modulating central pattern generators (CPGs) linked to both olive complex pathway and swallowing, improvement is likely to be VNS related. The results obtained suggest an additional therapeutic application for VNS and may represent a novel form of treatment in patients with severe MS. Multiple Sclerosis 2007; 13: 1200—1202. http://msj.sagepub.com
case study of three patients
improvements seen in swallowing and tremor

http://www.neurology.org/content/65/3/490.short#
case study of one MS patient
vagus nerve stimulation improved patient's score on the KRS scale (ataxia, tremors, gait) but not other MS symptoms
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Re: ballooning of nonobstructed jugulars

Postby 1eye » Thu Nov 08, 2012 10:07 am

I agree that ballooning, for the sake of treating the vagus nerve, when there are other less dangerous and invasive methods of vagus nerve stimulation, is not a good practice.

The benefit of ballooning a jugular which is stenotic is that blood flow is improved. If experimental evidence is to be believed, there is a demonstrable connection between "MS" and CCSVI. To ignore this connection is a disservice to anyone who has been diagnosed with having "MS". It also places them squarely in a grey area occupied by many other less well-documented and unproven if not completely deprecated treatments for "MS", as well as for other diseases. It opens them up to accusations of placebo, wishful thinking and gullibility.

It may be that vagus nerve stimulation is a treatment that can help all these diseases. I think it beats drugs if it works. My brother, the one who had hydrocephalus as an infant, has had episodes of seizures as well as a shunt in his jugular. However I think if we ignore CCSVI because of an unproven theory written on a blog, we do so at our own peril. In this case you can count me with the skeptics.

We are losing the thread, here. Doesn't the azygus vein have anything to do with the condition? I thought it did.
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Re: ballooning of nonobstructed jugulars

Postby Cece » Thu Nov 08, 2012 10:23 am

We have Dr. Arata's observation: ballooning of nonobstructed jugulars appeared to result in symptomatic improvements. Unpublished, unreplicated, but valuable as an observation by a practicing CCSVI IR. I don't accept where he goes from there, which is to declare the benefits of CCSVI treatment to be unrelated to improvements in flow and instead related to vagus nerve stimulation from the ballooning. But it should be a testable idea.

I look at my improvements post-procedure, and some of the strangest improvements are autonomic nervous system improvements: hands and feet the same body temperature as the rest of me, improved heat intolerance, improved sweating, improved swallowing. But other improvements are not autonomic nervous system, to the best of my understanding: improved cogfog, improved colors, improved clarity of vision.

http://www.webmd.com/a-to-z-guides/vaga ... c-overview
Vagal maneuvers are used to try to slow an episode of fast heart rate. These simple maneuvers stimulate the vagus nerve, sometimes resulting in slowed conduction of electrical impulses through the atrioventricular (AV) node of the heart. Be sure to talk to your doctor before trying these.

Vagal maneuvers that you can try to slow your fast heart rate include:
Gagging.
Holding your breath and bearing down (Valsalva maneuver).
Immersing your face in ice-cold water (diving reflex).
Coughing.
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Re: ballooning of nonobstructed jugulars

Postby Cece » Mon Nov 12, 2012 5:12 pm

from Dr. Arata on the CCSVI in MS facebook page in the comments under the article today about Pavarotti's widow's successful CCSVI treatment in Italy
With all due respect to the researchers looking at blood flow and it's connection to MS a relationship has not been proven. At this point everything is observational. My observation is that if a patient I treat has symptoms of dysautonomia they respond if they have MS and no symptom's of dysautonomia they do not respond. This response has no correlation with venous flow. In fact venous flow can be normal and dysautonomia respond to jugular ballooning. It is plausible that even MS itself could respond via vagal tone via a mechanism described as the neural inflammatory reflex.

This could be used to predict who will benefit from CCSVI venoplasty and who will not.
Oy the difficulty in even figuring out what is being treated during angioplasty. Is it MS? Is it CCSVI syndrome, a collection of symptoms including autonomic nervous system impairments accompanied by outflow obstructions in the extracranial veins, being treated? Or does it have nothing to do with that and it's dysautomia that's being treated? I think it's CCSVI syndrome but I am interested in reading what Dr. Arata publishes.
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Re: ballooning of nonobstructed jugulars

Postby cheerleader » Mon Nov 12, 2012 10:19 pm

Been reading up more on the vagus nerve and inflammatory reflex, trying to understand this---found an interesting paper.
http://www.ccjm.org/content/76/Suppl_2/S23.full
The heart and brain are obviously connected in ways we still do not fully comprehend, and I hope Dr. Arata is working with researchers that can help him model his observations so he can publish. I still think that treating and charging fees for non-stenotic veins is questionable, at best.
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Re: ballooning of nonobstructed jugulars

Postby NHE » Mon Nov 12, 2012 10:55 pm

cheerleader wrote:I still think that treating and charging fees for non-stenotic veins is questionable, at best.


Moreover, the danger of damaging a perfectly good vein and risking a clot or intimal hyperplasia makes the practice questionable.

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Re: ballooning of nonobstructed jugulars

Postby Cece » Tue Nov 13, 2012 9:10 am

I spent some time looking in google scholar for published literature regarding angioplasty done in healthy blood vessels but could not find any precedent.
But I am not convinced that Dr. Arata is treating healthy blood vessels, even if he thinks they are healthy, because the abnormal collagen seen in the jugulars of MS patients is indicative that they are unhealthy.

(This gets back to the technique of being very precise with the shoulder placement of the angioplasty balloon, to minimize the ballooning of the healthy vein. If it can be shown that there is benefit in ballooning the jugulars of MS patients both at the stenotic and at the nonstenotic portions of the vein, then the technique of precise shoulder placement would not be warranted.)

1eye raised a good point about the azygous. If an IR were 100% convinced of this dysautonomia theory, I think the azygous would be dropped from consideration and treatment.
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Re: ballooning of nonobstructed jugulars

Postby Cece » Thu Nov 15, 2012 8:47 am

http://alisonrichards.wordpress.com/201 ... rve-pinch/

"This diagram demonstrates what the vagus nerve does:"
Image
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Re: ballooning of nonobstructed jugulars

Postby Cece » Sat Nov 17, 2012 2:18 pm

https://twitter.com/MICHAELARATAMD/stat ... 00/photo/1

normalization of blood pressure as objective measure before and after venoplasty
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Re: ballooning of nonobstructed jugulars

Postby Cece » Tue Nov 27, 2012 10:21 am

I came across this on dysautonomia, and thought it was relevant. It's in Gulf War syndrome.
http://www.medpagetoday.com/Neurology/G ... id=5517461
Dysfunction of the autonomic nervous system may underlie the myriad symptoms experienced by veterans with Gulf War syndrome and its variant subtypes, a case-control study suggested.

The article also lists many ways to measure dysautonomia:
* the self-administered Autonomic Symptom Profile (ASP) questionnaire
* the Composite Autonomic Severity Scores, which combine objective measures of autonomic deficits on a scale of zero to 10
* another objective test of autonomic function measures axonal sweat gland stimulation
* Additional tests included investigations of circadian changes in parasympathetic tone using 24-hour electrocardiograms, in which the normal nocturnal increase in high-frequency heart rate variability was lacking in cases but not controls
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