DrSclafani answers some questions

[NZer1]

Hi Dr is the device that is used for testing oxygen saturation that is clipped to a finger or toe usable for clipping onto an ear?

I had my BP, blood sugar, and saturation checked yesterday as I am at a low at the moment and asked the nurse to try the clip on my ear. 99% on fingers and 82% when clipped to an ear?

Has anyone access to one of these who could experiment and let me know what you find please.

Regards Nigel

[drsclafani]

Hi Dr is the device that is used for testing oxygen saturation that is clipped to a finger or toe usable for clipping onto an ear?

I had my BP, blood sugar, and saturation checked yesterday as I am at a low at the moment and asked the nurse to try the clip on my ear. 99% on fingers and 82% when clipped to an ear?

Has anyone access to one of these who could experiment and let me know what you find please.

Regards Nigel

why did you want it on the ear?

if you had a measurement on your finger of 99% and it went to 82% on your ear, you obviously didnt have a good fit to your ear, or that diamond was getting in the way

[NZer1]

Possibly, we spent time getting readings and did it several times as I'm a fussy bastard. I am of the view that the blood in the hand and blood in the ear are from two separate pathways.
The brain blood does not has not traveled through the hand and vice versa.
So my logic is that the saturation difference, if I understand what saturation means, is different around the body due to separate in and outflows for the regions and limbs etc?

Does this make any sense?

I am wanting to know why I have become so depleted of energy, brain power etc in a short space of time, about seven to ten days. This is unusual for a PPMS person and the change is very noticeable like having low blood sugar or low BP, in fact both together, plus sleep issues are up and general discomfort/pain, difficulty doing my daily exercise routine which I have been doing for ever. And no I haven't had PTA yet!

Regards Nigel

[Cece]

nah, nigel wears his diamonds on the soles of his shoes.

Hope you feel better. And that PTA becomes a possibility.

[drsclafani]

Possibly, we spent time getting readings and did it several times as I'm a fussy bastard. I am of the view that the blood in the hand and blood in the ear are from two separate pathways.
The brain blood does not has not traveled through the hand and vice versa.
So my logic is that the saturation difference, if I understand what saturation means, is different around the body due to separate in and outflows for the regions and limbs etc?

Does this make any sense?

I am wanting to know why I have become so depleted of energy, brain power etc in a short space of time, about seven to ten days. This is unusual for a PPMS person and the change is very noticeable like having low blood sugar or low BP, in fact both together, plus sleep issues are up and general discomfort/pain, difficulty doing my daily exercise routine which I have been doing for ever. And no I haven't had PTA yet!

Regards Nigel

i see, you postulate that the vein in your ear is desaturated compared to your hand. is that because the flow is slower through the neck (read ear) than the arm. That is interesting possibility, that slow flow increase oxygen extraction.

I will check on a few patients nigel to see if this is duplicated.

in the meantime, why not repeat your experiment several times to see whether it is reproducible.

and you surely are a diamond in the rough

[NZer1]

Well caught Dr, Hi Cece.
Its Saturday here of a long weekend so when the world of the working restart I will ask at my GP's Centre if I can have a play with their toys. I know the Administration Manager of the Practice so I think I will be able to play with their equipment. My GP has recently left the practice and I haven't met his replacement yet.
Roughly Nigel

[msfire]

Dr.S
You fixed my plumbing in August this past year, we spoke about the procedure and how confident you were on your technique. I know this is a constant learning process and things change rapidly. The question I have for you Doc is one that I am asked every time I speak with someone who has CCSVI and is considering the procedure. What percentage roughly in your opinion is there of patients becoming worse after the "liberation" treatment. Please excuse me Doc because I am no where near the ballpark in regards to medical know how.

[NZer1]

"Pulse oximetry
From Wikipedia, the free encyclopedia

A finger mounted pulse oximeter taking measurement through the fingernail.

A wrist mounted remote sensor pulse oximeter with plethysmogram.
Pulse oximetry is a non-invasive method allowing the monitoring of the oxygenation of a patient's hemoglobin.
A sensor is placed on a thin part of the patient's body, usually a fingertip or earlobe, or in the case of an infant, across a foot. Light of two different wavelengths is passed through the patient to a photodetector. The changing absorbance at each of the wavelengths is measured, allowing determination of the absorbances due to the pulsing arterial blood alone, excluding venous blood, skin, bone, muscle, fat, and (in most cases) fingernail polish.[1]. With NIRS it is possible to measure both oxygenated and deoxygenated hemoglobin on a periperhal scale (possible on both brain and muscle)."

So far I haven't found much info on what is to be expected as a reading from various body positions.

[Cece]

Venous congestion, particularly when caused by tricuspid regurgitation, may produce venous pulsations which may produce low readings with ear probes.

http://www.nda.ox.ac.uk/wfsa/html/u05/u05_003.htm
http://www.oximeter.org/pulseox/lim_venous.htm
http://www.springerlink.com/content/q387524121462516/

Central venous pulsations associated with a falsely low oxygen saturation measured by pulse oximetry

But would the flow effects of CCSVI be comparable to that of central venous pulsations or tricuspid heart regurgitation, enough to register and interfere wth an ear oximeter?

[NZer1]

Thank you so much Cece. Once again you have given soo much to the think tank.

After reading these articles I am of the opinion that there is grey areas with results. The bottom line is that there are circumstances like CCSVI that cause readings that are of concern!

Doubled checking the equipment and fitting seems to still indicate that there is reason for further assessment of what is happening for the patient, IMO as always!

Thanks Cece,
Nigel

[mtf]

Hi Dr. S,

I just had my 5th treatment last week. Bynow, I do have my left jugular (with stent) trombosed and the Doc. couldn´t go in and clear the trombus. The right one (with another stent) was again opended.

What to do now? What is your advice?

TThanks

[drsclafani]

Dr.S
You fixed my plumbing in August this past year, we spoke about the procedure and how confident you were on your technique. I know this is a constant learning process and things change rapidly. The question I have for you Doc is one that I am asked every time I speak with someone who has CCSVI and is considering the procedure. What percentage roughly in your opinion is there of patients becoming worse after the "liberation" treatment. Please excuse me Doc because I am no where near the ballpark in regards to medical know how.

0

Dr.S
You fixed my plumbing in August this past year, we spoke about the procedure and how confident you were on your technique. I know this is a constant learning process and things change rapidly. The question I have for you Doc is one that I am asked every time I speak with someone who has CCSVI and is considering the procedure. What percentage roughly in your opinion is there of patients becoming worse after the "liberation" treatment. Please excuse me Doc because I am no where near the ballpark in regards to medical know how.

msfire, I am going to give you my impressions since mid-April 2011 when I determined that my technique had been largely optimized. Outcomes were difficult to understand during the learning curve. Still tweaking, I would say it is no longer about technique, but rather interpretations and judgments that continue to enhance.

I can give you an estimate, perhaps 1% truly deteriorate significantly. Were some of those patients who were already in exacerbations when we started? yes i think so. were there others who had a prolonged recovery from medications, anticoagulation, etc? Yes I think so. Is it possible that some patients react to the acute obstructions of angioplasty by extreme reflux that might cause an exacerbation. I believe this is also true. Do patients stop their DMD and perhaps relapse because of that? another possibility.Oviously, some patients never get any improvements. What does that mean?

But if you are asking me how often someone deteriorates and keeps going downhill. I would say it is very uncommon perhaps about 1.5%

t it is based upon patient discussions and monthly email reports. Unfortunately not all of my patients provide me with followup, even when solicited. Hard to tell whether the ones who abandon m e are doing so because they are feeling better, or feeling worse, or just didnt get any improvements

[drsclafani]

Hi Dr. S,

I just had my 5th treatment last week. Bynow, I do have my left jugular (with stent) trombosed and the Doc. couldn´t go in and clear the trombus. The right one (with another stent) was again opended.

What to do now? What is your advice?

TThanks

Dear mtf

you must have started this a long time ago.
The loss of a jugular vein is tragic. It should be pretty uncommonly occuring now. I would expect that most experienced IRs have found their "sweet spot" in terms of how they manage their venoplasties. It takes about 50-75 cases to reach that level of confidence. I was told by Dr zamboni's IR, Roberto Galleoti, that it took him 50 cases before he was comfortable, and he was a seasoned IR. I was surprised, but have now come to believe that that is a low number. I would recommend that any patient choose someone who has treated at least 75 patients. You on the other hand are so complicated, that you should only go to someone who has ever more experience. You are complicated because, with the loss of one jugular vein (not unexpectedly, the left whichis more commonly injured during angioplasty), you have to be extra careful not to sustain any further injuries.

So I can only give you a theoretical approach because i don't know you, your medical history, or the state of your MS). If you have had good relief from venoplasty and things are stable, I would leave well enough alone and focus on maintaining the flow in the stented right IJV. This would include periodic ultrasound examination to determine whether intimal hyperplasia is narrowing the lumen of the vein, antiplatelet therapy and possibly anticoagulation depending upon the state of that stented vein.

If you had benefits that left you and you want to explore possible improvements, then I would explore the remaining veins that you have to assure yourself that all are opened satisfactorily. Iwould also make sure to look at the secondary veins like the left iliac vein and the left renal vein because if they are obstructed they can augment low within the cerebrospinal venous circuits, something you cannot tolerate as well because your left jugular vein is obstructed. If there were any lesions, i would treat very carefully

If you had no improvements and no deteriorations, i would defer further treatments and just keep the improvements you had.

There are some who are attempting to open completely thrombosed veins by laser and other techniques. With a clotted stent i would consider such a procedure as long as my patient understood the risks of such procedures that include burning into adjacent structures such as the carotid artery or the subclavian or innominate artery or vein. In some circumstances such risk would be reasonable. That would require a great deal more information and a serious relationship with my patient.

Hope this helps

DrSclafani

[mtf]

Thanks Dr. S. for your advice.

My left iliac vein was stented too last year and is flowing well. Really don't know what to do now, but I think I have to wait and see what to do.

[drsclafani]

Thanks Dr. S. for your advice.

My left iliac vein was stented too last year and is flowing well. Really don't know what to do now, but I think I have to wait and see what to do.

metalmania

was your renal vein inspected