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I understand your frustration. I have been looking at this for thirty years now. Researchers are just waking up to the important role of the spinal canal in cranial hydrodynamics. That's ancient history to me. There is much more to discover about regional hydrodynamics. There is no need to continue at the current snails pace. Patients with neurodegenerative conditions don't have time to wait. The science and technology are here now and have been well tested. The science and technology just need to be applied and we don't need a lot of research to get started either. Most methods I have suggested are highly plausible and backed by a great deal of science. They also have proven clinical efficacy. More importantly, they have low morbidity. Treatment and ongoing research to improve the science, technology and treatment can be done simultaneosly.

FYI, from next door on Dr. S's thread,

NZer1 wrote:
Thank you for telling us about this Dr S.

I have a question that has come up on Dr F's thread about disc bulges and their effect on the Vascular system. It is becoming quite common to hear of the co-incidence of trauma, injury and Spine Alignment in PwMS, me included.

I am wondering if there has been any indications that you have seen where the disc bulges are associated with vein stenosis.

For me personally I am of the belief that the jugs are involved with CCSVI, but, there is more to learn about the veins used when Upright in the incidence of MS and other de-generative diseases. We are Upright for so much more of our time and we are active and creating opportunity for things like reflux to occur whether because of body position and vein compression or from malformation issues etc.
I guess you hear this often enough, the question is, has your imaging shown issues like we are starting to see from the use of Upright MRI.

Regards,
Nigel

Edited.
I am thinking that the flow in the VV's is impacted by these issues

Dr. S's reply
NIGEL
With IVUS we get a marvelous phasic view of the jugular veins. I am not seeing compression very often except at the midline in front of the C1-2 space. I have found that this compression is phasic, that with flexion of the neck, flow is improved, same with rotation. I am not convinced that these phasic narrowings need to be treated. afterall, flow in the inferior vena cava is phasic, same with many other veins. It is a very difficult proposition to prove that treatment of a phasic phenomenon will improve clinical symptoms.

i havent seen many abnormal vertebral veins. i dont get the sense that this is a major problem.

_________________
Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com

NZer1,

You've probably already read this but thought I'd post it in case you hadn't.
http://www.upright-health.com/vertebral-veins.html

Has Dr. S actually closely examined all VVs while diagnosing CCSVI or is it more of an "I didn't notice anything" kind of thing because that isn't where CCSVI is diagnoses/treated?

It's not about the vertebral veins Nigel. It is about cranial hydrodynamics in which the vertebral veins and subarachnoid space play an important role. Spondylosis, stenosis and scoliosis effect the design and dimensions of the spinal canal. The epidural space contains the vertebral veins. It is impossible for spondylosis, stenosis and scoliosis not to effect flow through the vertebral veins the same as narrowing, mineral deposits and bends effect flow through pipes. Spondylosis, stenosis and scoliosis aren't phasic either. Nor is it difficult to prove that treatment of spondylosis, stenosis and scoliosis can improve clinical symptoms. Surgical correction of the spine has a long history of showing clinical improvement. Basic orthopedic and neurological tests, EMGs, MRIs etc., can also prove clinical effectiveness.

Thank you both, I guess my question was purely to open discussion more than anything.

Dr F I understand what you are saying and that is why I have asked before about testing methods/visualisation in the past. If enough people begin to understand the dynamics we will see some innovations in test priorities.
I understand it as being a test procedure that at least requires the vertebral flow and the total blood flow (jugs, azygos etc, etc) out of the brain compared with the CSF flow patterns, not a just static test, it would need to be over time and in various body positions to get an understanding of the individuals structure.

Dr F, I saw John Funnell again today and it is interesting to hear his views on what Chiropractic adjustments are doing for our Health. The old model of its all electrical is stuck. I did get a chance this time to talk about your knowledge and Dr Rosa's work (for about the 10th time). This time I think I may have been able to explain myself better purely because your knowledge has rubbed off.
I am going back again next week so I will whittle away some more!

John's opinion on the noises from my spine is that it is Calcium build ups that 'could' be seen on Xrays as columns of deposits that collect on the sides of the vertebra in a vertical sense? and the noises are caused by the discs needing to spread further to ride over the build up. I think I understood him by writing what he said? Not sure, sounds like he is saying the disc is being drawn apart to cause the noises?

Regards,
Nigel

Nigel,
Cine upright MRI can be used to show flow in the vertebral veins and is more accurate than IVUS. Upright Cine MRI of blood and CSF flow is just getting started but from the little I have seen so far it shows that upper cervical misalignments do effect blood and CSF flow. It has also shown that spondylosis effects flow. It's hard to imagine how it couldn't.

I don't understand your chiropractor's explanation of the "noises" in your spine. As I have explained many times, there are several causes of noise in the spine such as poorly lubricated dry or inflammed joints, cavitation of gases in synovial joints, or connective tissues that snap upon movement as they rub over boney prominences such as tubercles. Bone spurs on the spine are deep and not likely to be heard. The synovial joints, paraspinal muscles and connective tissues of the spine are close to the surface and can be easily heard and palpated.

just wanted to share with you the results of my upright-mri this week in Hannover/Germany at Dr. Schulze's Office.
The whole examination took more than one hour, I had to sit still inside the machine (Fonar machine),
which was a little exhausting. The operator asked me during the examination if I had headache and told
me that I would have to see another doctor, I found out why later.

After the examination disussion of the findings with Dr. Schulze, as far as I understood everything looks
normal, no instable neck joint, no limitation of movement.

As suggested by Dr. Flanagan I insisted on taking images during flexion and extension (image series 13+14),
also here no problems (Dr. Flanagan, can I ask you to have a look at the images, Thank you).

I have translated the whole letter, its right underneath this text + I have posted the images on ImageShack

However, as a secondary finding they found a new lesion in the back of my brain on the left side (image serie 6)
Another mri will be performed on friday in order to further investigate this finding.

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Magnetic resonance imaging of the skullbase with regard to the cervico-ocipital junction and functional
imaging during antereflexion and hyperextension of the cervical spine.


Technique used

Neutral position (upright sitting)
following sequences were performed:
coronar T1-weighted Spin-eco in thin-layer-technique
axial T2-weighted fast-spin-echo in thin-layer-technique
sagittal proton-weighted in thin-layer-technique
coronar fatt-suppressed in thin-layer-technique
paracoronar right T1-weighted Spin-eco in thin-layer-technique
paracoronar left T1-weighted Spin-eco in thin-layer-technique

Upright-MRI functional examination, weight load natural (own weight)

lateral tilting (sitting position)
following sequences were performed:
tilting to right
coronar T1-weighted Spin-eco in thin-layer-technique
tilting to left
coronar T1-weighted Spin-eco in thin-layer-technique

rotation (sitting position)
following sequences were performed:
clockwise (right) rotation
axial T2-weighted fast-spin-echo n thin-layer-technique
counterclockwise rotation
axial T2-weighted fast-spin-echo n thin-layer-technique


Findings
1. Midsize dens in the coronar & sagittal sectional plane.
Normal distance between the top of the dens and the front atlas arch.
Normal distance between the dens and the posterior arch of the atlas.
Normal myelon.

2. No pathological findings in the area of the C0/C1 and C1/C2 joints.
Normal membrana tectoria, ligamentum apicis dentis, ligamente atlantookzipitalis posterior.

3. fatt-supressed coronar: no signs of water-accumulation in the area of the top of the dens

4. Ligamentum transversum intact and bold.
The subarachnoid buffer between ligamentum transverum and the meylon measures 2mm and is therefor
slightly constricted, no meylon-contact.
Normal arteria vertebralis on both sides.

5. Sufficient swinging on both sides when tilted to the side as well when rotated.
When rotated no further constriction of the buffer between ligamentum transverum and the meylon.
Physiological position of the dens when tilted to the side.

6. no suspicious alteration during antereflexion and hyperextension.


Evaluation
Constriction of the subarachnoid buffer between ligamentum and the meylon but no signs of meylon contact,
same is true when rotated.
Bold ligamentum transversum.
No signs of instability in the area of the cervico-ocipital junction.

Secondary finding: In the sagittal PD evidence of a suspecious round lesion (ca. 2,5cm diamater), which needs
to be further investigated.

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Serie 1 FLEXSIT SagT2FSE (13 Images)



Serie 2 AxiT2FSE_duenn (13 Images)


Serie 3 CorT1SE_duenn (13 Images)


Serie 4 CorT1_duennre.anguliert (10 Images)


Serie 5 CorT1_duennli.anguliert (11 Images)


Serie 6 SagPD (16 Images)



Serie 7 CorT1_duennli.angul. (11 Images)


Serie 8 CorFatSat (55 Images)


Serie 9 AxiT2_duennre.gedreht (13 Images)


Serie 10 AxiT2_duennli.gedreht (13 Images)


Serie 11 CorT1_duennre..geneigt (13 Images)


Serie 12 CorT1_duennli.geneigt (13 Images)


Serie 13 FLEXSIT SagT2FSE (13 Images)


Serie 14 EXTSIT SagT2FSE (13 Images)

Tore,
Refresh my memory. What are you signs and symptoms?

Never mind. I found them.

Tore,
Your initial symptoms were fatigue since early childhood followed by episodes of headache from age 16-25 and heat intolerance. You later developed right side tinnitus, severe right shoulder blade pain, fine motor disturbance of the right hand and sensory disturbance in the right thigh. You also have left knee pain due to running and pelvic obliquity.

I suspect you were injured in early childhood due to the fall from the gym bar. It caved in the left side of your rib cage and bent your thoracic spine. Later on you had a whiplash accident and another accident in which a chair slipped out from under you and you landed hard on your tailbone. The later accidents compounded the musculoskeletal injuries you have had since early childhood. Nonetheless, your spine is in reasonable condition and there is a good chance you can be helped if you find the right doctor.

Your x-rays are more revealing than the MRI scans. You have a significant acute curvature of the thoracic spine to right with severe malposition of the diaphragm. This will cause back pressure against the azygous and vertebral veins. It will also effect respiration. Running would certainly aggravate the condition. I am surprised you didn't get flank pain while running. Runner's call them "stitches" in their sides. You have unlevel clavicles and shoulders which can cause thoracic outlet syndrome that could effect your right ear, You have pelvic obliquity in which the left side is significantly lower than the right. The pelvis is also rotated to the right. Pelvic obliquity strains and distorts the pelvic outlets similar to the thoracic outlets. It also causes an imbalance of the forces acting on the knees which is why you got left knee pain when running. The pelvic obliquity, and the associated functional leg length discrepancy it is causing, is tipping the spine and shoulders. The tilt in the shoulders is most likely effecting the neck and the cause of the bilateral headaches.

The headache and white spots make me suspect migraines. Check your reports and find out for me where the lesions or white spots are located?

Questions from Troy might interest you Dr F,
https://www.facebook.com/CCSVI.BC

CCSVI at UBC MS Clinic - Information and Support
2 hours ago
I think I might have just stumbled onto something, does anyone do the "valsalva" technique? I have been kind of doing a variation of it for awhile.. unintentionally. I also "pop" or crack my back 4-5 many 20 times a day. I am a walking bowl of Rice Krispies .. snap crackle and pop. I may actually be "clearing" my veins in my neck when I am stretching, I need to make a video I think. (Troy)

Regards,
Nigel

Valsalva maneuvers increases intracranial and intraoccular pressure. I wouldn't recommend it as a therapy. Cracking joints is not the same as correcting fixations or misalignments. To crack your own joints you have to strain them in an uncontrolled fashion. Chronic strains can damage joints and connective tissues.

I just slipped this into the conversation on Dr S's thread,
http://www.thisisms.com/forum/post202188.html#p202188

"Hi Team,
I think that Dr F has more info on the functions of the various outlet flows that will explain the situation with headaches and other issues.
The 'chambers' of the Skull require the CSF to support the brain and decrease the contact points of the brain against skull, and also to keep the flow passages open.
In my understanding for example if the brain is not supported in the cavities of the Skull by CSF then there will be many issues such as the brain 'sitting' too low in the Foraman Magnum and causing Chiari Malformation (Brain Stem) issues etc, etc.
The blood flows impact other aspects of the system, CSF flow is created by Blood flow, CSF flow and functions are diverse, from cooling to support and then there is nutrient and waste transport. If the CSF is impeded by low flow then parts of the brain will suffer, such as the Thalamus and so on.

The whole system of Bloods and CSF is very complex and interdependent.

If there are also Alignment issues, scar tissues from injury, inflammation from infections, malformed bones and many other issues the fluid flows will be effected, that imo has to be addressed first and when the best is achieved then the flow issues will be simpler to address.
Upright MRI is now showing the complexity of the Atlas base of Skull region regarding alignments and flows which could not be imaged previously and therefore was misunderstood.

Each part of the system has to be assessed and optimised and a sequence approach has some logic I think.
Each Specialist has to link with the other Specialists to confront the complexity of CCSVI imo.

On with Flow as they say
Regards,
Nigel"

Thank you very much for your answer Dr. Flanagan.

You had asked about the locations of my lesions.

As a result of the performed MRI on Friday they told me there were two flourid lesions,
one of them rather big, both would need to be treated (I have set an appointment with my neurologist).
They didnt tell me the exact locations, the Upright-MRI report states one lesion
lying on the left side occipital intracerebral.

As far as I can see they all lay around corpus callosum.

The MRI report from 2010 states several lesions (I believe 6 in total), all of them in the area
of corpus callosum and periventricular, one flourid lesion laying in the area of the
posterior horn of the left lateral ventricle.

Nigel,
Your understanding and summary of cranial hydrodynamics is impressive.