DrSclafani answers some questions

[Cece]

Franz schelling thinks that the emissary veins, especially the condylar veins are very important. They may actually be strong contributors to ccsvi by driving venous blood back into the the head from the neck

I never thought of that. Once the jugulars are treated, would the condylar veins no longer be contributors in that way? There is still going to be occasional reflux such as valsalva. My first thought was that these veins could be treated with coil embolization which would get rid of them if sufficient flow was restored through other veins and these were a continuing problem. But it's hard to imagine wanting to get rid of a drainage route.

[ErikaSlovakia]

Franz schelling thinks that the emissary veins, especially the condylar veins are very important. They may actually be strong contributors to ccsvi by driving venous blood back into the the head from the neck

I never thought of that. Once the jugulars are treated, would the condylar veins no longer be contributors in that way? There is still going to be occasional reflux such as valsalva. My first thought was that these veins could be treated with coil embolization which would get rid of them if sufficient flow was restored through other veins and these were a continuing problem. But it's hard to imagine wanting to get rid of a drainage route.

It seems I might have this problem. My stent in LJV is patent but the drainage is very slow and when doctors do Doppler it looks there is something wrong. An angiologist in my little town does not understand why my blood goes back to brain as he says. My RJV looks normal. One red "highway" - artery and one nice clear blue "highway". However my invasive control venography in Poland wads negative. It was without IVUS and I do not think they checked veins in my brain. However, there are some not really normal conditions with my vessels in my brain -MRV (Haacke Protocol) schowed in Poland.
I plan to go for a CT venography in Slovakia in a month. Maybe we find something. They use the extra strong CT with contrast.
I still can walk but I feel miserable.
Erika

[HappyPoet]

Dr. Schelling's manuscript, "MS: The Image and its Message--The Meaning of the Classic Lesion Forms"
http://www.ms-info.net/evo/msmanu/839.htm
http://www.ms-info.net/ms_040504.pdf <---- download for reading/printing

Chapter V, "Lesion Explanation in Physical Terms"
http://www.ms-info.net/evo/msmanu/956.htm

My favorite part:

"Instead of speaking of clinically definite multiple sclerosis, it would be more adequate to speak of cases of unexplained neurological troubles in which the clinicians’ respectively neurologists’ diagnostic repertoire has been exhausted." [Chapter III-2: CDMS--Chronically Delusive Misidentification Syndrome (versus Clinically Definite Multiple Sclerosis)]

[NZer1]

I have been doing some reading lately on virus' that cross the BBB when there is back flows and there have been many references to the Herxheimer reaction. This from what I have read is common in other viruses as well.
If we have a leaky BBB and our CNS is effected/infected by '?' getting across the BBB there is also going to be other things such as immune system reactions and effects of things like amino acids that will kill or halt the cause of symptoms, sometimes brief and other times days.
I have always been fascinated by the episodic form of MS, I think its called RRMS, if stress exacerbates it there may be a reverse action happening, a Herxheimer reaction, where there is dead or dying 'things' that cause the symptoms as they cause cellular disruption as they are removed.
The action of N-Acetylcysteine, NAC in Chlamydophila pneumoniae, CPa virus is an example I have experienced.
" The NAC Test

One indirect indicator of chronic infection with this organism is the N-acetyl cysteine test. This relies on the ability of NAC to rupture the extracellular Elementary Body by opening up surface disulphide bonds in the organism’s geodesic coat, as described above. The EB opens and perishes. The release of naked bacterial components causes local inflammatory symptoms. Because EBs are more numerous in primary respiratory infections, the acellular load of EBs is likely to be highest around respiratory structures. In a positive NAC test the daily administration of 2.4 G of NAC will cause, after a few days, sinusitis-like symptoms, with watery mucous; also a cough productive of a clear, moderately viscous sputum. Systemic symptoms — 'NAC flu' — may also occur. If symptoms are severe, the dose of NAC may be cut down to 600mg and slowly built up as may be tolerated. Symptoms wane, sometimes quickly, after a few days if the chlamydial load is small; if the load is large they may continue for a month or more as the EBs are destroyed and their remains removed by the immune system. As far as I am aware, NAC is unlikely to produce die-off reactions with any other genus."

So my thinking is that we may be looking at some problems in MS back to front. CCSVI is possibly another where the BBB is being breached by the action of 'CCSVI issues' and the culprit causing symptoms may be something opportunist that travels only because of CCSVI. The culprit could vary from person to person as some may not be susceptible to CPa for instance and yet be effected by Lyme. And so on....
Everywhere around the body there is a blood barrier, what crosses this barrier that shouldn't and where it has its greatest negative effect is happening all the time. Having joint disease happens where the blood is allowing the culprit to cross into tissue from the arteries and veins. Heart disease is where there is weakness from various causes in the the vein and artery walls. Each disease has a point of access for its problem at a cellular level. Injury, wear and tear, physical damage etc.
So people with CCSVI are effected by their particular issue because that cellular issue crosses the BBB because of back flows allowing access to the CNS. People with out CCSVI have the same blood content, they don't have the mechanism to get the offenders across the try line.
So its Chicken or Egg, flow seems to win BUT once a virus, for instance, is across it will need to be eliminated before healing can occur. IMO
Regards , enjoy your Sunday,
Nigel

[blossom]

happypoet, very good post. seems dr. shelling's name for these symptoms someone named ms fits better.

[Cece]

Here is why talk of luxuriant vicarious drainage aka LVD came up. I had linked to this from July 2010:

andi
the theory of ccsvi postulates that there is resistance to drainage of the spine and brain. Luxuriant vicarious drainage (aaah, havent said it in a while) puts too much blood flow throught small veins in the spinal cord and brain. This leads to leakage or red blood cells and immune cells from those small blood vessels into the tissue. This in turn leads to demyelinization, iron deposits and damage to brain and spine.

PN asked how common luxuriant vicarious drainage is but I think it is going on in everyone who has CCSVI. Another word for luxuriant vicarious drainage would be collateral flow?

[NZer1]

LVD is happening everywhere around the body and yet there doesn't seem to be enough interest in the leakage into the CSN or CSF to get a new understanding of all diseases and de-generation!

Any thing that crosses the BBB, that shouldn't, will have a consequence to good health!

The reaction that happens in the CNS is possibly going to be different to other parts of the body where these same blood born cells are entering tissue.

Stop the leakage and also stop the cellular attack on the CNS.

[drsclafani]

I had an MRI of the spine recently that revealed 4 small MS plaques on the cervical spinal cord. Are MS lesions on the spinal cord associated with CCSVI? If so would it be the azygous vein that's involved? Maybe you've discussed this before but I don't remember.

spinal lesions are associated with shear stresses on the spinal cord. They are not the same as the lesions in the brain, according to dr Schelling, whom I must say is a most brilliant and wonderful man. We do not speak enough about him and his ideas here and elsewhere. This is not the post to do so,, but i am trying to collect my thoughts about h is ideas of spinal lesions. They are different but are associated with ccsvi. The entire spinal cord has an interconnected venous circuit. from vertebral veins to azygous to ascending lumbar to left kidney

Hi Doc,

Spinal cord, renal, azygous, lumbar.......PPMS patients have spinal lesions....is the idea right that PPMS patients 'should have' narrowings in the mentioned veins??
For me (PPMS), i still feel much better after my treatment in Poland in March 2010 (LJ valve). But walking still got worse, some tremors, stiffness. Makes me wonder if these veins have narrowings (May 2011 my azygous was balllooned in Belgium)

And...is the vein 'list' complete?? Or do you think that more veins with correlation to ccsvi will be added i???

Rgds,

Robert

Spinal cord lesions are present in many patients with all types of MS. in ccsvi theory spinal lesions are thought to require distension of the spinal venous bed. This can occur by obstruction of the jugular veins, the azygous or hemiazygous vein, the ascending lumbar vein or the vertebral veins. Flow from within this system may be augmented by added flow from collaterals due to renal vein obstruction, or even left common iliac vein obsruction.

This story keeps getting refined. We are a long way from clarity or surety about the extent of the impact of venous problems

[drsclafani]

I found it interesting that some neurologists looked at cog fog and fatigue as signs of depression rather than actual symptoms

i learned that neurologists see patient symptoms are varying quite a bit, that symptoms can be there one day and gone the next, that symptoms can be different during morning and evening. I wished I had a year to do some learning of neurology

When I was diagnosed in 1989, my doctor asked me to keep a journal of my symptoms. He was surprised to see that it was so thorough, broken down by body part (left arm, right leg, etc.) and by symptom (stiffness, tingling, etc.). He had no explanation for why these symptoms changed in less than 20 minute intervals all day long.

In 2010, my neurologist (head of MS at a major university hospital) looked at the images from from my venogram and said that I didn't have MS ever. Unfortunately, the procedure did not relieve my symptoms.

Given that my symptoms also change based on position, I think that there is something somewhere that acts like a plug in a bathtub. It's usually blocking the drainage, but sometimes, it swings out of place and everything works perfectly - for the few seconds or minutes before it drops back into its former position.

Now if only there was a better way to find that pesky (but flexible) bit of tissue. I think the catheter used during the procedure just pushed it aside thereby making it "invisible".

Since the vast majority of doctors don't use IVUS, Dr. Sclafani, if you didn't have IVUS, what technique would you use to find such a movable target?

Rosegirl, not sure that i understand or fully agree with your suggestion. I do not think everything is related to veins. there are many factors at play. what you postulate is also a factor but i think it might be really uncommon

sorry this hasnt worked for you

[drsclafani]

Some learned and esteemed physicians do not even think it is an insufficiency

Hypertension instead of insufficiency?
Do you think it is an insufficiency?

i do not think that insufficiency is a perfect word for this. insufficiency usually means valves that are incapable of preventing retrograde flow.

I think we are starting to thing a better word is necessary

[drsclafani]

other news, new IVUS unit will have 5 times the resolution, and be able to compete with optical computed tomography. resolution will be on order of 25 microns. a red blood cell is 6 microns!

Oh!! Is there any opportunity for you to get such a unit?

Yes, later in the year. I am hopeful that this will show abnormal veins before they thicken. I think that is why some patients with CIS and RIS and early MS do not have abnormal valves on IVUS or sonography. the valve is just too thin..Just conjecture

[mo_en]

Dr S,
I remember you once mentioned that your IVUS unit can support catheters for pressure gradient measurement. Dr.Schelling has proposed such measurements in jugular bulbs, inferior and superior vena cava as alternative/assisting method for diagnosis of flow problems. Do you consider using these catheters in the future?

[Cece]

other news, new IVUS unit will have 5 times the resolution, and be able to compete with optical computed tomography. resolution will be on order of 25 microns. a red blood cell is 6 microns!

Oh!! Is there any opportunity for you to get such a unit?

Yes, later in the year. I am hopeful that this will show abnormal veins before they thicken. I think that is why some patients with CIS and RIS and early MS do not have abnormal valves on IVUS or sonography. the valve is just too thin..Just conjecture

I have thought the abnormality was that they were thickened. The valve might be thin but fixed in place and not working? There should still be flow effects that would show up on flouroscopy but then again there are stenoses only visible on ivus whose flow effects aren't showing up on flouroscopy so this would be the same. Not visible on ivus because it's too thin. Yes, I am curious to see if this will be found, and hopeful that it will be of especial use to people with early MS or CIS or...RIS?
http://www.medscape.com/viewarticle/585254
Looks like RIS is Radiologically Isolated Syndrome, when asymptomatic patients have MRI lesions highly suggestive of MS.

It might also show the development of CCSVI from less severe to more severe as it thickens, which might then contribute to the development of MS. A very interesting question to explore. It also would be nice to get some close-ups of webs and septums with New IVUS!

[drsclafani]

Dr S,
I remember you once mentioned that your IVUS unit can support catheters for pressure gradient measurement. Dr.Schelling has proposed such measurements in jugular bulbs, inferior and superior vena cava as alternative/assisting method for diagnosis of flow problems. Do you consider using these catheters in the future?

yes, but as a pure research tool, i do not want to increase fees to patients. Thus I am looking for some funding: these catheters are very expensive

[Cece]

Dr S,
I remember you once mentioned that your IVUS unit can support catheters for pressure gradient measurement. Dr.Schelling has proposed such measurements in jugular bulbs, inferior and superior vena cava as alternative/assisting method for diagnosis of flow problems. Do you consider using these catheters in the future?

yes, but as a pure research tool, i do not want to increase fees to patients. Thus I am looking for some funding: these catheters are very expensive

Would this be fractional flow reserve measurements (FFR) or something different?
Best wishes with obtaining funding! It certainly is deserving of funding.