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Cece wrote: Of course I am very curious about what you are finding....

You have your neurologist hammer, but what do we send to the budding neurointerventionalist? ;)

I do not see diagnostic neuro as neurointerventional radiology. When i treat thrombosis in the dural sinuses or angioplasty stenoses there, then that would be neurointerventional radiology.

I have always performed neuro interventions. I defined the treatment algorithm for penetrating injuries of the internal carotid artery, and external carotid artery. I am comfortable and established in this area.

If a patient did not want you imaging their sinuses this way, would you perform the procedure without going into their sinuses?

i certainly would not tell the patient i would no longer care for them.

I would take out my empathy instrument and try to understand the reasons for their refusal. The dural sinuses are pretty tough structures and i havent had any problems or difficulties. If the patient persisted in their refusal, i would probably advise them that i would defer that part of the diagnostic workup but explain to them that obstructions of brain inflow into the neck by dural sinus problems would waste any improvements made by neck veno- or valvuloplasty.

Would it be safer to do this if a patient were sedated, so they wouldn't move? Do the neurointerventionalists sedate their patients before working in the sinuses?

often neurointerventionalists perform their procedures under general anesthesia.
for what i am doing, i do not think at all that this is necessary. Perhaps intervention, but not for a 2 minute diagnostic test.

Hi Doc,
Was just reading NotJohnson's Brooklyn Bound post, and NormB said his lower back pain improved after the procedure. I noticed my lower back pain dramatically decreased -- I hate to jinx it and say disappeared -- the day after my May 6 procedure. My back issues started with the onset of my diagnosis 5 years ago and had not let up. Before that time, I had no back problems. All of my doctors, neurologists, and pt's said the back pain was not connected to MS. I've never believed that. I've taken meds, have monthly massages, did my daily exercises and stretching every day and no improvements even tho I've wanted each and every treatment to work. You clear a moderate stenois in my LIJV and it's all better the next day. What's your best guess as to what's happening?
If this is placebo, I would have made it go away when you did my first procedure 14 months ago.

I am reposting from the Aspirin thread - Dr Sclafani you asked why I can't take Aspirin. Before my procedure in September my son (a medical student) checked and found that if you are on Methotrexate, which I am, you cannot take Aspirin.

I have to go off Plavix soon so was wondering if a baby Aspirin a day would be contraindicated to keep the blood flowing.

Needled wrote:Hi Doc,
Was just reading NotJohnson's Brooklyn Bound post, and NormB said his lower back pain improved after the procedure. I noticed my lower back pain dramatically decreased -- I hate to jinx it and say disappeared -- the day after my May 6 procedure. My back issues started with the onset of my diagnosis 5 years ago and had not let up. Before that time, I had no back problems. All of my doctors, neurologists, and pt's said the back pain was not connected to MS. I've never believed that. I've taken meds, have monthly massages, did my daily exercises and stretching every day and no improvements even tho I've wanted each and every treatment to work. You clear a moderate stenois in my LIJV and it's all better the next day. What's your best guess as to what's happening?
If this is placebo, I would have made it go away when you did my first procedure 14 months ago.

My GUESS would be reduction in back muscle spasm.

Anybody have Hugs go away after angioplasty?

Hooch wrote:I am reposting from the Aspirin thread - Dr Sclafani you asked why I can't take Aspirin. Before my procedure in September my son (a medical student) checked and found that if you are on Methotrexate, which I am, you cannot take Aspirin.

I have to go off Plavix soon so was wondering if a baby Aspirin a day would be contraindicated to keep the blood flowing.

i found the following:....Seems like it is wise to follow your son's advice.
---------------------------------------------------------------------------------
Adverse Effect:
aspirin increases toxicity of methotrexate

Severity Level:


Severe - The interaction between these medications may be life-threatening or may cause permanent damage. These medications are not usually used concurrently; medical intervention may be required.

Documentation Level:
Limited - Few reports of this interaction exist. These few reports usually consist of limited case reports where clinically sound justification of the interaction is found.

aspirin belongs to the class of Salicylates (systemic)
Analgesic, antipyretic and anti-inflammatory agents.

methotrexate belongs to the class of Methotrexate
Methotrexate is an antimetabolite antineoplastic and immunosuppressant. Caution should be exercised when methotrexate is given with protein bound drugs.

Probable Mechanism:
Salicylates have been reported to reduce the renal clearance of methotrexate. This may result in elevated serum methotrexate levels, resulting in increased methotrexate toxicity. Toxicity may be less likely to occur with weekly low-dose methotrexate used in the management of rheumatoid arthritis or psoriasis and in patients with normal kidney function.

Actions to be Taken:
1. Monitor renal function.
2. Monitor patient clinically.
3. Monitor complete blood count.
4. Use combination with extreme caution.

Hooch wrote:I am reposting from the Aspirin thread - Dr Sclafani you asked why I can't take Aspirin. Before my procedure in September my son (a medical student) checked and found that if you are on Methotrexate, which I am, you cannot take Aspirin.

I have to go off Plavix soon so was wondering if a baby Aspirin a day would be contraindicated to keep the blood flowing.

hooch
thank your son for me. Good to know this.

Needled wrote:Hi Doc,
Was just reading NotJohnson's Brooklyn Bound post, and NormB said his lower back pain improved after the procedure. I noticed my lower back pain dramatically decreased -- I hate to jinx it and say disappeared -- the day after my May 6 procedure. My back issues started with the onset of my diagnosis 5 years ago and had not let up. Before that time, I had no back problems. All of my doctors, neurologists, and pt's said the back pain was not connected to MS.

of course it is not due to your MS.....it may be due to your CCSVI, but not your MS
how could i possibly affect your MS within 24 hours?

drsclafani wrote:

Needled wrote:Hi Doc,
Was just reading NotJohnson's Brooklyn Bound post, and NormB said his lower back pain improved after the procedure. I noticed my lower back pain dramatically decreased -- I hate to jinx it and say disappeared -- the day after my May 6 procedure. My back issues started with the onset of my diagnosis 5 years ago and had not let up. Before that time, I had no back problems. All of my doctors, neurologists, and pt's said the back pain was not connected to MS. I've never believed that. I've taken meds, have monthly massages, did my daily exercises and stretching every day and no improvements even tho I've wanted each and every treatment to work. You clear a moderate stenois in my LIJV and it's all better the next day. What's your best guess as to what's happening?
If this is placebo, I would have made it go away when you did my first procedure 14 months ago.

My GUESS would be reduction in back muscle spasm.

Anybody have Hugs go away after angioplasty?

My husband too had back pain (left side) for almost 15 years and had been to many pain doctors/clinics. After his procedure with Dr. Sclafani, the pain has been reduced. This pain was always in the same exact spot, didn't radiate, just day in an day out, sometimes more severe and sometimes less but always there.

Just an added note. He is now dealing with (what I think is) sciatic pain because it is pain in right side of his back which radiates down his butt cheek and right leg. I don't think this is his CCSVI (or MS) but back problems that he has from issues with his discs. We go to the pain clinic next week.

Thanks Dr. Sclafani.

drsclafani wrote:

Needled wrote:Hi Doc,
Was just reading NotJohnson's Brooklyn Bound post, and NormB said his lower back pain improved after the procedure. I noticed my lower back pain dramatically decreased -- I hate to jinx it and say disappeared -- the day after my May 6 procedure. My back issues started with the onset of my diagnosis 5 years ago and had not let up. Before that time, I had no back problems. All of my doctors, neurologists, and pt's said the back pain was not connected to MS. I've never believed that. I've taken meds, have monthly massages, did my daily exercises and stretching every day and no improvements even tho I've wanted each and every treatment to work. You clear a moderate stenois in my LIJV and it's all better the next day. What's your best guess as to what's happening?
If this is placebo, I would have made it go away when you did my first procedure 14 months ago.

My GUESS would be reduction in back muscle spasm.

Anybody have Hugs go away after angioplasty?

I never had the hug...but my back issues are gone too..the very fact that I can lie FLAT on my back without my leg going into flexor spasms is huge for me. I read a book in bed last night...the first time in years.

I have never had the hugs, but I have read several individual's reports of reducing or eliminating them. Also reports of them returning later.

drsclafani wrote:Drs Sullivan and Ponec have joined me in an executive council of AAC for CCSVI. We have begun to create structure to that title, such as quality assurance, risk analysis and complication review. Drs Sullivan and Ponec will be present at my NY Symposium.

This is excellent.
I like that you're able to collaborate and accomplish more together than you would alone.

Dr. S,
Does heat intolerence and not sweating have a vascular connection? I must stay in a cool environment at all times. If I get too warm, I get lightheaded, weak, sometimes nauseous and can barely stand.
Is this related to ccsvi?

drsclafani wrote:

Cece wrote: Of course I am very curious about what you are finding....

You have your neurologist hammer, but what do we send to the budding neurointerventionalist? ;)

I do not see diagnostic neuro as neurointerventional radiology. When i treat thrombosis in the dural sinuses or angioplasty stenoses there, then that would be neurointerventional radiology.

I have always performed neuro interventions. I defined the treatment algorithm for penetrating injuries of the internal carotid artery, and external carotid artery. I am comfortable and established in this area.

If a patient did not want you imaging their sinuses this way, would you perform the procedure without going into their sinuses?

i certainly would not tell the patient i would no longer care for them.

I would take out my empathy instrument and try to understand the reasons for their refusal. The dural sinuses are pretty tough structures and i havent had any problems or difficulties. If the patient persisted in their refusal, i would probably advise them that i would defer that part of the diagnostic workup but explain to them that obstructions of brain inflow into the neck by dural sinus problems would waste any improvements made by neck veno- or valvuloplasty.

Would it be safer to do this if a patient were sedated, so they wouldn't move? Do the neurointerventionalists sedate their patients before working in the sinuses?

often neurointerventionalists perform their procedures under general anesthesia.
for what i am doing, i do not think at all that this is necessary. Perhaps intervention, but not for a 2 minute diagnostic test.

All right, this is reassuring.

You told me that my dural sinuses were "pretty good" based on the MRV image, I'm going to assume that indeed they're pretty good and nothing was missed!

Dr Sclafani,
I think you are too busy to answer my question, so I will post it again at another time. Keep up the great work.
Thank you,
CD

pklittle wrote:Dr. S,
Does heat intolerence and not sweating have a vascular connection? I must stay in a cool environment at all times. If I get too warm, I get lightheaded, weak, sometimes nauseous and can barely stand.
Is this related to ccsvi?

pklittle: Sweating seems to be my improvement from angio 2; also, my body temp is closer to 98.6 (my old norm was 97.4). This leads me to believe that I will better tolerate heat this summer. It's a little too soon to tell yet as the days are 50 degrees & nights are still 30 degrees here in Upper Michigan