DrSclafani answers some questions

Cece · Post by **Cece** » Wed Jun 01, 2011 10:36 am

Thekla, thanks.

I can see the valves in ivus images (the vein itself looks like a dark thumbprint, with the dark being what the echo doppler picks up when it encounters the blood stream; the white outline of the thumbprint is the vein wall; the edge of the valve sends back a bright signal, like a slightly curved line in the middle of the dark...) but am getting used to seeing the other things (pancaking, septums, thrombus, other oddities.) Arrows always help.

elliberato · Post by **elliberato** » Wed Jun 01, 2011 10:57 am

Cece when are you going to start treating?!?!

pklittle · Post by **pklittle** » Wed Jun 01, 2011 11:22 am

elliberato wrote:Cece when are you going to start treating?!?!

Perhaps a "Cece answers some questions" thread would be appropriate....

Donnchadh · Post by **Donnchadh** » Wed Jun 01, 2011 12:15 pm

elliberato wrote:Cece when are you going to start treating?!?!

Isn't she an intern yet?

Donnchadh

Cece · Post by **Cece** » Wed Jun 01, 2011 5:32 pm

I'll admit to being a CCSVI enthusiast....

bestadmom · Post by **bestadmom** » Wed Jun 01, 2011 6:11 pm

Cece wrote:
I'll admit to being a CCSVI enthusiast....

No way!!! Perhaps a 12 step program is in order if you're not going to start accepting insurance.

drsclafani · Post by **drsclafani** » Wed Jun 01, 2011 7:46 pm

Thekla wrote:You mention not treating/placing a stent in the renal vein because the necessary tests hadn't been done. With a positive outcome when you do treat this patient, would anticipatory testing be a good idea across the board for patients, or perhaps repeat patients? Or is this too rare to warrant it?

I love reading the cases you post here even though I seldom post any questions---I'm glad Cece does! I too have trouble seeing the details on the ivus, but I never was any good at seeing whether those baby ultrasounds had a penis or not! I was surprised by both of my boys!

Multiple renal veins are quite common. Catheterizing all of them is tedious and often not accomplished because they may be subtle to feel with the catheter.

I could have treated by stenting this renal vein, and this is more readily accepted as necessary in the renal vein than the jugular veins, but i believe that preparation is important in this particular situation. Also CTV is reliable for the most part.

Thank you for your kind words of appreciation. It means a lot to me. Preparing those cases takes upward of two hours to do. When few questions arise, i wonder whether it is valuable to patients.

Your words encourage me to continue.

DrS

drsclafani · Post by **drsclafani** » Wed Jun 01, 2011 7:49 pm

Cece wrote:Thekla, thanks.
I can see the valves in ivus images (the vein itself looks like a dark thumbprint, with the dark being what the echo doppler picks up when it encounters the blood stream; the white outline of the thumbprint is the vein wall; the edge of the valve sends back a bright signal, like a slightly curved line in the middle of the dark...) but am getting used to seeing the other things (pancaking, septums, thrombus, other oddities.) Arrows always help.

I have been looking at these IVUS for a long time. When i first saw those bright dots and blotches, i wondered whether they were real. I am now convinced that I can see webs. before i wasnt sure and i left them alone. Now i am considering angioplasty of the webs

drsclafani · Post by **drsclafani** » Wed Jun 01, 2011 7:50 pm

elliberato wrote:Cece when are you going to start treating?!?!

i think she treats me really well

Cece · Post by **Cece** » Wed Jun 01, 2011 8:44 pm

It is a treat to take part in this thread.

ozwannabe · Post by **ozwannabe** » Wed Jun 01, 2011 9:43 pm

Dr Sclafani,

I too want you to know how valuable your thread is. I don't post much but love soaking up everything there is to learn about this. I just had my first angio four weeks ago and it was reading your thread that convinced me to go for it. Knowledge is power, especially when this damn disease knocks the wind right out of you sometimes.

Anyhow it has been nothing short of miraculous. Well beyond my expectations and only goes to show that there is a large vascular component to MS. It has taken me back at least six years symptom wise. I feel almost 'normal' now

Cheers,
Vicki

Thekla · Post by **Thekla** » Thu Jun 02, 2011 3:05 am

oh! I get it, I think my ultrasounds were too early, they were silent! It would have been so much easier with sound!

bruce123 · Post by **bruce123** » Thu Jun 02, 2011 4:28 am

drsclafani wrote: Thank you for your kind words of appreciation. It means a lot to me. Preparing those cases takes upward of two hours to do. When few questions arise, i wonder whether it is valuable to patients.
DrS

I don't post on this thread because I don't know enough to ask an intelligent question, but I ALWAYS read this thread. I continue to learn so much. Thank you Dr. S.

Good luck with you meeting in Toronto with the Canadian MS Society.

Bruce.

pklittle · Post by **pklittle** » Thu Jun 02, 2011 4:33 am

Thank you for your kind words of appreciation. It means a lot to me. Preparing those cases takes upward of two hours to do. When few questions arise, i wonder whether it is valuable to patients.

Dr Sclafani,
Let me also express my appreciation for the detailed documentation of these cases. I don't ask many questions because I am not as well versed as others but thanks.
Pam

munchkin · Post by **munchkin** » Thu Jun 02, 2011 4:47 am

Thank you for all of your input Dr. S. There are so many of us that read and learn from what you are showing.

I don't ask questions but I always follow this thread and appreciate the insightful questions others ask and the answers you provide.