I am confused about this statement and am worried that it is misleading. "LR1234" referred to a difference in diagnosis between the two, and "wonky1" posted an email from Simka that says that their treatment of upper jugular veins after venography (injection of dye, observing collaterals, etc) is fundamentally different as well.cheerleader wrote:I do not believe Dake and Simka are treating any differently
After following this forum for some time and reading some of the literature, it seems that there are crucial differences between the doctors. Some of them are:
1) It appears that Dake's most commonly diagnosed and treated "problems" were in the upper jugular veins like the ones of LR1234. Both Simka and Zamboni on the other side only treated problems in the lower jugular veins (annular stenoses, malfunctioning valves membraneous obstructions), and rarely diagnosed problems in the upper jugular veins.
2) It appears that in the majority of the patients in whom Dake saw this a problem on MRV, he also ended up seeing it on venography. So it is likely that LR1234 would have ended up with stents in her upper veins if she would have been treated by Dr. Dake, like most of his other patients.
3) We also know that Zamboni was able to open most problems he saw using angioplasty, and keep them open for several years, while Dake, apparently, almost always needed stents. Simka seems to agree with Zamboni in this respect, though in some of his patients he used a stent, while Dake used 2-3 in most patients, sometimes more.
So it seems to me that while there were similarities in diagnosis of the lower vein issues, the treatments, especially of the upper veins, were not only different, but almost diametrical between Dake on one side and Simka/Zamboni on the other, and there were only minor differences in diagnosis and treatment between Simka and Zamboni.
Most of Zamboni's patients seem to be doing great clinically and do not seem to exhibit radiological reasons either to treat upper jugular vein "stenosies". As Simka's email states, these are usually only secondary problems, that naturally open once there is more flow in the vein when the lower jugular vein problem is repared. Some patients may eventually need stents in their lower jugular veins to keep them open permanently, but need for any treatment of the upper jugular veins appears to be an exception.
So while there may be a few exceptions it seems that for the majority of "problems" in the upper jugular veins there are only two feasible possibilities: Dr. Simka and Dr. Zamboni are wrong, or Dr. Dake is wrong.