Jugular wrote:What, false readings from False Creek? We should have expected that!
Seriously, has anyone allowed for the possibility that Dr. Zamboni's study may have included false positives? In other words, the correlation may not be as "robust" as initially reported.
I also don't understand why imaging reflux and stenosis requires special training (indoctrination?) from Dr. Zamboni. Shouldn't it be obvious without having to squint or hold one's jaw right?
Straighten me out on this.
Lol@ your false double entendre.
There's always going to be possibilities in the medical field of false positives, and as marcstk has delineated before, people who were misdiagnosed for MS in the first place, muddying the scientific and statistical waters.
As to the problems with the imaging, part of it is our equipment here in the states, we need the stuff they have, we don't have it, at least not on a scale as in Europe. My thought is the profit motive. Since the government pays for a goodly number of services and equipment there, and funds so much of the research, there's incentive on all sides to produce bigger and better and more $$. Kind of like our jet fighters, good just aint good enough when it's on the taxpayer's dime. Or for a better example, motorized wheelchairs, subsidized by Medicare. We had a neighbor who had an unfortunate accident years ago, and was a quadraplegic. Oh boy you should see what those voice and mouth activated chairs run, paid for by the government since he's on permanent SS and Medicare. Even dinky parts are a ton of money. When one of the struts that holds the back of the seat up failed, in the middle of Magnolia, he was left by himself (his name was Jeff, and he would ride that thing all the way to Walmart with his kid boy in tow, really great guy), and his kid couldn't lift him upright, and the strut and it's piston driven mechanism, wouldn't have helped anyways to KEEP it up. Luckily my buddy has a machine shop, so he fixed it for free and we repaired the chair til he could get the new one. Gotta hand it to the paramedics though, AMR, since he was not necessarily hurt (but stuck laying flat on his wheelchair on the side of the road), they left him there to fend for himself. It was the most disgraceful and disgusting thing I've ever seen what they did just leaving him there, but I digress back to wherever I was, oh yeah, the ultrasound equipment.
I'm still not convinced that we even have the equipment on a large scale here in the states, that can adequately (and with enough sensitivity), detect reflux. My thought is that they are used to detecting arterial reflux which would be much more forceful and apparent, and the level of reflux we speak of here on the venous side, is MUCH more subtle. It's the subtlety that makes it difficult, not it's mere existence.
I was pondering tonight, if people who had strictly
valve issues, and resultant reflux, would show any
stenosis at all, for instance, lets say you have MS, you suspect CCSVI. You get MRV, it's negative. You then get on a plane, fly to Dr. Zamboni, and get only an ultrasound, and he finds refluxing in the veins, and a suspicious looking valve, or membrane, or whatever. Okay so now you are on the table, he lights up the venogram, confirms the valve issue, angioplasties the spot and sends you on your way. Granted that is a hypothetical situation, but lets say 20% of the people get negative MRV's, and have a strictly valvular issue, but can't get a proper scan, they would appear to any outsider, to be the exception to the rule, but in truth, have fallen through the cracks, they just don't know it yet. Obviously the medical field is not going to put all 20% on the op table and do a proper venogram in real time. So now what? Only option available to rule OUT CCSVI would be a properly conducted ultrasound, or a re-interpretation of the original MRV.
This is definitely not a one-size-fits-all approach.
Let me put it to you this way, if I thought my MS was very typical in presentation, and I had one scan by someone newly trained, and they ruled out stenosis and/or reflux, I'd want copious amounts of 2nd opinions on that before giving up, as I really do hope the neg's which have popped up so far (and it aint just false creek it's all over), will fall into the learning curve category and not dissuade people from pursuing this further, for their own sake.