DrSclafani answers some questions

[pelopidas]

So the question is, is angioplasty the only way to achieve "pressure release"?

Diamox is used for glaucoma and idiopathic intracranial hypertension and chiari malformation. It may be useful for resistant CCSVI but no research has been done. I am not sure if pressure release means the same as relief from venous congestion in the muscles of the eye and iris. For venous congestion, there is leech therapy.... http://books.google.com/books?id=BXWqJT ... &q&f=false But the proposed venous congestion is secondary to the extracranial outflow obstructions. Treating the outflow obstructions should treat the venous congestion of the neck muscles or eye muscles.

Eye's pressure symptoms are typically eye pain, blurred vision, headaches.
I think that CCSVI contributes more to eye's muscles congestion than ocular hypertension.
For example, diplopia could only be the result of extraocular muscles malfunctioning.
There is a possible mechanism: the two opthalmic veins of each eye bulb drain right to the cavernous sinus.

(welcome back, Cece!)

[NZer1]

So what are tests that are used to prove that 'pressure' is the issue.

It could be 'pressure' or it could be low pressure due to bypassing or the flow circuit is increased because of flow issues elsewhere. This is such a complex system within the Cranial vault, there are multiple regions with different pressures and different flows, different bypasses and regions of common flows, it's too complicated to guess and experiment by using drugs or theories that have no basis or tracking methods.

Treat when you know what is wrong! Stop guessing and muddying the waters!

Assume if you must, but stay focussed on the issue! What's causing the symptoms and why! It's no different to fault testing in your car or computer, do you want to fix it or mask it and cause more damage and dysfunction.

Nigel

[Squeakycat]

The main point of this post was that there is a possibility of reducing venous hypertension with Vitamin D which controls the production of the vasodilator , NO.

Off topic so moved here.

[NZer1]

Thanks Ed,
the other important detail with Vit D is that it is a vital element when the Immune System is developing, that is to say, studies have shown the Mothers Vit D level is very important from conception to birth and from birth onwards it is also required to complete the development over years, so therefore the individuals supply of Vit D is also important during the earliest time of Life.

Gards,
Nigel

[EJC]

Assume if you must, but stay focussed on the issue! What's causing the symptoms and why! It's no different to fault testing in your car or computer, do you want to fix it or mask it and cause more damage and dysfunction.

Nigel

You think along the same lines as myself - this is exactly what I say to the Doc. If Emma were a car - they would be "pulling fuses" until the problem was isolated then address the issue.

Why do all the symptoms automatically become attributed to "oh it's your MS"...can't we please take a look at them individually to see if the symptom can tell us something?

[Squeakycat]

Thanks Ed,
the other important detail with Vit D is that it is a vital element when the Immune System is developing, that is to say, studies have shown the Mothers Vit D level is very important from conception to birth and from birth onwards it is also required to complete the development over years, so therefore the individuals supply of Vit D is also important during the earliest time of Life.

Gards,
Nigel

Nigel,

More to the point here is that regulatory hormone Vitamin D is what controls the development and final differentiation of veins. So with studies already showing high levels of vitD deficiency in mothers during fetal development, is it any wonder that there are congenital venous malformations?

PS All of Kiwi Land is south of the 34th Parallel which means low levels of UVB during a good part of the year, except now.

[CureOrBust]

please lets get back on topic or start a new thread.

[Squeakycat]

please lets get back on topic or start a new thread.

Cure, agree completely. There is already a fairly robust discussion of Vitamin D here.

The relevance here was simply to answer EJC's question: "So the question is, is angioplasty the only way to achieve "pressure release"?"

And since it may have already gotten lost, the answer is that since Vitamin D controls the main process by which vein dilation is controlled through the release of NO, this suggests that ensuring adequate levels of VitD may help in this regard.

[NZer1]

please lets get back on topic or start a new thread.

Cure, agree completely. There is already a fairly robust discussion of Vitamin D here.

The relevance here was simply to answer EJC's question: "So the question is, is angioplasty the only way to achieve "pressure release"?"

And since it may have already gotten lost, the answer is that since Vitamin D controls the main process by which vein dilation is controlled through the release of NO, this suggests that ensuring adequate levels of VitD may help in this regard.

Thanks Ed, I must have been looking with my Neurologist (auto-immune) eyes and instead should have been listening with my student ears! I guess Chiropractic inferences get the same treatment.

One more fine point about Vit D is that it is required for the trigger of Apoptosis and therefore low levels and other blocking issues of Vit D access to cells will mean that cells are not dying and replacing at the Natural time.

So I would imagine that not only is the Vein dilation process an issue, the ageing cells are not functioning as they should to enable eg Vein Dilation? Vein Malformations? Valve thickening? Unusual Webs and Septums? Infections of Vascular Systems caused by Under developed and faulty Immune Systems? Vein Wall health and function issues?

I wonder whether there is a link with Vit D and Collagen (types and transforming process) as well?

From Summer down Under where the Sun is meant to Shine,
Nigel

[1eye]

I'm with you all here.

The only logical explanation for the instant improvements in sight are pressure release. Nothing else could provide that reaction?

So the question is, is angioplasty the only way to achieve "pressure release"

I think I heard even the ancient Egyptians effected pressure release by drilling holes in the skull. This has been repeated at later times, and may have been done even before that. The modern procedures for hydrocephalus (normal pressure and other) relieve CSF pressure.

[NZer1]

I'm with you all here.

The only logical explanation for the instant improvements in sight are pressure release. Nothing else could provide that reaction?

So the question is, is angioplasty the only way to achieve "pressure release"

I think I heard even the ancient Egyptians effected pressure release by drilling holes in the skull. This has been repeated at later times, and may have been done even before that. The modern procedures for hydrocephalus (normal pressure and other) relieve CSF pressure.

Do we know what the pressure should be?
The pressures throughout the Skull Cavity are different depending on region and there is the added issue when there are lesions and tumours disrupting the flow paths plus all the other results from impacts and the disrupted flows of CSF caused by Vascular flows altering the CSF pressures.

Mine field!
Where do you look first, there is no Manuel or Research results (Peer reviewed of course) to consult!

Go with flow and measure it!
Nigel

[drsclafani]

i have been busy with holidays. Will respond to all these posts and give my viewpoint as soon as possible, probably this weekend
S

[milesap]

Maybe worth a read!
http://www.hindawi.com/journals/ad/2012/160830/

[drsclafani]

http://www.erinelster.com/files/jvsr%20 ... d%2081.pdf

I was one of the subjects in this study by Dr. Elster. I do not agree that my problems should be attributed to the disagreement I had with that horse many years ago, but I do strongly support the hypothesis that the misaligned C1/C2 was impinging on the jugular vein and contributing to the MS symptoms. Fortunately, the stent that Dr. Sclafani placed in that jugular seems to have resolved the problem so I no longer need the upper cervical treatments. That is even more fortunate because Dr. Elster has sold her practice and moved on, plus she would no longer treat me with the stent in place. I hope you will comment on the paper, Dr. S. It has been eleven months since you treated me and everything is great. Great thanks for choosing this route.

Thanks for the followup. And congratulations on successful durable treatment.

Let's review this case. notadoc is a man with relapsing remitting MS for about 12 years, first symptoms being vertigo and ON. Symptoms at presentation included migraines, life style limting fatigue, difficulties with concentration, vertigo, imbalance, tinnitus, numbness and neuopathy on both fee, fingrs and lower legs, temperature intolerance, weakness in legs and neck with spasticity, urinary dysfunction.

He received treatment on October 2010 at another institution with positive results that gradually regressed after six months of benefits. the next six months.

I treated notodoc in January 27, 2012. Let me show the images of the procedure.

right IJV


There was high grade stenosis of the right IJV at the confluens. IVUS shows that this is caused by immobile valves and it was treated with a large balloon angioplasty with about 22 atmospheres of pressure. as you can see by ivus and by venography, treatment was successful with a wide open jugular vein.

Left IJV


image #1 shows tremendous reflux through numerous emissary veins that drain into the posterior cervical vein. A high grade stenosis at the second cervical vertebra narrowed the vein to less than 2 mm diameter. Flexion/extension, and rotation imaging with IVUS did not show any improvement in luminal area.
image #2 showed those cervical collaterals draining slowly and also showed reflux in pharyngeal veins. A typical valvulare stenosis was seen in the lower J1 segment on both ivus and catheter venography. . I was quite surprised that the apparently large diameter of he middle of the jugular vein actually was an early division into a facial vein and the internal jugular vein. This is important if you do not perform ivus because one could easilyil oversize the balloon based on the apperently large IJV on image #2

Without performing a catheterization of the dural sinus ()image 1), the interventionalist would have missed this upper jugular lesion.

Left IJV treatments



Angioplasty of the J1 segment was pretty good (see image 3). However in the same image one sees collaterals refluxing in image 3 (red arrow). Also look at the dilated subclavian vein to the right of the IJV on image 3, suggesting that there was obstruction in the brachiocephalic vein. Image 4 shows a narrowing in the brachiocephalic vein. We treated that with angioplasty too.

Left J3 treatment



here the focus is on the J3 segment stenosis. It is not located at the skull base, but more inferiorly. I didnt recognize any subluxations on my images. This stenosis is usually caused by a compression and treatment is usually not successful. I haven't put many stents in but I have treated several patients who have had problems with stents placed by others. Problems include migration, kinking, fracture, intimal hyperplasia. I havent seen a thrombosis yet. The details are a bit murky now but i think i treated by stenting because the usual angioplasty of the valves did not result in better flow. After stent placement (see image 3) there is no reflux in the emissary veins and the stenosis is no longer present.

azygos treated too.

Venography did not see a problem but ivus revealed a thickened valvular stenosis in the azygous arch

[NZer1]

Thanks Dr S.
What do you think is happening with the study of Dr Rosa and the Atlas adjustments?

Is it a case of method of testing is producing the outcome they want to find?

Is it more likely a muscular issue than a bone issue?

Is testing in various positions (as you do) going to show different findings to what Dr Rosa is seeing?

The Franz Schelling discussions on back jets talks about blood and or CSF flow that accelerates back to the brain because of fixed as well as positional stenosis plus a scenario of physically causing back flow such as Vasalva action.
My understanding of that is that the breach of the BBB occurs in some instances because of body position and self generated back pressure on the Veins or CSF and that can be very short lived, the damage occurring is brief and the issues of Grey and or White lesions are caused by inflammation and following Immune System activation and clean up causes the 'MS' symptomatology and disease processes. This happening in a relapse/remit fashion whereas the continuous progression form of 'MS' is more related to the ongoing effects of a fixed vascular stenosis and reflux process that as 'regularly' breaching the BBB and creating more continuous inflammation and white and grey matter damage.

I guess more time will be needed to scrutinise the Dr Rosa findings when more detail becomes available for critiquing ;)

Hope you made some head space and Family time over the end of the Year period Dr S!

Regards,
Nigel