DrSclafani answers some questions

[1eye]

Hi Dr.S

My GP had a question. He was wondering why shunts aren't being used if stents have so many issues.

I hope you and everyone here at ThisIsMS have a wonderful holiday season.

Thanks

I agree with the sentiment and the question. Also, I didn't know there was a Broadway Sherlock! (And I am old enough to remember.) Must be great to live in New York! Did you ever see "Dressed To The Nines"?

[drsclafani]

Two good questions from over at Dr. Sclafani's Facebook site:
https://www.facebook.com/Sal.Sclafani.M ... l&filter=1

Dr. Sclafani, back in 2010 Dr. Tariq Sinan presented at your symposium. I believe he was also the lead investigator for the Kuwait CCSVI study. We have not heard much about him or the Kuwait study for the last year. Do you have any information if this doctor is still involved in CCSVI treatments or if the study is still in progress?

I don't have contact with my surgeons in Poland but I was wondering if anyone out there who IS in contact with their surgeon can ask a question for me. Please ask if veso dialators would help prevent re-stenosis POST PROCEDURE. I have very limited knowledge of their intended use but maybe they would help prevent future narrowings? ....Can you answer this question Dr S?

i h ave been a bit busy, preparing for sir and isnvd.

i have not been in contact with dr sinan since my symposium in 2010.

i do not think that vasodilators would be of much value in preventing restenosis. Vasodilators relax the smooth muscle in vessels, mostly in arteries which have significant muscle in the wall. Veins have limited muscle in the wall, hence their ability to dilate up quite a bit as needed when flow increases.

restenosis seems to be a restricture of valvular abnormalities most of the time. i dont think valvular stenosis would be affected by vasodilators at all.

DrS

[drsclafani]

I found the answer to my first question :

"The valves in the jugular veins are not essential with over 20% of the population having no valves in these veins. It is thought that permanent disruption of the valves using balloons alone is not possible at present and that over aggressive high pressure ballooning may risk venous damage.(Dr Sclafani, ccsvi-locator)

I bet the 1/5 of humanity who don't, are not in the Cirque du Soleil, or the space program either. I don''t think being upside-down a lot is essential for most people. If you have jugular reflux problems, wouldn't it help to have those valves?

i agree

[cervocuit]

I bet the 1/5 of humanity who don't, are not in the Cirque du Soleil, or the space program either. I don''t think being upside-down a lot is essential for most people. If you have jugular reflux problems, wouldn't it help to have those valves?

But for what reason would we have chronic jugular reflux ? Hypertension, heart problem, constipation ? Thoses deseases only exists in our modern society no ? Does Homo erectus had jugular reflux ?

[drsclafani]

hi dr. sclafani,

i just got a doppler fri. dec. 30. they say i have flow. i had my procedure aug. 2, 2010.

i declined faster after the procedure than before. anyone i've read about that had a faster decline afterwards either had clots or intimal hyperplasia. i was asking the doppler tech. questions. i know the entry is the femoral vein to get to the jugulars. i'm not good at naming the whole route but it's not a real straight shot anyway. i know that anywhere the angioplasty goes though the veins there could be a chance the vein could be scraped or injured. thus possible clotting or intimal hyperplasia. the tech. said that the middle veins would have to be checked by a ct scan something besides a doppler. and that i could still have jugular flow even if there was a problem in between.

Blossom, the veins between the leg and the neck are usually not injured because a safety guidewire is likely to be used to advance the catheter up into the neck. That indeed would be a very surprising turn of events.

i always got the point of entry checked too. are you or anyone else checking this possibility out? the ones that had improvement and lost it i'd say were more likely to get the procedure again if they could and that's when clots or scarring was usually found.

iUnfortunately for me, most of the patients that I now see were already treated while I was not allowed to perform procedures. It is my experience that most of these patients, who clinically improved from angioplasty and then had symptoms worsen, DO NOT have thrombosis. Most commonly they have restenosed, or have missed diagnosis, or other technical issues that were not addressed by the first treating interventionalist. Some of them do get better after repeat treatment; no all, but some.

now, in my case getting worse faster but still have flow in the jugulars, people like me aren't as likely to want to hurry back. we're kinda sitting back and waiting.

ok...

the numb leg is another issue. i agree with your explanation. kinda strange that when i came out of recovery and asked the dr. what happened to my leg it was so numb and i never had numbness anywhere before. she gave me no explanation. my brother and my friend were standing right there and heard me and her so it wasn't the drugs making me goofy. in fact i mentioned it to dr. sisken when he checked the flow afterwards and i got a answer something like oh that will probably clear up. that was at the time they were real busy and at least with me very little time was spent.

you asked me if the numbness had improved. the answer is no. it has gotten worse.

i'm anxious to hear your input to my questions.
as always thank you for your interest and work you are doing.

Blossom, if it is getting worse, do you mean more numb or is it getting painful?

[drsclafani]

Hi Dr.S

My GP had a question. He was wondering why shunts aren't being used if stents have so many issues.

I hope you and everyone here at ThisIsMS have a wonderful holiday season.

Thanks

I agree with the sentiment and the question. Also, I didn't know there was a Broadway Sherlock! (And I am old enough to remember.) Must be great to live in New York! Did you ever see "Dressed To The Nines"?

it is great! i can never understand the position that it is dangerous and a den of sin. the people are as nice as any where i have traveled. sure, some feel intimidated by the large population but everyone who isnt staring at people and rides the subway looks the same. I look like a tourist more than m any tourists

Many of my patients have come to realize that with a little bit of advice.

yes it was called Baker Street, written by Hal Prince, starring fritz weaver in 1965. you can still get the broadway album if you want it.

here is a taste on YouTube


I dont recall "dressed to the nines"

[drsclafani]

I bet the 1/5 of humanity who don't, are not in the Cirque du Soleil, or the space program either. I don''t think being upside-down a lot is essential for most people. If you have jugular reflux problems, wouldn't it help to have those valves?

But for what reason would we have chronic jugular reflux ? Hypertension, heart problem, constipation ? Thoses deseases only exists in our modern society no ? Does Homo erectus had jugular reflux ?

cervocuit
i will bet that homo erectus had constipation, heart disease and chronic cough. The survival of the fittest left him far behind.

Jugular hypertension is usually a reflection of problems of the heart and lungs. If right heart hypertension occurs from heart failure or emphysema, that pressure will be reflected into the jugular veins. So reflux can occur if the valves are absent. The difference is that it is not a closed system as with valve stenosis.

[1eye]

I bet the 1/5 of humanity who don't, are not in the Cirque du Soleil, or the space program either. I don''t think being upside-down a lot is essential for most people. If you have jugular reflux problems, wouldn't it help to have those valves?

But for what reason would we have chronic jugular reflux ? Hypertension, heart problem, constipation ? Thoses deseases only exists in our modern society no ? Does Homo erectus had jugular reflux ?

cervocuit
i will bet that homo erectus had constipation, heart disease and chronic cough. The survival of the fittest left him far behind.

Jugular hypertension is usually a reflection of problems of the heart and lungs. If right heart hypertension occurs from heart failure or emphysema, that pressure will be reflected into the jugular veins. So reflux can occur if the valves are absent. The difference is that it is not a closed system as with valve stenosis.

I'm having difficulty with this one. Are you saying with valve stenosis reflux can't even occur? I thought, according to all I have seen, one of the problems fixed by the CCSVI procedure is reflux. You are saying that doesn't happen with valve stenosis?

[Cece]

i h ave been a bit busy, preparing for sir and isnvd.

Lots to do, I am sure!
The first of the conferences start next week with ISET!

So reflux can occur if the valves are absent. The difference is that it is not a closed system as with valve stenosis.

1eye, I think this means that while reflux can occur if valves are absent, the flow can get out again, because the valves are absent. With reflux in valve stenosis, which would be our CCSVI reflux, the vein may be closed off and the reflux must reroute and is more serious of a condition.

[mo_en]

Hi, best wishes to all.
Dr S, i would like to bring back a question from the past that seems to have passed unanswered:
The ability of each IJVr to act as a collateral for the other depends on the patency of the confluence of sinuses between the left and right side. I've been told that underdevelopment or even absence of the confluence is commoner than one would expect. If such an obstacle was present then someone would need both her/his IJVs to remain functional in order to have adequate outflow.
Do you consider the state of the confuence of sinuses critical? Do you intend to incorporate it in your future procedures?
Thank you.

[blossom]

dr. sclafani,

thanks for answering.

the numbness is worse and has increasingly gotten painful. this has spread across the private part and into the right leg also. i never in 20 yrs. had a symptom just pop up and then maybe lighten up like say rrms. mine were slow steady down hill ppms type. until i had the angioplasty and woke up to the numb left leg. with this spreading from the nerve getting injured "similiar to a reflex sympathetic sympathy" type condition and it were to spread more i doubt i could live with it. you as a dr. knows rsd has no cure either. i hope i'm dead wrong i'm no dr. all i know is what my body tells me and it's not good what happened. i knew going in maybe it might not help but never expected to have this outcome. i had enough going on as it was.

again i appreciate your input. and in your experience if you have heard of this happening to anyone what if anything can be done to fix it?

after 20 yrs. i can hardly move but severe pain and numbness was not an issue. i have never taken an ms med. or anything stronger than an asparin.
what a shame if this is added to this pot of misery-and all i wanted was the hope of moving again.
when doing the doppler they checked the whole left leg for flow and that was good.

[1eye]

i h ave been a bit busy, preparing for sir and isnvd.

Lots to do, I am sure!
The first of the conferences start next week with ISET!

So reflux can occur if the valves are absent. The difference is that it is not a closed system as with valve stenosis.

1eye, I think this means that while reflux can occur if valves are absent, the flow can get out again, because the valves are absent. With reflux in valve stenosis, which would be our CCSVI reflux, the vein may be closed off and the reflux must reroute and is more serious of a condition.

It sounds like what you're saying is that a complete blockage is a more serious condition because it forms a dead-end where blood can accumulate. I would hope it would die off before that happened, but that is not reflux. I saw, or thought I saw, blood refluxing, on a fluoroscope with Dr. Zamboni attending, on TV. Does the widening a balloon does swamp the reflux with good flow?

[Cece]

No, no, it's that valve stenosis (where the valve leaflets are fixed, creating some percentage of blockage, as seen in CCSVI) is a more severe condition than jugular insufficiency (where the valve leaflets are ineffective, which lets reflux back into the jugular from the innominate vein but also lets it out again).

[cervocuit]

cervocuit
i will bet that homo erectus had constipation, heart disease and chronic cough. The survival of the fittest left him far behind.

Jugular hypertension is usually a reflection of problems of the heart and lungs. If right heart hypertension occurs from heart failure or emphysema, that pressure will be reflected into the jugular veins. So reflux can occur if the valves are absent. The difference is that it is not a closed system as with valve stenosis.

So what happens if the jugular valves are present with heart problems. the high pressure above the heart will close the valves if if works correctly. Then we have a closed system as with valve stenosis. Are heart desease and MS associated conditions ?

[Cece]

yes it was called Baker Street, written by Hal Prince, starring fritz weaver in 1965. you can still get the broadway album if you want it.

here is a taste on YouTube

Another seeing quote!

"If you learn not just to see but to observe.
Put your brain to work, not just the optic nerve."