DrSclafani answers some questions

[pklittle]

Dr S,
My son married his love on Nov 5th! Did your son marry on the same date?

[drsclafani]

Dr S,
My son married his love on Nov 5th! Did your son marry on the same date?

I GUESS THAT IS A QUESTION..

No, he was married on 11/11/11. Was afraid he would not remember the date!

[Cece]

But was it at 11 am?

If you're looking for questions, I've been wondering about the Canadian SAB board. Are the members in fairly good consensus about what the trials should look like? Is there anything that is a disagreement point? How soon can we expect Canadian trials to commence? Canadians have been waiting a long time already....

[drsclafani]

But was it at 11 am?

If you're looking for questions, I've been wondering about the Canadian SAB board. Are the members in fairly good consensus about what the trials should look like? Is there anything that is a disagreement point? How soon can we expect Canadian trials to commence? Canadians have been waiting a long time already....

Cece
i think that we must work behind the scenes right now. Best not to push anyone into a corner. you know how PwMS can be persistent.

I am hopeful that they are listening to our advice

[pklittle]

DrS,
Questions for you... can you tell us about renal stent followup? Is it the same as jugular stent followup at 3 months? Can the flow be clearly seen on ultrasound? Have you seen any thrombus in a renal stent? How many cases of nutcracker syndrome have you diagnosed and stented?
thanks

[mo_en]

Dear Doctor, two questions:
1. How often have you seen the external jugular vein be used as a collateral of the internal?
2. Provided that the above is true, wouldn't be useful to check and restore a probable valve problem in the external?

[Cece]

There was a case study involving treatment of an external jugular!
http://www.thisisms.com/forum/chronic-c ... ml#p164611
Skip to the last set of images labelled 1,2,3 and the paragraph starting, "But that is not why I show this case."

We've also seen this rotating MRV image of a stenotic external jugular (bottom right image, click to play): http://www.mrinnovations.com/portfolio.php

[PointsNorth]

Dr. S,

Are the stenoses found in vessels other than the IJVs valvular in nature? Is this relevant in any way?

BTW-I read that tarsiers can be kept as pets!

PN

[drsclafani]

Dr. S,

Are the stenoses found in vessels other than the IJVs valvular in nature? Is this relevant in any way?

BTW-I read that tarsiers can be kept as pets!

PN

the azygous abnormalities are also frequently valvular. However the inflow vein problems on the iliac vein or the renal vein are compressions rather than intrinsic disease.

[Cece]

Dear Doctor, two questions:
1. How often have you seen the external jugular vein be used as a collateral of the internal?
2. Provided that the above is true, wouldn't be useful to check and restore a probable valve problem in the external?

I was hoping to hear about prevalency of the EJV being blocked, although if he's not checking for it, he would not know prevalency. During my procedures, both times, my azygous was said to have very rapid flow. It looked like an azygous carrying the extra flow from another vein, and at one point during my second procedure, Dr. Sclafani expected to find nutcracker syndrome based on the flow in my azygous, but there was no nutcracker syndrome. The external jugular vein was never checked and, if there was an external jugular blockage, could that flow be rerouted to the verts and down the spine and to the azygous? This is the route that my collateral flow for my jugulars took.

If rapid flow in the azygous looks identical to flow in the azygous when nutcracker syndrome is present, and nutcracker syndrome may cause chronic fatigue, could my rapid flow in my azygous be causing fatigue?

Can external jugulars be assessed through doppler imaging?

I should add that I am ridiculously better than I was prior to my procedures. Yesterday I was able to exercise with ankle weights on, which I hadn't been able to do since 6 years ago when I acquired mild foot drop during a relapse. The day before yesterday, I was able to do three hours of driving; driving takes concentration and wears me out, so this is remarkable for me. I'm not 100% but I am much better.

[mo_en]

One more: How can one tell whether a vein is hypoplastic or simply narrow due to small blood flow? If the accumulation of lesions in the spinal cord diminished the available room in the vertebral column or exerted pressure on vertebral plexus, could this result in reduced spinal flow capacity and, subsequently, less blood volume in the lumbar veins?

[NZer1]

One more: How can one tell whether a vein is hypoplastic or simply narrow due to small blood flow? If the accumulation of lesions in the spinal cord diminished the available room in the vertebral column or exerted pressure on vertebral plexus, could this result in reduced spinal flow capacity and, subsequently, less blood volume in the lumbar veins?

I am personally interested in this as well mo-en, I also would be concerned about the flow of CSF in the cord due to the lesions on the cord as well as the flow of CSF due to its pump system being effected by slow flow through the brain stem area. The cord has much more importance than we give it credit.

Cece don't forget that the reduced flow of blood any where is the beginning of problems, that plays out to be symptoms. The flow around the brain and cord is important because of the tasks the blood does. When the system re-routes and effects another region where the extra flow is now combined. Other flow dynamics in the whole system are effected any time there is disruption, so although there may be a jugular slow flow, it is the entire system that has to adjust, not just where the flow is re-directed to, everything backs up. So we don't know what will be effected by a route having no flow or that bypass blood added to another flow path, not designed for that much flow and it slows as well.

Regards Nigel

[CureOrBust]

If rapid flow in the azygous looks identical to flow in the azygous when nutcracker syndrome is present, and nutcracker syndrome may cause chronic fatigue, could my rapid flow in my azygous be causing fatigue?

Is it the rapid flow OR the question of what is causing it that raises our concern?

[Cece]

If rapid flow in the azygous looks identical to flow in the azygous when nutcracker syndrome is present, and nutcracker syndrome may cause chronic fatigue, could my rapid flow in my azygous be causing fatigue?

Is it the rapid flow OR the question of what is causing it that raises our concern?

In my azygous, the flow was rapid but not refluxing. In CCSVI with azygous obstruction and nutcracker syndrome, there would be reflux. But in pediatric chronic fatigue in nutcracker syndrome despite no azygous obstruction, what is causing that chronic fatigue?

Cure, your question gets to the debate of whether to treat the stenosis or treat the flow!

[NZer1]

If rapid flow in the azygous looks identical to flow in the azygous when nutcracker syndrome is present, and nutcracker syndrome may cause chronic fatigue, could my rapid flow in my azygous be causing fatigue?

Is it the rapid flow OR the question of what is causing it that raises our concern?

And even more importantly how do we know that it is rapid flow, and why?

Is there a way to prove that any of us have flow that is not "normal", or simply put, is it unique to us for reasons as yet unknown?

We don't know what is 'at risk, or the risk factor' for MS or any of the de-generative diseases, YET!

Regards Nigel.