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Holly at Stanford

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

Postby Loobie » Thu Jun 04, 2009 4:13 pm

mrhodes40 wrote:azygos wow! that is expected I would think given her history.


I hope to God that you are all saying this about me in 5 weeks, 4 days, 21 hours................
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Postby cheerleader » Thu Jun 04, 2009 4:18 pm

Loobie wrote:
mrhodes40 wrote:azygos wow! that is expected I would think given her history.


I hope to God that you are all saying this about me in 5 weeks, 4 days, 21 hours................



But who's counting, right, Lew?? :wink:
Holly...I'm praying for you, dear heart. Can't believe you flew home after a double whammy procedure. You are a brave and unstoppable woman. Sending those healing vibes-
cheer and Jeff
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby peekaboo » Thu Jun 04, 2009 5:34 pm

Hi guys...i am home now and feel pretty good. fatigued phyisically but mentally bright :roll: no headache sore neck and sore schest area...yeah..azygous you should have heard dr dake...he was going nust exclaming to his staff saying this is real intervention :!: I have lots to share w/you guys so tomorrow it will be my priority...it will be a marathon post :)

love you all...talk to you tomorrow

holly
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Postby Loobie » Thu Jun 04, 2009 5:37 pm

Bring it on, but don't hurt yourself!
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Postby Sharon » Thu Jun 04, 2009 5:52 pm

Holly - I can't believe the minute you walked out of the hospital that you were on your way to the airport. I needed a few hours to rest up before heading to the airport. I was so surprised when Trudy told me about the asygous vein. Can't wait to hear your story!!

Get a good night sleep.

Sharon
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Postby mrhodes40 » Thu Jun 04, 2009 7:16 pm

Oh Holly God Bless You ! you will be in my thoughts I can't BELIEVE you flew today!! I can't believe it at all.

I can't wait to hear your story. I am on bated breath...............
blessings to you dear Holly,
marie
I'm not offering medical advice, I am just a patient too! Talk to your doctor about what is best for you...
http://www.thisisms.com/ftopic-7318-0.html This is my regimen thread
http://www.ccsvibook.com Read my book published by McFarland Health topics
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Postby whyRwehere » Thu Jun 04, 2009 10:28 pm

Holly, hope you heal quickly and look forward to your story!!
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Postby peekaboo » Fri Jun 05, 2009 9:58 am

Ok here we go....

Day 1 =

I must say i was pretty relaxed before going in...although i was anxious to get going. Catching up w/my sista, wallowing in the flora and fauna of sunnyvale california a couple of days prior, (they have their own brewd of mexican green parrots calling sunnyvale home) must have relaxed me somewhat.

My MRI/MRV's (brain, neck, spine) was scheduled for 12:00 but i got a call early that morning saying something is wrong w/my insurance. My SSDI is an HMO and prior approval w/ the HMO had to be reconciled before doing anything. I talked w/ the finance dept and she was working up cost for the MRI's and procedures. each mri was 5/K+ change and the procedure w/o doc fees would be 82/K + change....whoa but for some reason i was not upset. i just knew that everything was going to be all right. ( i also was in possesion of a credit card with up to 30K credit limit from my past life income). Remeber folks we will need to pay our 20% if you do not have an extra ins. supplement :!:
Well wouldn't you know that Dr. D personally went to the finance lady and bargained for me so atleast i can get the dx from MRI's. I was to receive only a pic of my neck at a discount fee. So at 3:30pm I was scheduled and met w/ Dr D afterward for consult.

Well...the pics showed my left jug with about 5cm of stenonis No flow :!: and the right jug with a small section narrowing. hence the double jug dx.

This is important we all know this. during the consult, we brought up zambonis results and he had questions regarding them. He explained that Dr.Z only used doppler and sonogram technolgy and was missing images ear level of the head. so some people may not be dx'd and those supposed "normal healthy" people may have venous issues.

Day 2

Now what do we do? does surgery commence? Well the finance lady must have been influenced somehow w/o HMO approval (keeping the faith) ...because i was to only pay the 20% of the procedure fee. So off I go to surgery later that day. Was in surgery from 12:00 ish to about 4:00ish.

Surgery comments -

Thankfully i did not eat/drink past 12:00pm so i could get surgery if approved. Normal pre-surgery prep...IV salene solution, a valium 5mg, and a child asprin. no super pain killers. Wheeled in to op room where a handful of people were mulling around. Dr. D and one of his resident staff dr. so and so and a few nurses. All of whom were very attentive and gracious. Another IV bag that was an abx to catch any post surgery infection. one nurse said she was going to give me some painkiller through IV...the name began with an F...then the swabbing of my abdomen and the incision was made on my right femoral vein. It was no big deal, due to pain killer? I can't remember when Heparin was introduced, during, before or after the op.

Blood tests were also part of pre op to compare INS and D-Dimmer? we have to ask marie what this is. her doc did this before she left and when she got home and there was a significant difference between the two.

When wheeled in, one is laying over a special camera which is horse shoe shaped. It is called a floroscope. (sp?) It can be electronically moved around for different views. it projects upon flat screens infront of the docs and can be scene while laying there. I was witnessing the op/my body in realtime. first stop was the left jug. It seemed uneventful... saw some collateral veins and the vein looked short. once the stent was put in place i could see it lengthen and collateral veins disappear. Sensations during placement of stent weren't too bad. one can feel it move in your body and for me my ears popped like adjusting to the pressure of an airplane ride. Dr D preformed before and after pressure readings...dang it I forget what they were. All the time this was going on Dr D was explaining everything and directing people to perform certain tasks. Dr. so and so was involved atleast partially in the procedures.

Next stop Right Jug...they are fishing around and could not find the small area that was supposed to be a narrowing of that vein. So Dr D went hunting for my azygous... WOW Dr D said... When i looked at the screen to what was supposed to be my azygous, it looked like something out of greek mythology. There were so many collateral veins looking like snakes on medusa's head. Also a portion near the stomach was collasped and need to be stented. Once stented, all snakes deflated :D During the Azygous procedure Dr D was very excited and was saying to all in the room that this is real intervention. Dr D told me later that he wants follow ups to be w/him. He also told me that i was the worst person yet that he has seen. is that good or bad?

I was wheeled to recovery, was given a turkey sandwhich. my neck hurt to move, felt like a really bad sprain. my chest, breast bone wsa sore too. My headache was much like a sinus headache, mute pain above the left eye and left rear skull behind the ear. i had no nausea. today is much better with just a little sore neck left. i will post progress in regime forum with the rest.

Getting PCP on board and referal experience - Dr Dake emailed me last night stating:

I spoke to Dr. Rxxxxx yesterday and also dictated a letter to him regarding your follow-up care, blood tests, meds, etc. He seemed a bit taken back that you had been here and was asking who referred you, etc., type questions. So, I felt it necessary to tell him the headache, swelling while visiting “my sister” version, which he seemed to understand. Any way, I hope he is understanding and sensitive to your condition

And I gave my PCP a packet...guess he read thru it carefully :evil:

Remeber I have an HMO SS advantage program where the headache scenario may need to be played out as last minute approval...PPO folks - pre approval may not be necessary and go w/o a glitch but...if you have an on board PCP or Nuero things should go well. but if you are working w/old school drs. you may have to use the "While visiting my sister...routine.

Meanwhile I have a plavix and warfarin rx for the next two mos. Dr Dake said do not change your habits (eating, supplemetns etc.) even though eating spinache may scew blood thinning results, it would be worse if you do and slip up and your results will fluctuate grossly and one can risk to high or too low amts. Ofcourse we know not to take aspirin and one can take aleve or motrin if needed.

What do you guys think? Holly
Last edited by peekaboo on Fri Jun 05, 2009 12:31 pm, edited 1 time in total.
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Postby Sharon » Fri Jun 05, 2009 10:53 am

Holly -

Excellent post - I have PM'd Marie about the D-Dimer test - Dr. Dake explained it to me, but I thought it necessary to get a few thoughts from Marie before posting it on the forum.

I was not able to see as much as you - they had my head and neck stabilized - Dake kept saying "don't move, don't move"; I was just amazed at the conversation taking place.

So, you are the first one on the block with the Asy vein - it is interesting that he found it so easily in the OR.

I have been on the computer for too long, so I need to get up and get that blood flowing through my new stents.

I am so happy that things worked out for you - take care

Sharon
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Postby Sharon » Fri Jun 05, 2009 10:54 am

Oh, Holly - I am on a baby aspirin per day - are you sure you are not to be taking one?
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Postby whyRwehere » Fri Jun 05, 2009 11:06 am

Oh, wow, that sounds intense....maybe you shouldn't print your pcp's name, in case he sees it, or in case the insurance catch on. But, Bravo, well done and all that...can't wait to see how everyone progresses.
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Postby mrhodes40 » Fri Jun 05, 2009 3:41 pm

Great post holly! Good job recounting the events.

pre op to compare INS and D-Dimmer? we have to ask marie what this is. her doc did this before she left and when she got home and there was a significant difference between the two.

actually I have the d dimer done regularly I have high thrombin and fibrin levels so I am cheked regularly for the d dimer. It was up the friday before I left for stanford so we had a mild emergency on that. Dr Dake, who my PCP called to alert to the d dimer suggested it would be down when we recheck in 2 months but we have not retested the d dimer yet
infor on d dimer http://www.clotcare.com/clotcare/faq_ddimertest.aspx
Last edited by mrhodes40 on Fri Jun 05, 2009 4:56 pm, edited 1 time in total.
I'm not offering medical advice, I am just a patient too! Talk to your doctor about what is best for you...
http://www.thisisms.com/ftopic-7318-0.html This is my regimen thread
http://www.ccsvibook.com Read my book published by McFarland Health topics
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Postby cheerleader » Fri Jun 05, 2009 4:42 pm

Holly...
If I understand correctly, Dr. Dake was OK'd by your insurance to do the jugular MRV only, so he found the jugular issues and got the stent procedure OK'd. Then he found your azygos problem once he was inside the vein????
Wow...no wonder he was excited. I think you're his new favorite :wink:

I'm so glad you were able to do this, and Jeff and I send you our hopes and prayers for a smooth recovery-
(Jeff also takes a baby aspirin a day along with the plavix and coumadin)
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby peekaboo » Fri Jun 05, 2009 5:14 pm

baby asprin...i posted wrong. i had to look back at my docs and sure enough i am to take one a day.

no favorites..ms has none...

i am so glad i was able to do this too :!: if it weren't for you, marie and TIMS i would have never known :D

I was purusing the TIMS site and saw marie post in ABX forum... OMG now i am worried that the stents are just a beginning ....it would be awful to have the stents done and then have to have them re-done because the lesions/ulcers would still be activated.....Ho Hum...wait and see...

holly

p.s. John my sig other said i should get a license plate saying azogos :wink:
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Postby peekaboo » Fri Jun 05, 2009 6:25 pm

The Azygos System of Veins


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Manubriosternal plane | Main Anatomy Index | Pleurae and pleural cavities

Last updated 30 March 2006

The Azygos System of Veins

The azygos system consists of veins on each side of the vertebral column.
These veins drain the back, thoracic and abdominal walls.
It exhibits much variation, not only in its origin, but also its course, tributaries, anastomoses, and termination.
The azygos vein and its main tributary, the hemiazygos vein, usually arise from the posterior aspect of the IVC and the renal vein respectively.
These veins provide another means of venous drainage from the abdomen and thorax.


The Azygos Vein

The azygos vein connects the superior and inferior venae cavae, either directly by joining the IVC or indirectly by the hemiazygos and accessory hemiazygos veins.
The azygos vein drains blood from the posterior walls of the thorax and abdomen.
It ascends in the posterior mediastinum, passing close to the right sides of the bodies of the inferior eight thoracic vertebrae (T4-T12).
It is covered anteriorly by the oesophagus as it passes posterior to the root of the right lung.
It then arches over the superior aspect of this root to join the SVC.
In addition to the posterior intercostal veins, the azygos vein communicates with the vertebral venous plexuses.
This vein also receives the mediastinal, oesophageal, and bronchial veins.


The Hemiazygos Vein

This vein arises on the left side of the junction of the left subcostal and ascending lumbar veins.
It ascends on the left side of the vertebral column, posterior to the thoracic aorta, as far as T9 vertebra.
Here it crosses to the right, posterior to the aorta, thoracic duct, and oesophagus, and joins the azygos vein.
The hemiazygos vein receives the inferior three intercostal veins, the inferior oesophageal veins, and several small mediastinal branches.


The Accessory Hemiazygos Vein

This vein begins at the medial end of the 4th or 5th intercostal space and descends on the left side of the vertebral column from T5 to T8.
It receives tributaries from veins in the 4th to 8th intercostal spaces and sometimes from the left bronchial veins.
It crosses over T7 or T8 vertebrae, posterior to the thoracic aorta and thoracic duct, where it joins the azygos vein.
Sometimes the accessory hemiazygos vein joins the hemiazygos vein and opens with it in the azygos.
The accessory azygos vein is frequently connected to the superior intercostal vein.
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