DrSclafani answers some questions

[drsclafani]

Good Morning Dr. Sclafani,
I would like to ask you a question regarding reflux post procedure. I had stenosis in both of my jugular veins. The veins were opened using stents as balloon did not hold. During my 1 month follow-up appointment one of the veins still showed a minimal reflux, not as bad as before the procedure, but it is still there.
My question is, in your experience with CCSVI have you seen the reflux not stopping immediately but going away gradually?

Thank you for your time.

Hmmm,let me explain my thinking on this because there are subtleties regarding reflux that need diffierentiation.

in CCSVI, the obstructions lead to reflux back up into the head because there is no direct line flow from the brain, through the jugular veins back into the chest

In CCSVI there is less chance of refluxing from the chest into the jugular vein because there is narrowing of the vein, blocking free flow backward.

After stenting, if its doing its job, then there is good flow down from the brain through the jugular vein to the chest without obstruction and reflux back into the brain is stopped.

However if the stent expands the lower part of the jugular vein then there is some likelihood that blood can back up from the chest into neck but without the problems of reflux back into the brain because of obstruction

understand?

[drsclafani]

There we go; for what it means; have my MRx's in the mail to you

Your Left jugular vein is compressed by the cervical spine at level of C 1. The lumen of Lt jugular vein is very small at the level of C1, >90% stenosis by MRV study. The jugular venous valves are functioning normal. Because there is no any stent designed for the vein, therefore Dr. XXX, who is responsible for the intervention treatment, will find a suitable stent available on the market, though designed for the artery, for the special location of the vein. The detailed study of azygos vein needs conventional venogram, and MRV of azygos vein only can provide limited information.

Please comment when/if you can

i wouldnt rely upon the MRvenogram to determine how you should be treated

[Algis]

Thank you Doctor;

i wouldnt rely upon the MRvenogram to determine how you should be treated

I assume they prefer to have a stent ready in case ballooning doesn't do the job :/

But just an assumption.

[drsclafani]

Thank you Doctor;

i wouldnt rely upon the MRvenogram to determine how you should be treated

I assume they prefer to have a stent ready in case ballooning doesn't do the job :/

But just an assumption.

they should have it ready anyway. Good luck Algis....when is your liberation planned? We will all be anxious for you and look forward to a positive outcome

[Algis]

Thank you Doctor; and all who give it a thought.

I have no date yet; but I will broadcast it here when I know it

Be well; all!!

[selkie]

Thank you, Doctor. That hypothetical person is not obese, slightly overweight, not extreme. She does have "rolly" veins, but IV specialists & techs with the right technique (get in fast before the vein gets away) do the job. But there have been plenty of encounters where a more experienced IV tech was called in. But sounds like the veins being examined in the CCSVI diagnostic procedure would be fairly normal, if I understand you correctly.

When the tachycardia is controlled, perhaps through correct thyroid hormone dosage, she can consider liberation as safe for her as any other MS patient.

Thank you again, aloha.

[1eye]

Please tell me if this is a boring topic, maybe but somehow I don't feel bored.

Perhaps in an effort to be objective, the "why" got left out. It may be obvious to some but not me.

Do jugulars collapse because they are floppy and lay flat? In that very-low-pressure environment, that would happen slowly, if the veins were floppy. Just a gradual shift, on account of the very light wall weight, and the relative absence of gravity's pressure keeping them 'patent'. Kind of like a liquid, spreading out flat on the floor when there's no container any more?

At that time, since gravity is less of an influence, we would have to rely on other pressure to get the fluid down. The vertebral veins are more narrow. So is there more pressure on them, to get similarly large volumes of blood through the narrower channel in the same time? Is any of it negative pressure?

Seems like a gizmo like IVUS would be useful, a tiny strain guage measuring very very localized pressure, with ones for arteries and ones for veins. And while we're at it, a very very small Doppler probe. IVDUS.

What am I driving at? I am trying to understand flow changes. Plus I am still interested in the lying-down change, because I wake up feeling worse than when I went to bed, and as soon as I sit up, better. And I am also intrigued by the 3D vein images with ballooned veins above the stenosis. Age and gravity may cause loose vessels, when they are under pressure, to change shape over time. But these really look blown up like a balloon.

I am getting something wrong? Yes; NORMAL is for the jugulars to be OPEN when you are lying down, and SHUT when you are standing up. When you are lying down, MORE bloodflow goes through the jugulars, (LESS through the spinal column path?). I can't understand that. If the path is more open, there should be less velocity, too. I wake up feeling like my brain has been shut down for 7 hours, not asleep. If you'll accept Bill Gates' terms (asleep and shut down -- does it have to do with oxygen?).

Why are these vessels used more when we lie down? We lie flat, they inflate. Counter-intuitive to me. The flow would slow. That's when they should collapse, when less gravitational pressure is forcing liquid through them, and more pulling the top wall down toward the bottom. Is it because the vessel just works that way, and top and bottom attachments assure that? Is it maybe because we are lying down on the other path? Or because it changes somehow, pinching off the vertebral path? What happens when the poor sod has problems in both? Aaack. Evolution seems to have me extremely baffled.

Maybe there's a function being done while we lie down that's more important, and requires more flow in a certain area? Like unconscious vigilance to predators?

What's supposed to inflate my jugulars when I lie down? Even if it isn't doing that in my case. Why is what's supposed to be normal, normal at all?

Please do not bother with this if it is too scattered. Loss of cogneetoes does that to me sometimes. I know this must be second-nature to someone looking at them through fluoroscopes. Also if it will all be clearer after I read the paperback version.

[irishmum]

Hi Dr Sclafani,

sorry to bother you with this question but I have tried to get an answer from my gp who didnt have a clue about 'sticky blood syndrome' tested me for facor V and told me I had no problem.

You had advised me sometime ago to have my blood tested for this condition before I would attend for the ccsvi treatment as my brother suffers from this. I got the results about five weeks ago orderd by my work/college gp who thinks there is an issue with it and to bring the result to my next appointment with my neuro which is not until end of august...

I havent got a clue what kind of test they are only that they are for coagulation. They were ran in a lab in a university hospital in Ireland.

Antithrombin 120.0 u/dl (79 - 131)
Protein C 120 u/dl (64 - 128)
Free Protein S 146.0 u/dl (65 - 124) H
APC resistance 2.9 (2.1- 4.0)
Lupus Inhibitor Negative

What do you think. I suppose I am ever hopeful as I have not got a proper diagnosis and I know that sitcky blood can mimic ms. Although my brother has sticky blood and a missing or undeveloped vein into his kidney and both conditions contrived to cause dvts in both legs. (he was diagnosed in London)

Thank you so much for your time.
Regards

Maureen

[NHE]

Hi 1eye,

n being the length and r being a single radius (half a diameter). Same units of length all round, please.

• --------------------------------------------------------------

So n*r*r of that cylindrical section is really volume of a cylindrical vein of length n and radius r. Clear as mud?

This wouldn't give you volume. For that you need length x area or n*π*r². In addition, cross sectional area is used for the comparison instead of something like the radius or diameter since the veins are often not perfect circles.

Hope this helps, NHE

[LadyGazelle]

I have MRV scheduled AGAIN for 7/20/10 WITH CONTRAST this time because they realized they needed it after I had dropped off a CD of my brain MRI with Zamboni's protocol before the first MRV test on 7/7/10

I also faxed over the meeting January 26th to Dr. Sarah, (the IR who read the first MRV) who said they needed time to investigate CCSVI before they use the contrast dye. Friday I learned she will be out of the country INCLUDING NEXT WEEK! Perhaps it will be the chairman of the diagostic imaging department at the Hospital who needed extra time.

The question is: My PCP ordered the tests at my request, so should I talk with the IR (who will be reading them) to see if he will do Catheter Venogram GOLD STANDARD next no matter what he finds? My PC appreciates my help and will prescribe it if/when I find someone to do it. I also appreciate your intervention!

Inverted valves is all they think I have so far, but I don't trust them with stents in the veins. The more I know, the more I learn what I don't know! I'm afraid they won't listen when I ask that during the CV they use the LEFT femoral vein. I don't want to be the first unsuccessful liberation because they don't know what they're doing!

[1eye]

Hoo boy. Told you my eyes crossed when you add in valsalva. I knew that. I was just seeing if you were paying attention. The area of a unit circle is what? Now let's not always see the same hands...

[Nunzio]

Hi 1eye,

So n*r*r of that cylindrical section is really volume of a cylindrical vein of length n and radius r. Clear as mud?

This wouldn't give you volume. For that you need length x area or n*π*r². In addition, cross sectional area is used for the comparison instead of something like the radius or diameter since the veins are often not perfect circles.

Hope this helps, NHE

I think the 1eye misunderstanding come from the fact that n represent the greek letter Pi or 3.14 which look like an eglish alphabet "n" or TT, therefore r*r*Pi is the area of a circle.

[suzq77]

Dr. Sclafani,
I had a venogram/angioplasty on June 18th on 3 areas: 2 at the base of each jugular (probable 50% occluded) and 1 in the left upper IJV (probable 75% occluded).

I had a one month follow up MRV this past week and my IR found that my right sigmoid sinus is almost completely occluded - to the point where all of the blood flow is draining from the left side.

He conferred with a neuro IR in his practice that said my IR can and should correct it. My IR also told me he would need to use a stent.

Though I'm showing marginal improvement, this occlusion is by far the worst. My question: is stenting the sigmoid sinus more dangerous/complicated? Should I go for it or be more cautious?

He's going to the seminar on the 26th and said he would present my case.

I'd love to hear your feedback.

Thanks!

[shye]

1eye-
can't answer your questions, but have you tried Inclined Bed Therapy????

[HollyBarr]

This might be a prime opportunity to get on the good doctor's waiting list, here is the email:
ccsviliberation@gmail.com
Contact person is Holly Barr
She may or may not ask for your mother's maiden name, do not joke about it being tattooed on the inside of your jugulars, she not seem to find that as amusing as we did!

Au contraire, my only caveat re intake info tattooed on the inside of your jugulars was a wee bit of insecurity over whether the IVUS could differentiate between things like a number 3 and a number 5 . But I did want everyone to know that while Dr. Sclafani's treatments are on hold here I've drastically shortened the form you need to fill out to get on his waiting list and, since I'm only 99% unreasonable, no longer request your kindergarten transcripts . Again the address is ccsviliberation@gmail.com.