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i agree, ivus seems to be the best way to image the azygous. and probably the jugulars as well. still, i am occasionally disappointed with how hard it can be to see the valve leaflets on ivus when they are easy to see on conventional us.drsclafani wrote:mikeDrCumming wrote:fixed image link
expiration imaging was sal's idea. but i have seen this happen on several patients now. so, it may not be the best way to image the azygous.
in this case, I did expiration imaging, followed by ivus which showed no abnormality, and then did the imaging at full inspiration.
ideas are ideas. I throw out a lot of them. Not all pan out. Expiratory phase azygography didnt pan out. o, well.
i tend to first do end inspiration in the azygous for two reasons
1. less subtraction artefact for some reason
2. better distension of the azygous
Drs Zamboni and Galleoti often used the degree of reflux on the venogram to diagnose what they called subtle irregularities (webs). I have a great deal of difficulty seeing them, as do others. IVUS sometimes shows subtle sound reflections in the vein but i do not know what they represent.
IVUS definitely has shown abnormal valves in the arch that are not visible on Azygous venography tho.
The findings are much more difficult to analyze in the chest compared to the neck. Why? because there is constant motion during the chest venogram that we can generally avoid in the neck. You can stop breathing, but you cannot stop beating (the heart)
The Medicover in addition a few thousand even cheaper than in Euromedic.Liberation wrote:I fully agree, Rici. A month ago I had an appointment with one doctor for CCSVI operation, but I got flu and I cancelled it. Before doing so, I called the doctor and asked him about it, but I was told that I can go for the operation, no problem if I have flu, high temperature, sneezing, coughing. In my country doctors had a different opinion, if it is not an emergency operation, I was told operation with such condition that involves even long, tiring flight should be cancelled. Rici, you are right some doctors consider us as a cash machine. You probably know what is the real cost of such operation in Poland, so you can easily do the math.Rici wrote:
I agree with Doz. Kielar about the fact that a medical reason for any treatment MUST be present, otherwise patients are "treated" like "earning machines" for the unscrupulous clinic.
Regards
Rici
My doctor told me that always be leary when money is involved in a medical treatment.
Rici I am so glad you managed to find a hospital where we are treated with respect and dignity. It is nice to know you are in a place where money is not more important than your well being.Rici wrote:Medical ethics in practice.
Yesterday I had a long meeting with the medical director of the Chirugical Clinic in Medicover Hospital in Warsaw, Poland (Doz. Maciej Kielar) about the
ethic component of healing medicine. Doz. Kielar is strongly of the opinion, that any patient deserves the right to be diagnosed exactly and to receive also an exact assessment of his/her situation after the diagnose.
This means also that the patient may receive a denial of CCSVI treatment if the diagnosic picture is such that the treatment is not helpful or too risky. The patient - according to Doz. Kielar - accepts this verdict knowing finally what the clinical status of the own condition really is and why the treatment is denied.
I agree with Doz. Kielar about the fact that a medical reason for any treatment MUST be present, otherwise patients are "treated" like "earning machines" for the unscrupulous clinic.
Regards
Rici
I thought that Zamboni found an affected Azygos in 86% of the patients in the original study? Is this not true? Did Simka find a low number?DrCumming wrote:Actually, most patients do not have azygous lesions. Simka's presentation says only 5%. My experience using both venography and IVUS is a slighter high - need to look to give an exact number.
Mike, two more valvular stenoses of the azygous picked up with IVUS with normal venograms this weekendDrCumming wrote:i agree, ivus seems to be the best way to image the azygous. and probably the jugulars as well. still, i am occasionally disappointed with how hard it can be to see the valve leaflets on ivus when they are easy to see on conventional us.drsclafani wrote:mikeDrCumming wrote:fixed image link
expiration imaging was sal's idea. but i have seen this happen on several patients now. so, it may not be the best way to image the azygous.
in this case, I did expiration imaging, followed by ivus which showed no abnormality, and then did the imaging at full inspiration.
ideas are ideas. I throw out a lot of them. Not all pan out. Expiratory phase azygography didnt pan out. o, well.
i tend to first do end inspiration in the azygous for two reasons
1. less subtraction artefact for some reason
2. better distension of the azygous
Drs Zamboni and Galleoti often used the degree of reflux on the venogram to diagnose what they called subtle irregularities (webs). I have a great deal of difficulty seeing them, as do others. IVUS sometimes shows subtle sound reflections in the vein but i do not know what they represent.
IVUS definitely has shown abnormal valves in the arch that are not visible on Azygous venography tho.
The findings are much more difficult to analyze in the chest compared to the neck. Why? because there is constant motion during the chest venogram that we can generally avoid in the neck. You can stop breathing, but you cannot stop beating (the heart)
btw, not faulting you suggestion. we are all learning with every procedure we do. and there is still much to be learned.
Expiration was Zamboni's idea. He was thinking that end expiration would maximize the thoracic pump and get optimum flow. I think that is correct.DrCumming wrote:fixed image link
expiration imaging was sal's idea. but i have seen this happen on several patients now. so, it may not be the best way to image the azygous.
in this case, I did expiration imaging, followed by ivus which showed no abnormality, and then did the imaging at full inspiration.
RiciRici wrote:Medical ethics in practice.
Yesterday I had a long meeting with the medical director of the Chirugical Clinic in Medicover Hospital in Warsaw, Poland (Doz. Maciej Kielar) about the
ethic component of healing medicine. Doz. Kielar is strongly of the opinion, that any patient deserves the right to be diagnosed exactly and to receive also an exact assessment of his/her situation after the diagnose.
This means also that the patient may receive a denial of CCSVI treatment if the diagnosic picture is such that the treatment is not helpful or too risky. The patient - according to Doz. Kielar - accepts this verdict knowing finally what the clinical status of the own condition really is and why the treatment is denied.
I agree with Doz. Kielar about the fact that a medical reason for any treatment MUST be present, otherwise patients are "treated" like "earning machines" for the unscrupulous clinic.
Regards
Rici
I have no issue with professionals being well paid and I suspect many others would think the same. I was the third cab off the rank in Katowice after Rici and Erika. I didn't see that Drs Ludyga and Simka were treating only for money. Dr Simka is committed to CCSVI.drsclafani wrote: I have worked with people you are upset with and i am not of the opinion that they are only doing this for money or that they are not trying to get quality.
perhaps i was too harshBrainteaser wrote:I have no issue with professionals being well paid and I suspect many others would think the same. I was the third cab off the rank in Katowice after Rici and Erika. I didn't see that Drs Ludyga and Simka were treating only for money. Dr Simka is committed to CCSVI.drsclafani wrote: I have worked with people you are upset with and i am not of the opinion that they are only doing this for money or that they are not trying to get quality.
But emotionally I feel a little like Rici. There are not only pioneering doctors - there are also pioneering patients, and I think some of us feel that we have been left a bit high and dry by people we have put our faith in.
MS is a lonely enough gig at the best of times, but when we are not getting the assistance we believe we should, it can be a battle and a half. Additionally, our treatments stretching back a year and a half, should be cases of considerable interest to the professionals, but sadly this does not seem the case.
So I think it could be just a little inappropriate to say that someone like Rici, after all he's been through, should lighten up. Having said that, I certainly respect all you are doing Dr S, to propel CCSVI forward. Where would we be without you? The treatments you and your colleagues are providing now, are a long way from where things were a year and a half ago.
Agreed! And thank you for hurting for us... as we also hurt for RiciCece wrote:As patients I think we go into this knowing it is a new use of an old procedure, all the details have not yet been ironed out. The feeling of being left high-and-dry may be because there is nothing more the doctor can do?
The extra costs of IVUS (both in hardware and time added on to the procedure) are part of the cost at the Brooklyn AAC. I've been excited about IVUS since around this time last year! As for Dr. Sclafani leaving the university to make the big bucks, I have been under the impression that it is the other way around, that he made a sacrifice in order to take part in this discovery.
For the sacrifices and the trail-blazing, thank you.
drsclafani wrote:perhaps i was too harsh
