DrSclafani answers some questions

[Squeakycat]

By flexing the neck, the vein is completely occluded with a lot of filling of posterior cervical veins connecting to emissary veins. In extension, the lumen looks great!

Can you explain what flexing and extension of the neck means? With such a dramatic difference, it would almost seem like an exercise that might provide some temporary relief.

Flexing the neck means bending your head forward, chin to chest.
Extending your neck means bending your back to your face it to the sky.

but squeakycat, sometimes flexion and sometimes extension seem to block flow and other times the reverse is true.

On the record, I do not endorse this exercise. I fear that PwMS will be walking around pecking like birds, doing the sclafani manuever.

I was asking for our friend with the sphenopalatine attacks just in case something that simple might have a positive effect. She can try flexion and extension and see if she gets any benefit pending future treatment. She's having an awful time now that they have returned with increasing frequency.

[DougL]

On the record, I do not endorse this exercise. I fear that PwMS will be walking around pecking like birds, doing the sclafani manuever.

LOL

[tiltawhirl]

On the record, I do not endorse this exercise. I fear that PwMS will be walking around pecking like birds, doing the sclafani manuever.

LOL

Did you also have a vision of Dr S doing the bird dance to the music of the same name? I did. ROFL.

tilt

[Thekla]

Flexing my neck used to trigger Lhermitte's sign, could there be a connection?

I found that odd shaped pillow in the Fall. I find it more comfortable. Here in Germany, they are called 'side-sleeper' pillows but they don't fit in any of the normal pillowcases!

[NHE]

Hello Dr Sclafani,
I am new to this forum so please excuse me if I am posting in the wrong place.
I am hoping to attach images of my partner's second angioplasty of last year. The first, to clear the left jugular vein was a success in that my partner experienced significant improvements in fatigue, bladder control and mobility. The improvements were however short-lived; after about 8 weeks the symptoms began to return. The next angioplasty, 6 months after the first, found the left jugular vein to be blocked to the extent it was not possible to proceed. Is anyone able to advise how I can insert angioplasty images ( saved as jpg files) in the same way as others seem to have done in this thread? Thanking you in anticipation

From the Forums FAQ thread...

Q: How do I post a picture to the forum?
http://www.thisisms.com/forum/site-supp ... tml#p40760

Posting Pictures, Part 2
http://www.thisisms.com/forum/site-supp ... ml#p161827


NHE

[Cece]

On the record, I do not endorse this exercise. I fear that PwMS will be walking around pecking like birds, doing the sclafani manuever.

LOL

hee
Walking around, our jugulars are shrunk down to 10%, so that would just be silly...
But lying down, Tilt has got it covered by using a towel for a pillow. I double-up my pillows by folding them in half and using the folded side, which brings my chin down toward my neck. Tilt's way would be extension, my way would be flexion. Not endorsed by Dr. Sclafani.

[Squeakycat]

With the new Sclafani Maneuver® and Sclafani Venous Flow Pillows®, I'm betting there will be a line of t-shirts and posters next.

[tiltawhirl]

With the new Sclafani Maneuver® and Sclafani Venous Flow Pillows®, I'm betting there will be a line of t-shirts and posters next.

tilt

[drsclafani]

With the new Sclafani Maneuver® and Sclafani Venous Flow Pillows®, I'm betting there will be a line of t-shirts and posters next.

tilt

Thanks tilt. The laughter is good. As therapeutic as the SM.

[NZer1]

Good Humor this morning!

Dr. S the Australian TV article on Crissy has aired here on National TV and my phone has been running hot.
http://au.news.yahoo.com/sunday-night/f ... treatment/

Some opinions and stories are flowing on FB as you can imagine.

*The main interest that has been asked of me is "what is happening when ballooning, does the damaged material remain against the vein wall, does it reabsorb or is it removed by the healing processes".
**Can you give some sort of answer please?

Easy question as always,
Nigel

[drsclafani]

Good Humor this morning!

Dr. S the Australian TV article on Crissy has aired here on National TV and my phone has been running hot.
http://au.news.yahoo.com/sunday-night/f ... treatment/

Some opinions and stories are flowing on FB as you can imagine.

*The main interest that has been asked of me is "what is happening when ballooning, does the damaged material remain against the vein wall, does it reabsorb or is it removed by the healing processes".
**Can you give some sort of answer please?

Easy question as always,
Nigel

Nigel, this is a good question and i can only give an educated theory as there is little autopsy material after treatment.


when angioplasty is performed, the vein is stretched. Adjacent to the vein, within the vessel, the valve stretches. The leaflets of the valve appear to be fused or adherent to each other. So the leaflets are stretched as well and in being stretched, the valve is opened. it is likely still attached to the wall of the vein and is either compressed against the wall and then comes back into the flow of things with time, perhaps to restenose in the future.

I do not think that tissue is absorbed. Some of it may be torn off the vein wall. in such cases it would likely travel and lodge in the small blood vessels of the lung, obviously doing to no hemodynamic harm.

this is my best case conceptualization of what happens.

[drsclafani]

Flexing my neck used to trigger Lhermitte's sign, could there be a connection?

I found that odd shaped pillow in the Fall. I find it more comfortable. Here in Germany, they are called 'side-sleeper' pillows but they don't fit in any of the normal pillowcases!

thekla, i think flexing the neck causes stretch on the spinal cord resulting in the sign. i do not think there is any connection to the flexion causes change in the vein size

[NZer1]

Thanks Dr.S
In my mind we are hoping for the obstruction to stay against the wall, in reality of course we are open to every possibility imaginable.

**When there are other findings such as webs, septums and membrane is there any guesses/experiences there?

I am guessing also that retreating is a mine field knowing if there is an old or previously unseen issue.

*When I read some of your comments I get the impression that using IVUS in re-treat situations you are looking for original issues, treated issues and 'new' issues?

**Is there an actual situation we might call a new issue. Something that has happened as a result of flow improvement elsewhere in the vein or elsewhere in the collective system? Not caused by treatment in the past rather something that develops now the flow is increased where there has previously been low or less flow?

**Have you recovered, and are you looking after your self?

Regards Nigel

[drsclafani]

Thanks Dr.S
In my mind we are hoping for the obstruction to stay against the wall, in reality of course we are open to every possibility imaginable.

In my mind, i am hoping that the valve is opened up and will function again. But the primary goal is to keep the flow so that reflux above the valve no longer occurs. i am hoping over the years for a better solution, such as a percutaneously deployable synthetic valve replacement.

**When there are other findings such as webs, septums and membrane is there any guesses/experiences there?

webs are lacy tissue that divides the vein drainage into smaller channels. Balloon should tear them open
septums are very challenging structures. their nature makes balloon angioplasty less effective than against valves. I think greater balloon diameter may be an answer. we shall see.

I am guessing also that retreating is a mine field knowing if there is an old or previously unseen issue.

I don't look at it in that way.
I look at retreatment of patients previously treated by others as if my treatment was their first. So IVUS is very important to me. We know that venography can miss 25% of abnormalities. So why would i trust venography performed by others without IVUS?

*When I read some of your comments I get the impression that using IVUS in re-treat situations you are looking for original issues, treated issues and 'new' issues?

yes, of course. I am trying to avoid using IVUS on my own retreatments. I reload the images from the first IVUS back into the IVUS unit and work from that. Hoping to save patients $2000 on retreatments.

**Is there an actual situation we might call a new issue. Something that has happened as a result of flow improvement elsewhere in the vein or elsewhere in the collective system? Not caused by treatment in the past rather something that develops now the flow is increased where there has previously been low or less flow?

I cannot think of any

**Have you recovered, and are you looking after your self?

Regards Nigel

very kind, Nigel, thank you. I am recovering nicely. I didnt miss or reschedule any patients. I have had some delay in addressing some patient email inquiries and questions but no patient was delayed! I feel very lucky to be alive and have a renewed sense of urgency to perfect my techniques

[numbness23]

Have u treated or can u see a problem with treating a pwms who has a baclofen pump?