Posted: Mon Nov 08, 2010 2:33 pm
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You've given so much thought to this, when we could just ask him again.Lyon wrote:I remember the question and appreciated Dr Sclafani's response very much. A couple of things at play here though. One is that, even after I'm convinced it's still going to remain to convince the medical community and I'm pretty sure that Dr Sclafani would be first to admit that his word alone wouldn't convince them and I'm certain he wouldn't want that to hinge on his word alone anyway.CCSVIhusband wrote: I believe Dr. Sclafani answered directly (a question you asked) ... that he said in his 3+ decades of medical practice in the field ... he has NEVER seen veins in the NON-MS population that he has seen since he began performing liberations. I guess you are choosing to ignore that piece of evidence? You can search for his response to your question ...
My personal feelings? I documented it at the time (which went over like a fart in church) but is that Dr Sclafani is doubtlessly an expert of what is known of the venous system and its routing.
Considering his many years of ER experience I'd dare put him as a foremost expert, but it's also important to realize that no especially accurate and trustworthy studies of the veins have been done and until recently no one had even been looking for venous stenosis. Accurate venous imaging is recent and as is becoming evident, it could be said that ACCURATE imaging still is beyond us.
Though he's an expert, Dr Sclafani's experience has often been under time constraint and pressure with the emphasis on keeping the patient alive. Additionally, his frequent canvas of gunshot, knife, explosion, car accident wounds seldom leave untainted viewing of the venous system.
It's only common sense that until recently venous stenosis wasn't an issue and Dr Sclafani wouldn't have been looking for it.
We now have better imaging and ARE looking for stenosis and still it isn't easily noticed. Considering all of the above we are to think he would have happened to notice stenosis and filed it in mind? It's not obvious how or why he would have noticed or kept it in mind and in essence what he would be noticing is the lack of something that he wasn't looking for?
Dr Zamboni feels that it's essential for researchers looking for stenosis to be trained in the tricks of the trade by him because it's evidently so hard to notice and Dr Sclafani would have noticed, while not looking for stenosis and most of the time without benefit of our modern, more accurate imaging equipment. Despite a long career, under those conditions it's unimaginable that he would have noticed stenosis, one way or the other.
Maybe he will expand on this answer. No, his word is not gospel...I've disagreed with him at least once in the last seven months...but he is the only one here with actual experience putting catheters in veins.Lyon wrote:I'd be interest to hear but....not to prove Rick correct in that we skeptics will never be convinced, but in this situation, considering the points I've made and others, I'm not easily going to be convinced and last time Dr Sclafani's response wasn't much more than I've been doing it for years and would have noticed.Cece wrote: You've given so much thought to this, when we could just ask him again.
The training that Dr. Zamboni gives is how to do a CCSVI transcranial color doppler ultrasound. We are talking about Dr. Sclafani doing a catheter venogram, not a doppler ultrasound, as part of treatment for his trauma patients or others.
I think it's a valid question for him: how obvious are these outflow obstructions in CCSVI, if you weren't looking for them would you go right past them during all catheter venograms in a forty-year career?
I never said it isn't enough that polio doesn't exist in our part of the world, but I have a friend from Bangladesh who is in a wheelchair because of polio, and there was no cure for him. Preventing something isn't the same as curing it, that's all I said.CCSVIhusband wrote:
concerned doesn't seem to think it's enough that Polio doesn't exist (for the most part) anymore because "it hasn't been cured" ... so are we going to have one of those, where proof comes out, it is stopped, but it's not "cured" so how does CCSVI ever "cure" MS because you have to know that someone has MS before they have CCSVI? Like I've said ... circular logic.
Lyon wrote: I remember the question and appreciated Dr Sclafani's response very much. A couple of things at play here though. One is that, even after I'm convinced it's still going to remain to convince the medical community and I'm pretty sure that Dr Sclafani would be first to admit that his word alone wouldn't convince them and I'm certain he wouldn't want that to hinge on his word alone anyway.
Perhaps an expert on this forum. but i accept the expertise of many others who have looked at this in many different forms.My personal feelings? I documented it at the time (which went over like a fart in church) but is that Dr Sclafani is doubtlessly an expert of what is known of the venous system and its routing.
i am not sure what this means. There have been studies of the veins and they have noted many things. For example we know that 15% of patients do not have valves in the jugulars. it is inconceivable to me that pathologists looking at veins long enough to note the absence of valves in 15% of patients would not have recognized stiff, inflexible, stenotic valves or stenoses above the valves due to hypoplasia , and not commented on that in papers reviewing the normal anatomy. But if we are asking whether someone should do venography on hundreds of normal subjects to prove that stenoses are atypical of normal, I say we need to see whether we have the time, money and resources to do this.
Considering his many years of ER experience I'd dare put him as a foremost expert, but it's also important to realize that no especially accurate and trustworthy studies of the veins have been done and until recently no one had even been looking for venous stenosis. Accurate venous imaging is recent and as is becoming evident, it could be said that ACCURATE imaging still is beyond us.
as i said above I WAS looking for abnormalites like narrowing, which is a common imaging finding of trauma.Though he's an expert, Dr Sclafani's experience has often been under time constraint and pressure with the emphasis on keeping the patient alive. Additionally, his frequent canvas of gunshot, knife, explosion, car accident wounds seldom leave untainted viewing of the venous system.
It's only common sense that until recently venous stenosis wasn't an issue and Dr Sclafani wouldn't have been looking for it.
i do not think that venography has improved greatly in the past 10-15 years. it was and remains a quite clear imaging study. I do not think that MRv or CTv are any better. They might on occasion be preferable because they are less invasive, but they are not better at seeing the veins.We now have better imaging and ARE looking for stenosis and still it isn't easily noticed. Considering all of the above we are to think he would have happened to notice stenosis and filed it in mind? It's not obvious how or why he would have noticed or kept it in mind and in essence what he would be noticing is the lack of something that he wasn't looking for?
It is true that i was looking at carotid arteriograms and their venous phase images during emergency situations. but rest assured that all of these angiograms were reviewed after the heat of the battle had cooled. Also these angiograms were done for injury. As such a trauma radiologist looks at all possibilities, including occlusions of the jugular veins. I was exploring at that time whether or not damaged veins needed to be ligated. Turns out that they do not unless the wound allows the blood to drain onto the floor. so, my dear friend, Lyon, I was very much focused on the veins. Not looking for obstructions but looking for occlusions. I can say that there were certainly cases of occlusion of veins. This was always associated with significant hematoma in the neck that would compress the veinsDespite a long career, under those conditions it's unimaginable that he would have noticed stenosis, one way or the other.