Zamboni in his 2006 paper "the Big Idea" proposed that MS lesions are like venous ulcers in the legs. He mentions several similarities in the lesions themselves like iron deposits and MMp9.
here's a blurb on venous ulcers from Wiki...
The exact etiology of venous ulcers is not certain, but they are thought to arise when venous valves that exist to prevent backflow of blood do not function properly, causing the pressure in veins to increase. The body needs the pressure gradient between arteries and veins in order for the heart to pump blood forward through arteries and into veins. When venous hypertension exists, arteries no longer have significantly higher pressure than veins, blood is not pumped as effectively into or out of the area, and it pools.
Venous hypertension may also stretch veins and allow blood proteins to leak into the extravascular space, isolating extracellular matrix (ECM) molecules and growth factors, preventing them from helping to heal the wound. Leakage of fibrinogen from veins as well as deficiencies in fibrinolysis may also cause fibrin to build up around the vessels, preventing oxygen and nutrients from reaching cells. Venous insufficiency may also cause white blood cells (leukocytes) to accumulate in small blood vessels, releasing inflammatory factors and reactive oxygen species (ROS, free radicals) and further contributing to chronic wound formation. Buildup of white blood cells in small blood vessels may also plug the vessels, further contributing to ischemia. This blockage of blood vessels by leukocytes may be responsible for the "no reflow phenomenon," in which ischemic tissue is never fully reperfused. Allowing blood to flow back into the limb, for example by elevating it, is necessary but also contributes to reperfusion injury. Other comorbidities may also be the root cause of venous ulcers.
It is in the crus that the classic venous stasis ulcer occurs. Venous stasis results from damage to the vein valvular system in the lower extremity and in extreme cases allows the pressure in the veins to be higher than the pressure in the arteries. This pressure results in transudation of inflammatory mediators into the subcutaneous tissues of the lower extremity and subsequent breakdown of the tissue including the skin.
SO that kind of oulines the problem with venous ulcers and what happens, note the classic issues that we have seen time and time again as 'evidence' of autoimmune disease: the lymphocytes in the area, the inflammatory factors etc.
I wonder looking at this if reducing inflammatory factors would make a difference in healing? Notice that the inflammatory factors contribute to the wound formation
, so would steroids/ immune suppressives help reduce the injury and make things seem better? I can't find any reference attempting it, but then again no one ever thought venous ulcers were autoimmune............
So you will wonder what the treatment is for venous ulcers? Below is a link to a study that showed surgical treatment to repair the valves and restore venous competance worked well in most cases (there seems to be a difference with post thrombotic syndrome)http://www.ncbi.nlm.nih.gov/pubmed/8126852
CONCLUSIONS: This report highlights a difference found in very long-term prognosis of surgical treatment of primary valve insufficiency as opposed to postthrombotic syndrome. Long-term elimination of symptoms of chronic venous insufficiency is achieved by valve repair for primary valve insufficiency beyond 10 years, whereas late results of treatment of postthrombotic syndrome in this study was accompanied by high recurrence rates and warrants further investigation.
They don't know why post thrombotic syndrome, which is a person who had a clot in the leg then developed venous problems after that, is different than people with primary venous problems. I think, and just IMHO, that the MS type is probably like primary venous ulcers because we are talking about a stricture that causes problems upstream without another initiating event.http://ves.sagepub.com/cgi/content/abstract/38/3/209
The aim of this study was to define the underlying anatomical and pathophysiological conditions in limbs with venous ulcers in order to get information for the most appropriate treatment selection. Ninety-eight limbs (83 patients, 59 men), with active chronic venous ulcers, were analyzed retrospectively and classified according to the CEAP (clinical, etiological, anatomical, and pathophysiological) classification. Duplex-ultrasound was performed in all patients, while air-plethysmography and venography were performed selectively on potential candidates for deep venous reconstruction. Sixty-six ulcers were primary in origin and 32 were secondary. Reflux was present in all limbs except 1. Isolated reflux in 1 system (superficial = 3, deep = 4, perforator = 3) was seen in 10 legs (10%), while incompetence in all 3 systems was seen in 51 legs (52%). Superficial reflux with or without involvement of other systems was seen in 84 legs (86%), 72 legs (73%) had deep reflux with or without involvement of other systems, and incompetent perforator veins were identified in 79 limbs (81%). Axial reflux (continuous reverse flow from the groin region to below knee) was found in 77 limbs (79%). The femoral vein was the single most common deep venous segment in which either reflux or obstruction was found. Axial distribution of disease was found in the majority of cases and no patient had isolated deep venous incompetence below knee. Primary disease was the predominant etiologic cause and reflux was the main pathophysiological finding. Practically all patients were found to have 1 or more sites of reflux or obstruction that could benefit from operative treatment.
It'll be good if it becomes well known that we too have strictures, like those noted above in the FEMORAL veins that are identifiable so they are operable in the same way. I think this is interesting because the femoral veins are large and actually are more central to the system; a lot of smaller things drain to them, and they go directly to the vena cava which is the biggest vein that drains everything else and goes directly to the heart.
The azygous vein and the jugular are also attached to the vena cava, so they could be considered similar in size and function. If femoral veins can have strictures that cause venous ulcers upstream (which is actually below in the feet because veins drain from bottom up in the legs) then why on earth not the azygous and jugular????
One thing I came across several times was that if the stricture has been present a long time other veins not so deep/large would also end up being injured by being over capacity, backed up, and stretched trying to deal with the local congestion, so their valves end up being incompetant too. What happens then is those other smaller veins also need repairs complicating treatment to several sites, and this messes up the pure science results of the effort to evaluate the success of surgical intervention. Like if you decided you didn't need to repair the smaller veins and the person still has issues later is it because the femoral vein repair failed or you just didn't repair enough?
Further studies to check and see what is going on later to evaluate your results are needed.
it is a little bit complicated!
I wrote and asked Dr Schelling what we could do to help while we wait and he said nothing but surgery will help. I had wondered if breathing hard/straining should be avoided and he mentioned that some MS exacerbations had been noted in people who'd done huge efforts with heavy breathing in some early work around WW1 & 2. In other words yes, straining is a bad idea, but because it is unavoidable in living people surgery is the only real option.
In the feet with venous ulcers one can keep one's feet up to aid drainage, use pressure stocking etc (this is considered "conservative treatment" you know how health systems like to find cheap ways to deal with stuff....)but the head is not really conducive to anything like that at all.
In general though it seems the surgical repair is the best approach with long term success in many people when looking at venous ulcers (edt to clarify venous ulcers specifically).
I still have not heard from my chosen vascular dude.........