DrSclafani answers some questions

[Johnson]

Dear Dr. Sclafani,

I would like to echo the appreciation of others, for your participation in this forum, and in treatment. My hat is off to you.

so my answer is rather philosophical.

... So i think the decision is about how far out into the frontier you want to travel. Me? I would venture forth and look for a solution to some future recurrence or complication when i see it

I tend that way myself, and I can't tell you how many times I've leapt from the pan to the fire, but once in the fire, the next leap is into the cool water, and then, I swim.

My over-arching questions about stents are;

Can they be removed, or do they become "endothelialized", and meld with the vessel? Do the veins, or surrounding tissues become calloused? Is that a problem?

Out of curiosity, is it possible that the low blood pressure that many with MS/CCSVI have is a metabolic reaction to the flow issues. IE: a higher blood pressure might start creating venous angiomae, are worse, arterial blowouts in the brain. Perhaps the hypothalamus is pressure sensitve, and drops the blood pressure - as in ICP.

No need to answer that last, it's just an extrapolation of ideas I have all the time.

[Hope66]

First, thank you so much for post here Dr S. It is truly appreciated.

My question relates to what you said in post your second post, namely:

"Dr. Zamboni’s theory makes a lot of sense to me and I think that others will come around to understanding his elegant and simple conceptIf you have resistance to outflow from the brain, you will develop reduction of inflow. Inflow to the brain is a good thing."

Specifically, could you please expand on the effects of the reduction of "in flow?" What effects could be/would be felt from a lack of in-flow? Could it be that the in-flow is just as an important piece of the puzzle as blocked drainage?

To TIMS, please forgive me if this issue has been discussed here before. If that is the case, kindly provide the links to me. If not, I would very much appreciate Dr S's reply.

be well all,
Hope

[cheerleader]

Hope-
Inflow means normal oxygenation. Here's a thread on hypoperfusion and slowed mean transit time in the MS brain to read until Dr. S checks back in. This has been noted in MS for years, and CCSVI gives us an explanation-

http://www.thisisms.com/ftopict-7708-hypoperfusion.html

cheer

[MS_mama]

Thanks for the replies, doctor, it is much appreciated. At the risk of sounding hostile--my intentions are good, I promise!--is there any way you can let us know with some certainty that you are indeed dr. Sclafani? The net is a crazy place and I would hate to see someone take the doctor's name and give their own answers, causing confusion.

[mshusband]

I spoke to Holly (via email) today ... she confirmed it is indeed them - her and Dr. Sclafani.

Just so you all know ... I was suspicious too ... but it is confirmed.

[Ruthless67]

Dr. Sclafani,

Or the “lunatic fringe from Brooklyn” I just had to include your description, lol. I would guess most of us here at Tim's could be referred to as "lunatic fringe MS patients", especially by the Canadian MS Societies! And like you said, we'll see who gets the last laugh here.

Thanks for your answer to my question. It's so hard sometimes to make these kinds of decisions. The only surgery I’ve ever had was an emergency surgery, never an elective one.

But in the case of MS, if correcting my valves could help stave off progression, this surgery is somewhere in the middle. That being the situation, I think I’ll call it “Absolutely Necessary” surgery.

I'm so looking forward to Dr. Dake's being able to begin his trials later this year as I have an opportunity to be a participant.

Thank you so much for being one of our "Pioneer" doctors when it comes to CCSVI, if I had a hat, I'd take it off for you. Instead, you have my greatest respect.

Respectfully,
Lora

[Vonna]

Hello,
Can someone please help me out? Is Dr. Mehta's office and Dr. Sclafani's office the same location? If not, what is Dr. Sclafani's contact information? I really appreciate it!
Lavonna

[tzootsi]

Hi Dr. Sclafani,

This is very exciting, having someone of your expertise responding to our questions.
My wife, who has mild ms, was checked with a doppler by our local IR. He quickly found some 'turbulence' in her left jugular. We are now waiting to hear back as to when he can do the procedure.
My wife has some concerns, her main one being - if ballooning is done on a stenosed vein and it has collaterals, we understand the collaterals will wither up. Then suppose a few months later the stenoses re-occurs. Since the collaterals are gone, would this make the blockage even worse than before the procedure?

thank you!

[drsclafani]

Specifically, could you please expand on the effects of the reduction of "in flow?" What effects could be/would be felt from a lack of in-flow? Could it be that the in-flow is just as an important piece of the puzzle as blocked drainage?

Consider the brain to be like a barrel with two openings.
take two hose and place them in the openingsl
push water into one hose and let it drain through the other hose
by regulating input and output you can get a steady state to keep the fluid in the barrel to the same level

now block the drainage.
eiither less water can go into the barrel or the barrel will explode.

in the body, if you reduce the amount of blood getting out of the skull, then the amount of blood that gets into the brain must be reduced.

Reducing the blood flow into the brain is a bad thing most of the times. Flow in the carotid and vertebral arteries is essential for brain life.


why? Because oxygen and nutrients get to the brain via the carotid arteries so reducing inflow to the brain leads to inadequate oxygen to the brain. that can lead to cell death or dysfunction.

[drsclafani]

Specifically, could you please expand on the effects of the reduction of "in flow?" What effects could be/would be felt from a lack of in-flow? Could it be that the in-flow is just as an important piece of the puzzle as blocked drainage?

Consider the brain to be like a barrel with two openings.
take two hose and place them in the openingsl
push water into one hose and let it drain through the other hose
by regulating input and output you can get a steady state to keep the fluid in the barrel to the same level

now block the drainage.
eiither less water can go into the barrel or the barrel will explode.

in the body, if you reduce the amount of blood getting out of the skull, then the amount of blood that gets into the brain must be reduced.

Reducing the blood flow into the brain is a bad thing most of the times. Flow in the carotid and vertebral arteries is essential for brain life.


why? Because oxygen and nutrients get to the brain via the carotid arteries so reducing inflow to the brain leads to inadequate oxygen to the brain. that can lead to cell death or dysfunction.

[drsclafani]

My wife has some concerns, her main one being - if ballooning is done on a stenosed vein and it has collaterals, we understand the collaterals will wither up. Then suppose a few months later the stenoses re-occurs. Since the collaterals are gone, would this make the blockage even worse than before the procedure?

You are on a highway. the road ahead is blocked by an accident. So you get off and take a service road around the accident. You are not the only one so the traffic on the service road grows.

then the accident is cleared and the road is clear sailing again.

the service road goes back to little traffic.

unless you permanently barricade the service road, it will again be used to bypass delays.

same with the veins. they will shrink but they generally will not evaporate

have a nice trip!

[drsclafani]

Hello,
Can someone please help me out? Is Dr. Mehta's office and Dr. Sclafani's office the same location? If not, what is Dr. Sclafani's contact information? I really appreciate it!
Lavonna

i have nothing to do with dr mehta, dont know him or live anywhere near him.

This keeps coming up. First i want to say that i started doing this because it seemed that you were asking questions and the answers didnt feel exactly right some times.

I am not doing this to grow my practice! I surely am busy enough I cannot answer personal patient related questions as that constitutes care, which i should not do on the internet.

you can reach our university practice via ccsviliberation@gmail.com.

[patientx]

Dr Sclafani:

I realize that you are being peppered with questions, but if I could ask one more...

In your original posting, you had written:

Imagine you had a flat soft hose and you ran a lot of water through it. It would distend and change shapes as it filled. If you slow the flow, the hose would partially collapse, perhaps becoming oval in shape.

The same thing happens to the jugular vein in CCSVI. Obstructions that increase resistance to drainage through the jugular veins drive the blood through the vertebral venous system. Thus as flow is reduced in the jugular vein it collapses and appears narrow.

In the absence of any pressure, the vein walls will collapse to their natural position. But in many of the venogram images, the jugular vein is obstructed in one particular location, caused by some external force, such as a bony protusion, malfunctioning valve, etc. These images still show blood flow above and below the narrowing. Shouldn't the image show no blood flow below the narrowing, if the vein was to collapse in the absence of any flow?

Also, if blood blow is being driven to the vetebral veins, in the presence of flow resistance in the jugulars, why is CCSVI a problem? Aren't the vetebral veins capable of handling this blood flow like when the person is supine?

Thanks in advance for reading these questions.

[drsclafani]

hanks for your answer to my question. It's so hard sometimes to make these kinds of decisions. The only surgery I’ve ever had was an emergency surgery, never an elective one

dear ruthless

i cringe whenever i hear anyone refer to the surgeries. This is as much standard surgery as a tuna fish sandwich is sushi

Did you notice that I never used the word cutting, scalpel, general anesthesia, blood loss, retractors or cautery. Did anyone hear transplant, excision, or anastomosis?

This procedure is performed through a needle the size of a safety pin without any cutting. As the wheelchair kamikaze said to me tonite, he cannot find the spot through which i placed my instruments.

So, while it is true that the dictionary defines surgery as the treatment of disease by instrumentation or manipulation, treatment of ccsvi is as much a surgical procedure as lighting a firecracker is a space launch.

[Ruthless67]

Dr. Sclafani,

My slip is showing, cause I know better, lol. Thanks for pointing that out.

Lora