DrSclafani answers some questions

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.
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drsclafani
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Post by drsclafani » Tue Sep 20, 2011 9:41 am

DougL wrote:
drsclafani wrote:i am back but not rested after visiting the mosel valley and the black forest and preoctoberfest munich
please rest up before Saturday :-D
work energizes me
Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

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Re: DrSclafani answers some questions

Post by mo_en » Tue Sep 20, 2011 2:24 pm

Dear Doctor, welcome back.
As i read here, http://www.ncbi.nlm.nih.gov/pubmed/12223389, the vertebral veins are also equipped with a pair of valves. Have you encountered any problems with these? Do you think a possible valve issue there could affect CCSVI severity?

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Re: DrSclafani answers some questions

Post by Taurus » Tue Sep 20, 2011 4:58 pm

Sir
My submission on checking of arteries is related to my earlier question which was:

"Dear Sir
Thank you very much for helping MS patients like me on this forum. Diagnosed with MS in December 2008, I got my MRV done at a local hospital. My MRI pics are posted at http://liberation-treatment.com/ms-patient-mrv-scans. My CT venogram also suggested of stenosis at C2 level But my IR disclosed that I have a rare case of Eagle Syndrome. With all this in back ground, I went for liberation treatment which resulted in small improvements as the doc said that he did not find high level of stenosis in IJVs while azygos was clear. Still, I find that my MS has to do something with hemodynamics as often experience heavy sweating from my head once I go on the treadmill. My spasticity in right arm changes with posture (sitting vs standing ) etc. May my IR has left something while doing the procedure or I need to check something else also. I have no typical symptoms of Eagle Syndrome except that lately I sometime felt dizzy one I turned my head towards right. Your expert opinion is solicited please."

Going for MRA very soon

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Re: DrSclafani answers some questions

Post by newlywed4ever » Wed Sep 21, 2011 5:39 am

Dr Sclafani, you did my 2nd venogram and we found that I have a completely occluded LIJV. I just read a paper by Dr McGuckin on CVO (chronic vein occlusion) and the use of a Baylis guidewire to open these veins. The paper is at http://ccsvism.xoom.it/ISNVD/Other/Abst ... guckin.pdf and I'm wondering if you are familiar with this and what your thoughts are.... (if this has been addressed previously, please someone direct me to more info - Cece, you probably know)

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Re: DrSclafani answers some questions

Post by drsclafani » Wed Sep 21, 2011 7:50 am

mo_en wrote:Dear Doctor, welcome back.
As i read here, http://www.ncbi.nlm.nih.gov/pubmed/12223389, the vertebral veins are also equipped with a pair of valves. Have you encountered any problems with these? Do you think a possible valve issue there could affect CCSVI severity?
I do not study the vertebral veins at this time. I have entered quite a few incidentally, and have occasionally noted a valve, less occasionally an unusual valve. The embryology of the vertebral veins seems different from the jugular veins and happens earlier in development , so not sure if this will be a major consideration nor whether treatment will be an option.

In 2012 it is my plan to evaluate a series of consecutive patients as part of routine testing.
Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

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drsclafani
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Re: DrSclafani answers some questions

Post by drsclafani » Wed Sep 21, 2011 7:52 am

Taurus wrote:Sir
My submission on checking of arteries is related to my earlier question which was:

"Dear Sir
Thank you very much for helping MS patients like me on this forum. Diagnosed with MS in December 2008, I got my MRV done at a local hospital. My MRI pics are posted at http://liberation-treatment.com/ms-patient-mrv-scans. My CT venogram also suggested of stenosis at C2 level But my IR disclosed that I have a rare case of Eagle Syndrome. With all this in back ground, I went for liberation treatment which resulted in small improvements as the doc said that he did not find high level of stenosis in IJVs while azygos was clear. Still, I find that my MS has to do something with hemodynamics as often experience heavy sweating from my head once I go on the treadmill. My spasticity in right arm changes with posture (sitting vs standing ) etc. May my IR has left something while doing the procedure or I need to check something else also. I have no typical symptoms of Eagle Syndrome except that lately I sometime felt dizzy one I turned my head towards right. Your expert opinion is solicited please."

Going for MRA very soon
Why not post your venogram. You already had an MRA which you have posted.
Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

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drsclafani
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Re: DrSclafani answers some questions

Post by drsclafani » Wed Sep 21, 2011 7:56 am

newlywed4ever wrote:Dr Sclafani, you did my 2nd venogram and we found that I have a completely occluded LIJV. I just read a paper by Dr McGuckin on CVO (chronic vein occlusion) and the use of a Baylis guidewire to open these veins. The paper is at http://ccsvism.xoom.it/ISNVD/Other/Abst ... guckin.pdf and I'm wondering if you are familiar with this and what your thoughts are.... (if this has been addressed previously, please someone direct me to more info - Cece, you probably know)
it is an interesting approach. I was eager to hear of the use of this device for occlusionof the central chest veins at CIRSE. One of the physicians showed where the Radiofrequency device burned right through the catheter a large hole.

the carotid artery and the internal jugular vein both run in the carotid sheath, indicating that they and the 10th cranial nerve are very close to each other. I have some concern that there is risk of burning a hole right through the carotid artery. Bleeding, stroke and arteriovenous fistula are my concerns.

Anyway, i suspect this is another topic that i will explore in 2012.
Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

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Taurus
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Re: DrSclafani answers some questions

Post by Taurus » Wed Sep 21, 2011 8:05 am

Sir
My posts are actually my venogram. I will be going for MRA of my neck shortly. Hopefully I would be able to post some pics. Thank you for your consideration

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Re: DrSclafani answers some questions

Post by Cece » Wed Sep 21, 2011 8:38 am

newlywed4ever wrote:Dr Sclafani, you did my 2nd venogram and we found that I have a completely occluded LIJV. I just read a paper by Dr McGuckin on CVO (chronic vein occlusion) and the use of a Baylis guidewire to open these veins. The paper is at http://ccsvism.xoom.it/ISNVD/Other/Abst ... guckin.pdf and I'm wondering if you are familiar with this and what your thoughts are.... (if this has been addressed previously, please someone direct me to more info - Cece, you probably know)
It hasn't been addressed much and, more distressingly, since the change of format for TiMS, any google site search that I do for past words of wisdom doesn't have current links, so I get the old link, and it reroutes to the front page!

Thanks for the link to Dr. McGuckin's paper.

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Re: DrSclafani answers some questions

Post by CureOrBust » Thu Sep 22, 2011 5:10 am

Google can filer by date range also. Its under "Advanced", "Date, Usage Rights..."

For example
http://www.google.com.au/search?q=McGuc ... %3Aw,qdr:y

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Re: DrSclafani answers some questions

Post by Cece » Thu Sep 22, 2011 5:51 am

drsclafani wrote:I do not study the vertebral veins at this time. I have entered quite a few incidentally, and have occasionally noted a valve, less occasionally an unusual valve. The embryology of the vertebral veins seems different from the jugular veins and happens earlier in development , so not sure if this will be a major consideration nor whether treatment will be an option.

In 2012 it is my plan to evaluate a series of consecutive patients as part of routine testing.
it is an interesting approach. I was eager to hear of the use of this device for occlusionof the central chest veins at CIRSE. One of the physicians showed where the Radiofrequency device burned right through the catheter a large hole.

the carotid artery and the internal jugular vein both run in the carotid sheath, indicating that they and the 10th cranial nerve are very close to each other. I have some concern that there is risk of burning a hole right through the carotid artery. Bleeding, stroke and arteriovenous fistula are my concerns.

Anyway, i suspect this is another topic that i will explore in 2012.
Any other strategies or concepts on the docket to be explored in 2012?

What have the other doctors thought of your condylar emissary veins insights? Or have you not had a chance to talk it over with anyone, outside of us?
And welcome back!

(CureOrBust, that could be useful, I didn't know how to do that. I also heard from a mod that Arron has been working on fixing the links. I had assumed they were unfixable, so that's cool.)

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Re: DrSclafani answers some questions

Post by bluesky63 » Fri Sep 23, 2011 12:47 pm

Welcome back! I am going to make a separate post about pelvic congestion because I don't want to clutter up this thread, especially since I have some specific personal stuff that should be separate from that.

The more I see of vascular information the more deep respect I have for what an art it is -- how much a doctor must have to be able to intuit where flow is needed, where it might be opened, where it might be redirected. This must be especially relevant as gravity comes into play and you get the differences in standing versus sitting in the legs, the pelvis, and the trunk. And how do you know what's a collateral, etc.? I am amazed at the work.

Dr. Sclafani, my son was diagnosed with Ehlers-Danlos a few years ago when he was sent to a geneticist to find a cause for his hearing loss. My sister definitely had it and a number of other family members also have it. I have never been officially assessed although a doctor told me I score 6 out of 9 on the Beighton scale.

I am curious about the pelvic veins. Like I said, I am making a separate thread about that whole thing in general, but I was intrigued by the idea of Nutcracker syndrome and ovarian vein syndrome.

I have had repeated bouts of "appendicitis" and also chronic kidney infections and UTI's since I was born. I had a ureteral stricture, which was dilated periodically throughout my childhood. I wonder about the possible connection to vein anatomy.

It sounds like you assess the entire pelvic vascular area and open the appropriate stenosed or poorly functioning veins while closing off others. Again, a work of intuition and experience.

Is this yet another manifestation of CCSVI? A step along the continuum? An overlapping issue? Does it need to be treated? Thank you for your thoughts and advice, both if someone were to pursue a procedure and if someone were to try conservative management.

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Re: DrSclafani answers some questions

Post by drsclafani » Fri Sep 23, 2011 5:04 pm

Cece wrote:
drsclafani wrote:I do not study the vertebral veins at this time. I have entered quite a few incidentally, and have occasionally noted a valve, less occasionally an unusual valve. The embryology of the vertebral veins seems different from the jugular veins and happens earlier in development , so not sure if this will be a major consideration nor whether treatment will be an option.

In 2012 it is my plan to evaluate a series of consecutive patients as part of routine testing.
it is an interesting approach. I was eager to hear of the use of this device for occlusionof the central chest veins at CIRSE. One of the physicians showed where the Radiofrequency device burned right through the catheter a large hole.

the carotid artery and the internal jugular vein both run in the carotid sheath, indicating that they and the 10th cranial nerve are very close to each other. I have some concern that there is risk of burning a hole right through the carotid artery. Bleeding, stroke and arteriovenous fistula are my concerns.

Anyway, i suspect this is another topic that i will explore in 2012.
Any other strategies or concepts on the docket to be explored in 2012?
1. 12 month followups of patients treated in 2011
2. Development of CCSVI Centers of Excellence at American Access Care
3. Dural sinus and deep cerebral vein pressure measurements with IVUS before and after treatment
4. A Bigger and Better Symposium
5. PwMS talent show at the symposium
6. Greater networking worldwide
7. publishing, publishing, publishing
Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

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Re: DrSclafani answers some questions

Post by drsclafani » Fri Sep 23, 2011 5:05 pm

Image

Comments :wink:
Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

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Re: DrSclafani answers some questions

Post by pklittle » Fri Sep 23, 2011 6:10 pm

drsclafani wrote:Image

Comments :wink:
The catheter advanced through the sheath, up the right jugular, across the transverse sinus, and down the left jugular?
Last edited by pklittle on Fri Sep 23, 2011 7:52 pm, edited 1 time in total.

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