Gibbledygook's stents

Tell us what you are using to treat your MS-- and how you are doing.

Postby munchkin » Wed Jul 06, 2011 1:34 pm

Hi

Congratulations on the pregnancy. Hope it is an easy one and all of the increase in symptoms clears up soon.
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Postby gibbledygook » Thu Jul 07, 2011 1:02 am

Thank you, Munchkin! It's very early days to feel confident that the pregnancy will last but I just wanted to note the marked deterioration in my symptoms which exactly mimics my previous experience of conception. Of course the only thing neurologists say about pregnancy is that you'll feel better. Don't they realize one's core temperature increases, sometimes quite dramatically, and don't they consider that the change in sex steroids might have a not inconsiderable effect on the cerebral vasculature? Still, I'm not really complaining, just remembering finally what it was like last time around...I seemed to have forgotten! :)
3 years antibiotics, 06/09 bilateral jug stents at C1, 05/11 ballooning of both jug valves, 07/12 stenting of renal vein, azygos & jug valve ballooning,
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Postby CureOrBust » Thu Jul 07, 2011 4:48 am

Cangratulations!
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Postby coach » Thu Jul 07, 2011 5:15 am

Adding my congratulations. Hope all goes well.
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Postby LR1234 » Thu Jul 07, 2011 5:22 am

Congratulations Alex!!!! xx
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Postby gibbledygook » Thu Jul 07, 2011 7:14 am

Thank you, everyone!
3 years antibiotics, 06/09 bilateral jug stents at C1, 05/11 ballooning of both jug valves, 07/12 stenting of renal vein, azygos & jug valve ballooning,
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Postby gibbledygook » Mon Jul 11, 2011 2:48 am

Right, as my MS symptoms deteriorated significantly within 12 hours of conception I'm having a dig around Pubmed to find anything to do with vascular changes in early pregnancy and I'm going to post them here. This more for my own understanding of why my walking is soooo CRAP now, just like the last time I became pregnant and contrary to how my neurologists said I would likely feel.


Looks like I could be not only undergoing a core temperature surge but an interferon gamma surge which, I recall, is highly inflammatory.

Cell Mol Immunol. 2011 Jan;8(1):1-11. Epub 2010 Aug 16.

Natural killer cell-triggered vascular transformation: maternal care before birth?

Zhang J, Chen Z, Smith GN, Croy BA.


Source

Department of Anatomy and Cell Biology, Queen's University, Kingston, ON, Canada.


Abstract

Natural killer (NK) cells are found in lymphoid and non-lymphoid organs. In addition to important roles in immune surveillance, some NK cells contribute to angiogenesis and circulatory regulation. The uterus of early pregnancy is a non-lymphoid organ enriched in NK cells that are specifically recruited to placental attachment sites. In species with invasive hemochorial placentation, these uterine natural killer (uNK) cells, via secretion of cytokines, chemokines, mucins, enzymes and angiogenic growth factors, contribute to the physiological change of mesometrial endometrium into the unique stromal environment called decidua basalis. In humans, uNK cells have the phenotype CD56(bright)CD16(dim) and they appear in great abundance in the late secretory phase of the menstrual cycle and early pregnancy. Gene expression studies indicate that CD56(bright)CD16(dim) uterine and circulating cells are functionally distinct. In humans but not mice or other species with post-implantation decidualization, uNK cells may contribute to blastocyst implantation and are of interest as therapeutic targets in female infertility. Histological and genetic studies in mice first identified triggering of the process of gestation spiral arterial modification as a major uNK cell function, achieved via interferon (IFN)-γ secretion. During spiral arterial modification, branches from the uterine artery that traverse the endometrium/decidua transiently lose their muscular coat and ability to vasoconstrict. The expression of vascular markers changes from arterial to venous as these vessels dilate and become low-resistance, high-volume channels. Full understanding of the vascular interactions of human uNK cells is difficult to obtain because endometrial time-course studies are not possible in pregnant women. Here we briefly review key information concerning uNK cell functions from studies in rodents, summarize highlights concerning human uNK cells and describe our preliminary studies on development of a humanized, pregnant mouse model for in vivo investigations of human uNK cell functions.


PMID: 20711229 [PubMed - indexed for MEDLINE] PMCID: PMC3079746
http://www.ncbi.nlm.nih.gov/pubmed/20711229

This isn't from pubmed but provides evidence of reduced blood flow owing to venous distension:

Venous Distension increases approximately to 150% during the course of
gestation and the venous ends of capillaries become dilated, causing reduced blood flow. These vascular changes contribute to delayed absorption of subcutaneously or intramuscularly injected substances. Distension of the extradural veins heightens the risk of vascular damage during institution of a regional block. The increased venous volume within the rigid spinal canal reduces the volume or capacity of the extradural and intrathecal spaces for local anaesthetic solutions. This will therefore increase the spread of injected drugs.
http://www.nda.ox.ac.uk/wfsa/html/u09/u09_003.htm


This just shows the increased blood flow
Am J Obstet Gynecol. 2010 Nov;203(5):475.e1-6.

Maternal cerebral blood flow during normal pregnancy: a cross-sectional study.

Nevo O, Soustiel JF, Thaler I.


Source

Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, 60 Grosvenor Street, Toronto, Ontario, Canada. ori.nevo@sunnybrook.ca


Abstract

OBJECTIVE:

Pregnancy is associated with substantial changes in the maternal circulatory physiology. Our aim was to investigate maternal cerebral blood flow (CBF) during normal pregnancies.

STUDY DESIGN:

We prospectively measured maternal CBF in 210 low-risk pregnant women at different gestational ages, and in 15 nonpregnant women. CBF was assessed by measuring blood flow volume in the internal carotid artery (ICA) by dual-beam angle-independent digital Doppler ultrasound.

RESULTS:

ICA blood flow volume increased during pregnancy from 318 mL/min ± 40.6 mL/min in the first trimester to 382.1 mL/min ± 50.0 mL/min during the third trimester, corresponding to CBF values of 44.4 and 51.8 mL/min(-1)/100 g(-1), respectively (P < .0001). CBF changes were associated with progressive decrease in cerebral vascular resistance and moderate increase in ICA diameter.

CONCLUSION:

Maternal CBF is gradually increasing during normal pregnancy. Vasorelaxing impact of estrogens and other factors on cerebral vessels may explain the changes in CBF during pregnancy.

Copyright © 2010 Mosby, Inc. All rights reserved.


PMID: 20599183 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/20599183
3 years antibiotics, 06/09 bilateral jug stents at C1, 05/11 ballooning of both jug valves, 07/12 stenting of renal vein, azygos & jug valve ballooning,
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Postby gibbledygook » Tue Jul 12, 2011 7:47 am

From the journal of applied physiology is a good reason why pregnancy may make you feel much worse:

Cerebral vascular adaptation to pregnancy and its role in the neurological complications of eclampsia

Marilyn J. Cipolla,
Julie G. Sweet, and
Siu-Lung Chan

+ Author Affiliations

Departments of Neurology, Obstetrics, Gynecology and Reproductive Sciences, and Pharmacology, University of Vermont College of Medicine, Burlington, Vermont

Address for reprint requests and other correspondence: M. J. Cipolla, Dept. of Neurology, Univ. of Vermont, 89 Beaumont Ave., Given C454, Burlington, VT 05405 (e-mail: Marilyn.Cipolla@uvm.edu).
Submitted 1 October 2010.
accepted in final form 8 November 2010.


Abstract

The cerebral circulation has a central role in mediating the neurological complications of eclampsia, yet our understanding of how pregnancy and preeclampsia affect this circulation is severely limited. Here, we show that pregnancy causes outward remodeling of penetrating arterioles and increased capillary density in the brain due to activation of peroxisome proliferator-activated receptor-γ (PPARγ), a transcription factor involved in cerebrovascular remodeling and highly activated in pregnancy. Pregnancy-induced PPARγ activation also significantly affected cerebral hemodynamics, decreasing vascular resistance and increasing cerebral blood flow by ∼40% in response to acute hypertension that caused breakthrough of autoregulation. These structural and hemodynamic changes in the brain during pregnancy were associated with substantially increased blood-brain barrier permeability, an effect that could promote passage of damaging proteins into the brain and cause the neurological complications of eclampsia, including seizure.

http://jap.physiology.org/content/110/2/329.abstract
3 years antibiotics, 06/09 bilateral jug stents at C1, 05/11 ballooning of both jug valves, 07/12 stenting of renal vein, azygos & jug valve ballooning,
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Postby ErikaSlovakia » Sat Jul 23, 2011 3:08 am

Wow, Alex! :)
Congratulations! I still remember your information from your last pregnancy. I really wish you good luck! I admire you.
I wish it goes without any complications. :wink:
Erika
Aug. 7, 09 Doppler Ultras. in Poland, left Jugul. valve problem, RRMS since 1996, now SPMS,
- Nov.3,09: one stent in the left jug. vein in Katowice, Poland, LDN, never on DMDs
- Jan. 19, 11: control venography in Katowice - negative but I feel worse
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Re: Gibbledygook's stents

Postby gibbledygook » Thu Dec 01, 2011 3:17 am

Right, it's been a very long few months of my second pregnancy. My walking has substantially deteriorated and is now much worse than it was during the first pregnancy. Here is my latest update for Professor Dake:
I'm now in my 27th week of pregnancy. The walking and spasticity have remained very, very poor and are a severe deterioration from the walking problems I suffered during the first pregnancy. However my bladder remains significantly better than it was during my first pregnancy. The night spasms have started to become quite problematic and I am getting only a few hours sleep as I can no longer calm them down particularly if there is any urine in the bladder. There is definitely a link between the bladder and the night spasms. In fact if my bladder is full my walking takes a turn for the worse. As it is difficult to void with the baby I should imagine and hope that a certain amount of the walking deterioration is due to a constantly near full bladder. My walking improves modestly once the bladder is more properly voided although this is now quite a difficult manouevre with the baby girl in the way. So far I have noticed only the most minor of nose bleeds. During the last pregnancy my nose bled a very great deal, which I'm sure is indicative of widespread venous permeability. I believe my blood pressure to be very low now as I am suffering quite a bit in the mornings from complete exhaustion coupled with a sensation of dizziness/head tingling. I have noticed a few more movement induced phosphenes. The sensory deficit in the left foot has been pretty noticeable too. All in all a bad update. 84 days until the c section.

The pdf file shows the chart update.

I am thinking of visiting Professor Sclafani in New York after this delivery.


I cannot print out my chart and scan it into a webpage as the printer makes all the lines look pink or yellow when they are green and blue and brown etc.

However I have the chart on a pdf file and need to work out how to get that uploaded somehow. It will come shortly.

https://acrobat.com/#d=sGSBuHCn-Dogn0COiLu2sQ
3 years antibiotics, 06/09 bilateral jug stents at C1, 05/11 ballooning of both jug valves, 07/12 stenting of renal vein, azygos & jug valve ballooning,
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Re: Gibbledygook's stents

Postby gibbledygook » Thu Dec 22, 2011 8:36 am

So far there has been no relief in the 3rd trimester and the right leg motor dysfunction continues to deteriorate. Here's my latest missive for Professor Dake.
I'm now in my 30th week of pregnancy. My right leg motor function has continued to deteriorate with terrible spasticity in the foot and knee area. I can barely walk around the house and need to use the wall for stability. I pray that this improves after delivery, like after the last pregnancy but fear that this relapse has left a permanent scar. However the areas of disability which have improved after venoplasty, the bladder and the myoclonus are still much better than the last pregnancy so I believe that the right leg motor dysfunction is not caused or affected by jugular stenosis. There is something else causing the nerve cells to die and this may be a different vein stenosis or simply the immune system. Given the immediacy of the motor deterioration after conception I expect that the heightened vascular permeability caused by chorionic gonadotropin is partly to blame. This hormone increases a lot in the first and second trimester and then declines precipitously in the third trimester. I will visit Dr Sclafani in New York next year to have the renal and iliac veins and the dural sinuses assessed. I will also have an upright MRI scan assessment to see what else might be disturbing the cerebro spinal fluid.

https://acrobat.com/#d=wuUrrLNqkM46RfqjChZtbw
3 years antibiotics, 06/09 bilateral jug stents at C1, 05/11 ballooning of both jug valves, 07/12 stenting of renal vein, azygos & jug valve ballooning,
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Re: Gibbledygook's stents

Postby LR1234 » Fri Dec 23, 2011 2:22 pm

Hey Alex,
Sorry to hear you are deteriorating during your pregnancy but I hope you feel better after the little one has arrived xx

Where are you having the Upright MRI done? I would be interested in having one of these done.
UK or US?
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Re: Gibbledygook's stents

Postby gibbledygook » Sat Dec 24, 2011 5:28 am

Hi L, I hoPe you are doing ok. I spoke with the fonar corp who said that they are trying to get an outfit in London set uP towards the end of 2013. I am to call again in a few months to see how this idea is evolving.
3 years antibiotics, 06/09 bilateral jug stents at C1, 05/11 ballooning of both jug valves, 07/12 stenting of renal vein, azygos & jug valve ballooning,
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Re: Gibbledygook's stents

Postby coach » Sat Dec 24, 2011 9:52 am

Sorry to hear of your troubles Alex. I am also having troubles. Plan on also getting an upright MRI of cervical spine and maybe the brain. I think some of my symptoms can not be blamed on MS because they don't fit the usual picture.
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Re: Gibbledygook's stents

Postby gibbledygook » Sat Dec 24, 2011 10:31 am

I will update ThisisMs as to Fonar's London updates. Fingers crossed they set up shop in London.
3 years antibiotics, 06/09 bilateral jug stents at C1, 05/11 ballooning of both jug valves, 07/12 stenting of renal vein, azygos & jug valve ballooning,
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