bluesky63 wrote:Maybe a medical person person (or savvy other person) can answer or speculate on this -- is it possible to have relapsing-remitting stenosis? You understand what I mean? In other words, if we image the veins over periods of time, would the degree of stenosis be variable, the way lesions are, and would that perhaps account for the differences in symptoms and lesions and disease course? Someone here has already had that experience if I am remembering right -- the first visit to Dr. Dake did not show stenosis but a later visit did.
Skydog did have an area of stenosis that was not as pronounced on his first visit to Stanford as it was on his second....I think this is a great question, bluesky, and more research needs to be done.
Dr. Zamboni has a hunch that a venous abnormality might be present at birth and that some outside factor (stress, virus, toxins, bacteria, etc) may further exacerbate the stenosis be creating endothelial (lining of blood vessels) disruption and worsen reflux. Or maybe a different neck position/postural change might also make the stenosis worse. This situation might create what we call a relapse. Dr. Zamboni and his team are studying endothelial disrupters and their affect on stenosis now.
The good news on this, if it is true, is that lifestyle, diet, nutrition, exercise, posture, etc. can have a very positive effect on the relapsing remitting types of venous occlusions....which is probably why those with less stenosis are able to keep their MS from progressing with changes to the endothelial disrupters. Also why some people can swear that their diet changed their MS...for some lucky ones, this is possible.
The less good news is that the congenitally absent veins and higher jugular stenosis we are seeing in more progressive MS is more difficult to treat and will require vascular surgical expertise.
Perhaps in the future each individual MS patient will get a print out of their type of occlusion, and have an individualized program for their situation....lifestyle, exercise, medication, postural changes, surgical intervention, endovascular ballooning and stenting. The veins can be monitored with doppler technology to make sure the stenosis is under control and blood is flowing correctly. I can dream....