i hope we can rain on his parade some daypklittle wrote:Dr Sclafani,
Thank you for giving me HOPE. I have SPMS and have been told by my doctor there is nothing that can be done, there is no effective therapy, and that the CCSVI theory is all wet. Now I am so thankful to be on your list, which I am sure is a mile long now.
Thank you for all you are doing!
Pam
DrSclafani answers some questions
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Wow, that's a tough question to answer. My mantra since they were itty bitty is "Nothing to it just do it" repeated over and over again. Especially when feedings happened every 3 hours and took at least an hour to complete if I had help.Marcia, i have a question for you. what is it like to care for triplets in the face of MS
I cried last week when one of them asked why I couldn't take them for a walk and why I always say no when they want to ride their bikes with me. Seven year olds just blurt it out. They think I don't like them enough to do these things with them.
Maybe following recovery from a hopefully soon to be scheduled liberation procedure I can dust off my bike, fill the tires back up, and take a ride with them.
Thanks for asking,
Marcia
Marcia
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Hi Dr. Sclafani. My question is: Will the 200 patient safety trial and the larger randomized trial provide testing and venogram procedures for all participants? In an earlier post you said it didn't seem feasible to do a placebo-controlled trial given the ethical considerations---so I'm wondering if everyone would get what you call the "Gold Standard"?i am currently undergoing IRB review of a 200 patient safety trial in preparation for a larger randomized trial. The purpose of these research efforts is to give neurologists the evidence they want to refer patients for the liberation procedure and for insurers to be required to provide payments for these procedures.
Hopefully your IRB proposal will sail through smoothly and get approved (not needing more revisions or rewrites)! Thanks for everything you're doing---hugs
Patrice
Re: DHHS
Thank you Dr. S.! "Patience dear patients" made me cry! Compassion streams out of your words and gives such hope! Thank you ~ thank you!drsclafani wrote: i do not think so, it is a hospital issue
momentum is growing
patience dear patients
Re: My Test Results - Barrie, Ontario, Canada
It has to do with haemodynamics, i.e. for the veins to widen when sitting or standing there has to be a problem with the vertebral plexus and/or azygos vein or with the IJV's valves. So the criterion seems a good one.patientx wrote:Is this another way of saying that in someone with CCSVI, the jugular veins don't open as much when lying down, compared to a normal person? If so, is this really a good criteria? In a person, couldn't the veins be open when supine and just not collapse when standing (or widen a little), still resulting in a negative delta?
Hi Dr Sclafani
Thanks for all the time you take answering all our questions. It is much appreciated, I have followed this thread from the beginning, fantastic information for us all. My husband has PPMS, full time in chair. He has been tested and found to have narrowings in veins, LIJV 10mm down to 1.7mm and RIJV 6mm down to 1.4mm. Is it safe to fly or will this put additional pressure on the veins? What are the normal parameters for veins width? Cheers
Thanks for all the time you take answering all our questions. It is much appreciated, I have followed this thread from the beginning, fantastic information for us all. My husband has PPMS, full time in chair. He has been tested and found to have narrowings in veins, LIJV 10mm down to 1.7mm and RIJV 6mm down to 1.4mm. Is it safe to fly or will this put additional pressure on the veins? What are the normal parameters for veins width? Cheers
I do not agree, in my case i had no Doppler because the venogram was clear (stuck valve in LJ) So...no scan in vertical position. I suspected that there was something wrong in the RJ which is confirmed by a Doppler a few weeks later.costumenastional wrote:just making sure everybody sees that.drsclafani wrote:my only comment is......JOhnnybaby248 wrote:It just keeps getting better and better more results out of Kuwait
http://www.ccsvikuwait.com/Details.aspx?d=4
Dr. S. any words of in encouragement
when do we abandon ultrasound and MRV?
the incidence of abnormality in MS is so high, that it has become irrelevant to have a noninvasive tesst to screen. unnecessary cost and inappropriate to deny the gold standard to anyone.
I fear it is just a method to delay treatment.
only reason to do noninvasives is to get enough experience to use it for followup screening
Robert
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Thank you. Well, did you have a second venogram that confirmed that problem on the right. And did you have a second treatment on the right yet?Robnl wrote:I do not agree, in my case i had no Doppler because the venogram was clear (stuck valve in LJ) So...no scan in vertical position. I suspected that there was something wrong in the RJ which is confirmed by a Doppler a few weeks later.costumenastional wrote:just making sure everybody sees that.drsclafani wrote:
my only comment is......
when do we abandon ultrasound and MRV?
the incidence of abnormality in MS is so high, that it has become irrelevant to have a noninvasive tesst to screen. unnecessary cost and inappropriate to deny the gold standard to anyone.
I fear it is just a method to delay treatment.
only reason to do noninvasives is to get enough experience to use it for followup screening
Robert
Screening is always about finding a reason to treat or not treat. No need to do a screening test if there is always a reason to do the invasive more definitive diagnostic test at the time of treatment.
There will always be false negative results of every test. One case where ultrasound showed a finding that was missed on venography does not yet change my mind about my opinion. I wish i could see the venogram blinded (pun) to the results to see if i agree with the person who did the venogram
As i say, still lots to discover.
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Interesting thought. As long as those who failed accepted no additional treatment. When one has a dramatic improvement that one loses during restenosis, would one be willing to not try again?frodo wrote:Dear Doctor,
One of the usual complaints about the test in CCSVI is the lack of controls. Some of us were thinking that maybe a clinical trial could accept restenosis cases as control.
Would it be acceptable such a control case?
But thanks, larmo's army to the rescue again!
May 27th i will have MRI and Doppler, we'll see what pops up \drsclafani wrote:
Thank you. Well, did you have a second venogram that confirmed that problem on the right. And did you have a second treatment on the right yet?
Screening is always about finding a reason to treat or not treat. No need to do a screening test if there is always a reason to do the invasive more definitive diagnostic test at the time of treatment.
There will always be false negative results of every test. One case where ultrasound showed a finding that was missed on venography does not yet change my mind about my opinion. I wish i could see the venogram blinded (pun) to the results to see if i agree with the person who did the venogram
As i say, still lots to discover.
Then a possible treatment.
after 1st treatment (stent to open the stuck valve) i show some improvents, but the physical things like walking are very unstable..sometimes walking 12 meters by myself, most of the time very difficult to walk.....and i did not have the well known warmth.
i'm curious what the opening of the RJ will bring.
I'll keep you informed...
Robert
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Dr. Sclafani:
I know I've read the question before but am not sure if I've seen the answer.
If you have a bad vein on one side, say the left. Is it better to sleep left side up, or left side down (if you're a side sleeper)? Or on your back? Or does it not make a difference?
If it wouldn't make a difference, any insight as to why?
I know I've read the question before but am not sure if I've seen the answer.
If you have a bad vein on one side, say the left. Is it better to sleep left side up, or left side down (if you're a side sleeper)? Or on your back? Or does it not make a difference?
If it wouldn't make a difference, any insight as to why?
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RobertRobnl wrote:May 27th i will have MRI and Doppler, we'll see what pops up \drsclafani wrote:
Thank you. Well, did you have a second venogram that confirmed that problem on the right. And did you have a second treatment on the right yet?
Screening is always about finding a reason to treat or not treat. No need to do a screening test if there is always a reason to do the invasive more definitive diagnostic test at the time of treatment.
There will always be false negative results of every test. One case where ultrasound showed a finding that was missed on venography does not yet change my mind about my opinion. I wish i could see the venogram blinded (pun) to the results to see if i agree with the person who did the venogram
As i say, still lots to discover.
Then a possible treatment.
after 1st treatment (stent to open the stuck valve) i show some improvents, but the physical things like walking are very unstable..sometimes walking 12 meters by myself, most of the time very difficult to walk.....and i did not have the well known warmth.
i'm curious what the opening of the RJ will bring.
I'll keep you informed...
Robert
i would love to see the first venogram if you could send me a copy of the pictures. I want to see if it is truly normal
i also do an intravascular ultrasound when I do the venogram, through a ultrasound probe i put inside the blood vessel. Perhaps it is more necessary that i have believed in the past
salvatore
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i do not know details of all the trials. Some are non-invasive diagnostic trials trying to confirm association of ccsvi and ms. These do not generally involve the Gold Standard of catheter venography. others are therapeutic and include the diagnostic questions and the safety and treatment trials. They all have at least the gold standard. My proposal indicates that I do not absolutely require noninvasives but prefer it and am willing to use studies done elsewhere if they meet our standards. I am not aware of any trials that are randomized prospective treatment trials yet.hopeful2 wrote:Hi Dr. Sclafani. My question is: Will the 200 patient safety trial and the larger randomized trial provide testing and venogram procedures for all participants? In an earlier post you said it didn't seem feasible to do a placebo-controlled trial given the ethical considerations---so I'm wondering if everyone would get what you call the "Gold Standard"?i am currently undergoing IRB review of a 200 patient safety trial in preparation for a larger randomized trial. The purpose of these research efforts is to give neurologists the evidence they want to refer patients for the liberation procedure and for insurers to be required to provide payments for these procedures.
Hopefully your IRB proposal will sail through smoothly and get approved (not needing more revisions or rewrites)! Thanks for everything you're doing---hugs
Patrice
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