DrSclafani answers some questions

[thornyrose76]

Thanks for the info, and while I still hope he responds, the info you gave me will/is be most helpful!

[Opera]

Dear Dr Scaflani,

I live in Australia and here they can only do extracranial doppler US.

My question is, if a venogram is done will it pick up any stenosis in the transcranial area? In other words, will the venogram pick up any stenosis from top to bottom of the jugualr veins?

Sorry for my ignorance.

Kind regards

[fogdweller]

there are many forms of trauma that can injure veins

1. iatrogenic trauma, caused by treatments, such as catheters in veins that lead to injections that cause strictures
2. actual violent trauma, stab or gunshot wounds
3. blunt trauma, car accidents, etc
4 radiation scarring.
5 chemotherapy scarring

to name a few

Interesting that you note chemical trauma. I have always had very, very slow progression. In fact I was able to remain in the closet about MS for almost 20 years. Then I participated in a trial for treatment of MS by infusion of mitoxantrOne. It did me no good, had horrible side effects and soon after my last infusion I had a visible collapse of a vein on the surface of my arm. My rate of progression has since accelerated, although I understand it usually slows down after age 50. Also the phlebotomists have a terribel time finding a good enough vein for blood draws.

Could systemic vein injury contribute to worsening CCSVI?

[drsclafani]

pam....visine might help remove that florida sand from you eye.

LOL! Thanks for the tip!

So the purple, swollen foot... would that lead to the possibility of getting treatment that an insurance co might actually cover? That's really what I was getting at. The sand in my eye was making it hard to see the keyboard so I may not have winked enough.

Some insurers do pay for ccsvi

[drsclafani]

Dr. S, Your reference to Aaron Miller sort of made me see red..I had a visit with him when I was first diagnosed----talk about a nonchalant attitude about this MesS we're in. While NOT LOOKING ME ONCE, he said, about which DMD to start- he told me to "pick one, they're all the same. Don't worry/" and handed me off to his nurse. I couldn't believe the way I was dismissed by him. He certainly does not know the first thing about the people with MS. He, I'm sure, can site you research results with flair but really knowing. I don't think so...
If he's the best they have -------one for our side!

His position as an advisor goves him a loud voice
My dealings with him have been collegial. It is not my intention to disparage him but to convince him

[drsclafani]

Hello and thank you Dr. Sclafani. I intend to have the procedure in the United States and I need your advise. If I have stents put in what are the chances that I could have some type of complication? Would I be on a blood thinner medication for life? I look forward your response.

Good luck in your treatment. I wish u some freedom on independence day.
I hope u don't need stents. I think it best to have successful venoplasty without stenting. However I have had an opportunity to learn that short term deliterious effects of stents are low. Now I will have to learn the long term deleterious effects before I become more liberal in the use. My tratment plan calls for stenting after second short term recurrence

Antocoagulation os used to avoid stent thrombosos and restenosis

[PCakes]

Good day, Happy 4th! and thank you!

my question(s).. chicken or egg kind of.. hypothetically afflicted from birth.. is a malformed valve the cause of a vein stenosing? causing a reduced flow/reflux that causes the vein to become insufficient? and if so.. are the valves being repaired somehow during the procedure? most talk is of vein ballooning.. how does this address the valve?

not that you need more to read.. http://healthblog.ctv.ca/post/CCSVI-tri ... stion.aspx

[drsclafani]

Dear Dr Scaflani,

I live in Australia and here they can only do extracranial doppler US.

My question is, if a venogram is done will it pick up any stenosis in the transcranial area? In other words, will the venogram pick up any stenosis from top to bottom of the jugualr veins?

Sorry for my ignorance.

Kind regards

I thought i answered this question, but cannot find the answer wo i will answer it again

firstly,
apologize only for ignorance you choose not to correct.

The usual catheter venogram does not visualize the intracranial veins. However the catheter venogram will pick up stenoses from the top to the bottom of the jugular vein, which actually begins in the neck, not in the skull or brain. The veins that are inside the skull are deep cerebral veins and dural sinuses which are the outflow pipes inside the skull. They drain into the jugular veins and vertebral veins, once they exit the skull.

MR venograms do show the dural sinuses and the deep cerebral veins are visualized on susceptibility weighted MRI

The ultrasound only visualizes the jugular and vertebral veins but not with as great detail as either of the two tests mentioned above. The ultrasound's purpose is to evaluate flow and direction of flow . By the pattern and direcdtion of flow, doctors infer a lot about derangements in outflow

[drsclafani]

there are many forms of trauma that can injure veins

1. iatrogenic trauma, caused by treatments, such as catheters in veins that lead to injections that cause strictures
2. actual violent trauma, stab or gunshot wounds
3. blunt trauma, car accidents, etc
4 radiation scarring.
5 chemotherapy scarring

to name a few

Interesting that you note chemical trauma. I have always had very, very slow progression. In fact I was able to remain in the closet about MS for almost 20 years. Then I participated in a trial for treatment of MS by infusion of mitoxantrOne. It did me no good, had horrible side effects and soon after my last infusion I had a visible collapse of a vein on the surface of my arm. My rate of progression has since accelerated, although I understand it usually slows down after age 50. Also the phlebotomists have a terribel time finding a good enough vein for blood draws.

Could systemic vein injury contribute to worsening CCSVI?

It depends upon which veins are used to infuse the chemotherapy. If the port is placed into the jugular veins, it could worsen the outflow obstructions. If it were in the subclavian vein, it could also cause damage that vein and worsen CCSVI.

[newlywed4ever]

apologize only for ignorance you choose not to correct

LOVE that! (your quote.) (it is yours, right?) When I repeat it, I want to be able to give credit as due...

[hwebb]

Hey Dr S,

in one discussion, Dr Zamboni said that if a patient has had two unsuccessful balloon angioplasty procedures, their problem jugular vein could/should (?) be repaired using surgery. Do you think this is true for high jugular stenoses? I had assumed my high jugular stenosis could not be surgically repaired (I thought it was in my skull)...but your comment here indicates the high jugular region is just below the skull...so maybe still quite accessible?

the catheter venogram will pick up stenoses from the top to the bottom of the jugular vein, which actually begins in the neck, not in the skull or brain

Helen

[Nunzio]

It depends upon which veins are used to infuse the chemotherapy. If the port is placed into the jugular veins, it could worsen the outflow obstructions. If it were in the subclavian vein, it could also cause damage that vein and worsen CCSVI.

Multiple Sclerosis: The recommended dosage of Mitoxantrone is 12 mg/m2 given as a short (approximately 5 to 15 minutes) intravenous infusion every 3 months.

Read more: http://www.drugs.com/pro/mitoxantrone.h ... z0snXImb6N

Normally this is done through a normal IV in the arm which is removed after the infusion.

[drsclafani]

Hey Dr S,

in one discussion, Dr Zamboni said that if a patient has had two unsuccessful balloon angioplasty procedures, their problem jugular vein could/should (?) be repaired using surgery. Do you think this is true for high jugular stenoses? I had assumed my high jugular stenosis could not be surgically repaired (I thought it was in my skull)...but your comment here indicates the high jugular region is just below the skull...so maybe still quite accessible?

the catheter venogram will pick up stenoses from the top to the bottom of the jugular vein, which actually begins in the neck, not in the skull or brain

Helen[/quote

Helen
as you know, i am not a practicing surgeon, thus i do not want to be definitive, but i do not think repair of the upper vein is a likely option. It is really not accessible

[drsclafani]

It depends upon which veins are used to infuse the chemotherapy. If the port is placed into the jugular veins, it could worsen the outflow obstructions. If it were in the subclavian vein, it could also cause damage that vein and worsen CCSVI.

Multiple Sclerosis: The recommended dosage of Mitoxantrone is 12 mg/m2 given as a short (approximately 5 to 15 minutes) intravenous infusion every 3 months.

Read more: http://www.drugs.com/pro/mitoxantrone.h ... z0snXImb6N

Normally this is done through a normal IV in the arm which is removed after the infusion.

thanks for clarifying nunzio, i was speaking about chemotherapy in general, not about an ms drug

[drsclafani]

apologize only for ignorance you choose not to correct

LOVE that! (your quote.) (it is yours, right?) When I repeat it, I want to be able to give credit as due...

i wrote it up sitting around a campfire while reading tims on my phone on july 4 2010, trying to figure out why my Fourth of July photo did not show up on tims

i apologize, i could not figure it out!