Dear MarkMarkW wrote:Hello Dr S,drsclafani wrote:...............I surely know much more about veins, valves, endothelium, balloons, stents, anticoagulation, neurological assessment, ms, lymes, chronic fatique, ivus, than when I started answering questions....................Its not like I am winding down. I remain wound up by this treatment. In fact as I have gained experience I am more confident but more reasoned about the effects
I have such confidence in your skills that I recommend pwMS (with sufficient funds) travel from Oxford England for diagnosis and de-stenosis by you. My question is:
Have your skills and techniques developed significantly over the last 3 years (when I visited your clinic) to justify another trip to Brooklyn???
that is a two part question.
first part: have my skills and techniques developed significantly in the past three years? absolutely. I always perform IVUS on the left renal vein, something I did not routinely do until 2012. I initially performed IVUS in the renal vein only when the venogram was suspicious. However now I always do it because I have found the venogram to be less than accurate. I am also more comfortable diagnosing webs and other forms of stenosis. My selection of balloon size is also more accurate and with less risk of injury to the vein and fewer complications. My anticoagulation regimen is improved and my surveillance of the dilated veins more logical.
the second part of your question is more complicated. Do I think it would be worthwhile to come back for another look. That is a clinical question that depends on your prior response, your smoking history, your prior symptom relief and your current symptoms.
That conversation belongs as a private dialogue. Give me a note at firstname.lastname@example.org and we can discuss your current situation.