DrSclafani answers some questions

bonzo1986 · Post by **bonzo1986** » Thu Jul 07, 2011 7:36 am

I agree healthy control is a better term. I did not mean any disrespect to anyone.

How many volunteers would it take to have a good conclusion?

flipflopper · Post by **flipflopper** » Thu Jul 07, 2011 7:42 am

drsclafani wrote:
flipflopper wrote:Dr S,

In the month of June you wrote "there are few procedures scheduled for the next couple of weeks for reasons i cannot explain. i will have some time to wonder why. perhaps everyone thinks that my waiting time is greater than it is."

I have been on your waiting list in the past but I have been thinking hard in the last 2 years when the right time to be treated would be (I also take the financial costs of the procedure under account and it is one of my reason for waiting a little longer). I have not had the chance to visit this site much in the last 5 months but I would love to know where your waiting list is at now. You don't happen to have space for an appointment next month do you ? I should probably e-mail Holly but I thought that perhaps others were wondering the same thing.

Thanks again for your time!
i am uncomfortable discussing my practice on this site. I have always tried to separate my practice from my caring for PwMS. Perhaps facebook is another way to address this.

but since you asked, it seems that there are many people who have assumed that it is the standard to have a long waiting list. I think that this is not true for me. I have an opening for tomorrow, for example.

But further discussion about this by me on this site is awkward and you can private message me if you like or email me at ccsviliberation@gmail.com

sorry for the intrusion. this site is for patients, not a doctor's practice.

S

I understand, respect and I agree with your reasoning. I am sorry for having asked an awkward question (I was going to send you a PM at first to ask you that question).

1eye · Post by **1eye** » Thu Jul 07, 2011 8:41 am

I am out of my league too; in fact the league has banned me.

Though the pictures are gone now ... if you recall that far (I do) ... you saw the flow of the contrast media back down the azygous instead of ascending.

And that back flow started right at the point of the phasic narrowing. Mind you it (the backflow) wasn't constant, because as is the nature of that particular narrowing, was that it opened upon DEEP breath (or DEEP exhale - not sure which), and flow was 'normal' then.

Reflux: can it be just as bad or worse for the spine, or lungs (drained and refluxed through the azygos) as for the brain (drained and refluxed through the IJVs)? Octopi have very long neurons, and you might think of their brain as being a very well-distributed organ, capable of amazing feats of camouflage. The spine is a long bundle of neurons that need the same food (glucose and oxygen) that the brain does. Can reversal of a long-standing refluxing problem (in the azygos or other spinal vein) or flow problem (stagnation, sluggish drainage) give enough oxygen to heal disability? Of course, we don't know. What people are hoping, is that there are answers, and that those doctors who are seeing the problems live, on camera, in a large enough group, will twig to what they are.

Also: does it matter where reflux comes from (brain, spine, kidneys, liver)? Are some organs more toxic than others?

magoo · Post by **magoo** » Thu Jul 07, 2011 9:24 am

What is the purpose for treating the renal veins?

As for the patient to patient questions, I'd like to know if anyone has had pain resolve in one area (such as headaches), only to experience new pain in another area after treatment?

CCSVIhusband · Post by **CCSVIhusband** » Thu Jul 07, 2011 12:21 pm

take note of Magoo's treatment areas by Dr. McGuckin ... azygous ... and her results she posted in her personal thread.

Another one.

Though it appears many of her veins were treated.

Sorry, Dr. S for semi-hi-jacking your thread with this thought. I just think it's too coincidental at this point. Similar to the way some try to argue it's "coincidental" all these MSers also have been diagnosed with CCSVI ...

thisisalex · Post by **thisisalex** » Thu Jul 07, 2011 1:01 pm

Hello doctor Sclafani!

May I share a very problematic case? My good friend Julia had her second CCSVI procedure, and her jugular vein was found to be completely closed (for the first time in Bulgaria it was open and treatable, but in California they found it completely closed and they couldn't get in)
Here are pictures of the second surgery by dr. Harris: http://img40.imageshack.us/slideshow/we ... 000000.jpg

Her letter describing the situation in more detail:

I was diagnosed with MS in 1993 at the age of 33. in 2003 the nature of the disease changed into the secondary progressive form. My walking ability started to decline quite badly.

I heard of CCSVI at first in the summer of 2010 and I was operated already in September the same year in Sofia, Bulgaria. My left jugular vein and also the azygos were severly strictured up to 30% and were dilated whereas the right jugular was all right. The following 6 weeks or two months were wonderful. I felt better day by day and could also move more and easier. Also my speach became better.

This wonderful period was followed by a slow decline and by the spring this year I decided to ask for a new treatment this time at Synergy in California. Despite my full optimism during the operation it turned out that my left jugular vein is totally recoiled and I was told that it cannot be operated any more. The azygos was narrower again as it should have been and was dilated. And though doctors suggested to be optimistic and wait for improvement through the dilatation of the azygos I feel worse and move worse and feel again the speaking difficulty sometimes.

Californian doctors do not advise to get any sort of bypass operation in the jugular though these are performed in India. According to them these spoil the veins totally. My question is whethere there is something that could be done for improving the blood flow in my jugular vein.

Thank you very much
Julia

drsclafani · Post by **drsclafani** » Fri Jul 08, 2011 8:18 pm

magoo wrote:What is the purpose for treating the renal veins?

As for the patient to patient questions, I'd like to know if anyone has had pain resolve in one area (such as headaches), only to experience new pain in another area after treatment?

the internal jugular vein carries approximatly 375 ml per minuted out of the brain. the Azygous probably drains about 50-75 ml per minute. Add it up the cerebrospinal venous flow is about800-1000 ml per minute.

Each renal vein drains 500 ml per minute.

obstruction of the renal vein means that about 500 ml of blood needs collateral blood flow. One of the important collateral veins is the hemiazygous which connects to the azygous. So if half of that blood went through the azygous, it would markedly increase the volume traversing that area. If two or three of the major cerebrospinal veins are occluded, you can see how the added drainage of renal venous flow through the cerebrospinal circulation is going to impact on ccsvi

does that help?

drsclafani · Post by **drsclafani** » Fri Jul 08, 2011 8:19 pm

CCSVIhusband wrote:take note of Magoo's treatment areas by Dr. McGuckin ... azygous ... and her results she posted in her personal thread.

Another one.

Though it appears many of her veins were treated.

Sorry, Dr. S for semi-hi-jacking your thread with this thought. I just think it's too coincidental at this point. Similar to the way some try to argue it's "coincidental" all these MSers also have been diagnosed with CCSVI ...

I will be willing to treat your wife's transient occlusion if she still has symptoms. No stone unturned. email me at ccsviliberation@gmail.com

S

drsclafani · Post by **drsclafani** » Fri Jul 08, 2011 8:26 pm

thisisalex wrote:Hello doctor Sclafani!

May I share a very problematic case? My good friend Julia had her second CCSVI procedure, and her jugular vein was found to be completely closed (for the first time in Bulgaria it was open and treatable, but in California they found it completely closed and they couldn't get in)
Here are pictures of the second surgery by dr. Harris: http://img40.imageshack.us/slideshow/we ... 000000.jpg

Her letter describing the situation in more detail:

I was diagnosed with MS in 1993 at the age of 33. in 2003 the nature of the disease changed into the secondary progressive form. My walking ability started to decline quite badly.

I heard of CCSVI at first in the summer of 2010 and I was operated already in September the same year in Sofia, Bulgaria. My left jugular vein and also the azygos were severly strictured up to 30% and were dilated whereas the right jugular was all right. The following 6 weeks or two months were wonderful. I felt better day by day and could also move more and easier. Also my speach became better.

This wonderful period was followed by a slow decline and by the spring this year I decided to ask for a new treatment this time at Synergy in California. Despite my full optimism during the operation it turned out that my left jugular vein is totally recoiled and I was told that it cannot be operated any more. The azygos was narrower again as it should have been and was dilated. And though doctors suggested to be optimistic and wait for improvement through the dilatation of the azygos I feel worse and move worse and feel again the speaking difficulty sometimes.

Californian doctors do not advise to get any sort of bypass operation in the jugular though these are performed in India. According to them these spoil the veins totally. My question is whethere there is something that could be done for improving the blood flow in my jugular vein.

Thank you very much
Julia

nice images....it might be necessary to enter the jugular vein in the neck and get a guidewire down into the chest and then rendevous i think it is possible to travese these stenosis and do slow, methodical dilatation. No guarantee that the opening of this vein would improve the situation

s

Robnl · Post by **Robnl** » Sun Jul 10, 2011 1:50 am

drsclafani wrote:
magoo wrote:What is the purpose for treating the renal veins?

As for the patient to patient questions, I'd like to know if anyone has had pain resolve in one area (such as headaches), only to experience new pain in another area after treatment?
the internal jugular vein carries approximatly 375 ml per minuted out of the brain. the Azygous probably drains about 50-75 ml per minute. Add it up the cerebrospinal venous flow is about800-1000 ml per minute.

Each renal vein drains 500 ml per minute.

obstruction of the renal vein means that about 500 ml of blood needs collateral blood flow. One of the important collateral veins is the hemiazygous which connects to the azygous. So if half of that blood went through the azygous, it would markedly increase the volume traversing that area. If two or three of the major cerebrospinal veins are occluded, you can see how the added drainage of renal venous flow through the cerebrospinal circulation is going to impact on ccsvi

does that help?

Hi Doc,

About the flow:

the internal jugular vein carries approximatly 375 ml per minuted out of the brain. the Azygous probably drains about 50-75 ml per minute. Add it up the cerebrospinal venous flow is about800-1000 ml per minute.

Each renal vein drains 500 ml per minute.

What 'speed' is sufficient??
If an ms-patient does not have ccsvi, but the jugs carries only f.e. 100ml/minute or the renal veins drains f.e. 100ml/mnute....is that a problem??

I don't know if you can measure the 'speed' of draining, but i was just wondering if slow draining without ccsvi could be a possible problem...[/quote]

Donnchadh · Post by **Donnchadh** » Sun Jul 10, 2011 8:29 am

Dr. Sclafani:

Has anyone been treated for stenosis in the sigmoid sinus?

Donnchadh

magoo · Post by **magoo** » Sun Jul 10, 2011 8:46 am

drsclafani wrote:
magoo wrote:What is the purpose for treating the renal veins?

As for the patient to patient questions, I'd like to know if anyone has had pain resolve in one area (such as headaches), only to experience new pain in another area after treatment?
the internal jugular vein carries approximatly 375 ml per minuted out of the brain. the Azygous probably drains about 50-75 ml per minute. Add it up the cerebrospinal venous flow is about800-1000 ml per minute.

Each renal vein drains 500 ml per minute.

obstruction of the renal vein means that about 500 ml of blood needs collateral blood flow. One of the important collateral veins is the hemiazygous which connects to the azygous. So if half of that blood went through the azygous, it would markedly increase the volume traversing that area. If two or three of the major cerebrospinal veins are occluded, you can see how the added drainage of renal venous flow through the cerebrospinal circulation is going to impact on ccsvi

does that help?

Yes, Dr. Scalfani, that does help. Thank you.
Another inquiry...Do you examine and treat this area, and if so, how often are you finding problems? If you do not examine this area, why? Is it only important to treat if you have significant blockages in the Azygous?
I hope your symposium is a great success! Wish I could make it!

drsclafani · Post by **drsclafani** » Sun Jul 10, 2011 9:37 am

the internal jugular vein carries approximatly 375 ml per minuted out of the brain. the Azygous probably drains about 50-75 ml per minute. Add it up the cerebrospinal venous flow is about800-1000 ml per minute.

Each renal vein drains 500 ml per minute.
What 'speed' is sufficient??
If an ms-patient does not have ccsvi, but the jugs carries only f.e. 100ml/minute or the renal veins drains f.e. 100ml/mnute....is that a problem??

Firstly the likelihood of an MS patient having no venous obstruction is really low. my experience is about 0.5%

The outflow of veins toward the heart is based upon the inflow of the arteries from the heart If flow is as low as you described, either the veins are obstructed and there is collateral flow that is not being measured OR there is poor arterial input that is reducing the output

I don't know if you can measure the 'speed' of draining, but i was just wondering if slow draining without ccsvi could be a possible problem...

slow drainage is a sign of ccsvi

drsclafani · Post by **drsclafani** » Sun Jul 10, 2011 9:39 am

Donnchadh wrote:Dr. Sclafani:

Has anyone been treated for stenosis in the sigmoid sinus?

Donnchadh

yes there are many reports of stenting of dural sinuses in the literature. But none to my knowledge have been reported in patients with MS or other demyelinating diseases.
I have only been looking at these sinuses in a limited number of patients and havent seen any stenoses, and only one thrombosis.The most important finding i am noting is a prominent collateral vein going posteriorly

drsclafani · Post by **drsclafani** » Sun Jul 10, 2011 9:44 am

magoo wrote:
drsclafani wrote:
magoo wrote:What is the purpose for treating the renal veins?

As for the patient to patient questions, I'd like to know if anyone has had pain resolve in one area (such as headaches), only to experience new pain in another area after treatment?
the internal jugular vein carries approximatly 375 ml per minuted out of the brain. the Azygous probably drains about 50-75 ml per minute. Add it up the cerebrospinal venous flow is about800-1000 ml per minute.

Each renal vein drains 500 ml per minute.

obstruction of the renal vein means that about 500 ml of blood needs collateral blood flow. One of the important collateral veins is the hemiazygous which connects to the azygous. So if half of that blood went through the azygous, it would markedly increase the volume traversing that area. If two or three of the major cerebrospinal veins are occluded, you can see how the added drainage of renal venous flow through the cerebrospinal circulation is going to impact on ccsvi

does that help?
Yes, Dr. Scalfani, that does help. Thank you.
Another inquiry...Do you examine and treat this area, and if so, how often are you finding problems? If you do not examine this area, why? Is it only important to treat if you have significant blockages in the Azygous?
I hope your symposium is a great success! Wish I could make it!

initially i looked periodically or when azygous disease was noted but more recently i am looking at it routinely and am finding nutcracker more frequently. Yesterday i found one in a patient with bilateral jugular valvular stenoses and a normal azygous vein (but with a large hemiazygous vein making me suspect that i was going to find a nutcracker syndrome). I did find one and stented it. It will be interesting to see how the patient does after this treatment.

Ideally it would have been more interesting to treat only the jugular valvular stenoses. Then after three months go back and treat the renal vein obstruction. But I chose not to propose that to the patient.