DrSclafani answers some questions

[1eye]

Perfusion or drainage? Hard to see how you could have one without the other. My guess, and it is an uneducated one, is that tissues depend on oxygen levels and sugar levels, and if they drain too slowly there will not be enough oxygen/sugar in the immediate area being supplied and drained. In the long run, there might be a larger problem with perfusion, that affects other organs. Physiology which adjusts to most things almost magically, cannot cope or heal, starving piece by piece. JMHO. Even while some of me remains overweight! Our bodies have mostly used all the fuel they are going to, by the time blood reaches the jugulars. Maybe eyes come late in the blood's circuit, too.

However, because of the nature of parallel flows, the biggest vessel gets the majority of the draining blood-flow, which has already been mixed up from various places in the big veins of the head, so for all I (representing the badly-educated) know, everything is affected. Does blood supporting vision have a straight shot flowing out, or does it pass through sinuses first? Does it change when upright vs. lying down?

...

I cannot tell you what a difference a few days of sunshine has made for my foot ulcers. I am clear now for the first time since October, and I think NO production in UV is key. Powerful magic. I may shave my head.

[aliki]

Hello Aliki:

I've come to the conclusion there are 3 major causes of the blood reflux 1) toxicity (e.g. dietary -see above)
2) skeletal and 3) vein stenosis (Dr. Zamboni's CCSVI).

Toxicity you can deal with yourself, though good guidance will help.

If the problem is skeletal body manipulators such as chiropractors and osteopaths may be needed. Dentists treat jaw misalignments which may interact with upper cervical misalignements. (Recent observations about cranial fluid dynamics, the possibility that cerebrospinal fluid build-up can "pressure" venous blood
circulation leading to a blood reflux implies that attention should be paid to
all aspects of brain physiology. In fact, before considering angioplasty, I
believe one should consult specialists in skeletal adjustment - chiropractors,
osteopaths, dentists - whose manipulations might release blocked blood/fluid
circulation from the head and spinal cord. This is especially important if the
MS develops after an accident. In such cases the problem does not reside IN the vein but
pressure ON the vein.)

Vein stenosis will require venoplasty, the use of a catheter to open and "balloon" a "stenosed" vein. This requires a competent, experienced interventional radiologist. I would eliminate the other possibilities before trying this, and it could well take a year to come to this decision.
For further information check out the site ThisIsMs.com. 2) Skeletal issues are discussed under "CCSVI and CCSVBP" a) upright doc (Dr. Michael Flanagan) and b) "When CCSVI fails try AO and/or the Dentist" by Rosegirl.
2) Skeletal issues are discussed under "CCSVI and CCSVBP" a) upright doc (Dr. Michael Flanagan) and b) "When CCSVI fails try AO and/or the Dentist" by Rosegirl. "

I'm sorry to hear you are having so many problems after having tried so hard to get treatment. It may be a problem of pressure on the vein rather than a problem in the vein. Dr Flanagan has alot to say about this, so maybe you can ask him what to do. (upright doc)

MS Cure Enigmas.net

Hello Aliki: I just want to direct you to Dania on the Rosegirl post "When CCSVI fails try AO and/or the Dentist" because her veins were damaged after angioplasty but she has since had good results with Chiropractic manipulation.

Aliki
Your case is very complicated, I do not want to discuss the details of your case history on this site, although you may if you wish.

because Vesta's response to you is on the "DrSclafani answers some questions" thread, i want to be very clear that i do not endorse Vesta's commentary because I am dissatisfied with the current evidence and its presentation.

I am not clear as to the relative roles of chiropractic, dental manipulations, muscle entrapments "toxins"in your situation.

Dear Doctor,

thank you very much for your answer .
I would like to learn about what happens to me and my veins do not respond to the angioplasty. At least the right vein . Dr Schelling after seeing my MRI told me that my lesions are from the right vein . At least if one vein works that's enough to not have new lesions but my head is full of them . Headaches every day, dizzyness, extreme fatigue , difficulties to concentrate , intolerance to the noise make my life very difficult .. I am ready to do everything in order to feel better but I would like to know first that what I do is right

[drsclafani]

Perfusion or drainage? Hard to see how you could have one without the other. My guess, and it is an uneducated one, is that tissues depend on oxygen levels and sugar levels, and if they drain too slowly there will not be enough oxygen/sugar in the immediate area being supplied and drained. In the long run, there might be a larger problem with perfusion, that affects other organs. Physiology which adjusts to most things almost magically, cannot cope or heal, starving piece by piece. JMHO. Even while some of me remains overweight! Our bodies have mostly used all the fuel they are going to, by the time blood reaches the jugulars. Maybe eyes come late in the blood's circuit, too.

However, because of the nature of parallel flows, the biggest vessel gets the majority of the draining blood-flow, which has already been mixed up from various places in the big veins of the head, so for all I (representing the badly-educated) know, everything is affected. Does blood supporting vision have a straight shot flowing out, or does it pass through sinuses first? Does it change when upright vs. lying down?

...

I cannot tell you what a difference a few days of sunshine has made for my foot ulcers. I am clear now for the first time since October, and I think NO production in UV is key. Powerful magic. I may shave my head.

Her vision problem is not cortical as best we can tell but by inability to focus because the eyes are not coordinated. This is due to extraocular muscle function and coordination. This is a cranial nerve function. Poor CSF drainage may result in compression of the cranial nerve pathways and dyscoordination. Poor cerebral perfusion may result in neuronal dysfunction and poor nerve impulse transmission. Sclerotic lesions may prevent normal transmission of cranial nerve impulses.

venous drainage of the globe goes from the ophthalmic veins into the sphenoid sinus and then out of the skull through a variety of sinuses and emissary venous channels. The muscles of the eyes, the eyelids and other nonneural parts of the eye drain superficially into facial veins.

DrS

[drsclafani]

Hello Aliki:

I've come to the conclusion there are 3 major causes of the blood reflux 1) toxicity (e.g. dietary -see above)
2) skeletal and 3) vein stenosis (Dr. Zamboni's CCSVI).

Toxicity you can deal with yourself, though good guidance will help.

If the problem is skeletal body manipulators such as chiropractors and osteopaths may be needed. Dentists treat jaw misalignments which may interact with upper cervical misalignements. (Recent observations about cranial fluid dynamics, the possibility that cerebrospinal fluid build-up can "pressure" venous blood
circulation leading to a blood reflux implies that attention should be paid to
all aspects of brain physiology. In fact, before considering angioplasty, I
believe one should consult specialists in skeletal adjustment - chiropractors,
osteopaths, dentists - whose manipulations might release blocked blood/fluid
circulation from the head and spinal cord. This is especially important if the
MS develops after an accident. In such cases the problem does not reside IN the vein but
pressure ON the vein.)

Vein stenosis will require venoplasty, the use of a catheter to open and "balloon" a "stenosed" vein. This requires a competent, experienced interventional radiologist. I would eliminate the other possibilities before trying this, and it could well take a year to come to this decision.
For further information check out the site ThisIsMs.com. 2) Skeletal issues are discussed under "CCSVI and CCSVBP" a) upright doc (Dr. Michael Flanagan) and b) "When CCSVI fails try AO and/or the Dentist" by Rosegirl.
2) Skeletal issues are discussed under "CCSVI and CCSVBP" a) upright doc (Dr. Michael Flanagan) and b) "When CCSVI fails try AO and/or the Dentist" by Rosegirl. "

I'm sorry to hear you are having so many problems after having tried so hard to get treatment. It may be a problem of pressure on the vein rather than a problem in the vein. Dr Flanagan has alot to say about this, so maybe you can ask him what to do. (upright doc)

MS Cure Enigmas.net

Hello Aliki: I just want to direct you to Dania on the Rosegirl post "When CCSVI fails try AO and/or the Dentist" because her veins were damaged after angioplasty but she has since had good results with Chiropractic manipulation.

Aliki
Your case is very complicated, I do not want to discuss the details of your case history on this site, although you may if you wish.

because Vesta's response to you is on the "DrSclafani answers some questions" thread, i want to be very clear that i do not endorse Vesta's commentary because I am dissatisfied with the current evidence and its presentation.

I am not clear as to the relative roles of chiropractic, dental manipulations, muscle entrapments "toxins"in your situation.

Dear Doctor,

thank you very much for your answer .
I would like to learn about what happens to me and my veins do not respond to the angioplasty. At least the right vein . Dr Schelling after seeing my MRI told me that my lesions are from the right vein . At least if one vein works that's enough to not have new lesions but my head is full of them . Headaches every day, dizzyness, extreme fatigue , difficulties to concentrate , intolerance to the noise make my life very difficult .. I am ready to do everything in order to feel better but I would like to know first that what I do is right

Aliki
it is not true that new lesions should not form if there is one vein . Lesion formation may not even be caused by venous obstruction.

I dont want to talk about your case specifically on line because it might violate federal standards of privacy

[vesta]

"because Vesta's response to you is on the "DrSclafani answers some questions" thread, i want to be very clear that i do not endorse Vesta's commentary because I am dissatisfied with the current evidence and its presentation.

I am not clear as to the relative roles of chiropractic, dental manipulations, muscle entrapments "toxins"in your situation."

Hello Dr. Sclafani:

How do you counsel patients who are considering angioplasty? Dania has reported that her veins were damaged by angioplasty and she has since had good results from chiropractic therapy. blossom is convinced her problems are "skeletal" since her foot drop began after an accident, and angioplasty didn't help and some things were worse. It seems to me one should consider "skeletal" problems before undergoing angioplasty as a basic precaution. Also, Dr Wahl's solution (diet as well as blood circulation stimulation) may alone deal with body tension issues sufficiently to overcome the "blood reflux".

I hope you can help aliki because it appears her condition has worsened after angioplasty. That gives pause to anyone considering the procedure.

[dania]

I think before considering angioplasty get X rays/scans etc of the neck and have the appropriate doctors and chiros (not just one) view to see if there is more going on than stenosis of the veins. In my case my CSF is pinched because of a spinal issue, cervical lordosis. I know someone who had multiple angioplasties with short term improvements to find that his ligaments in his neck are torn due to a roof falling on him. Another found that he has Eagle's syndrome. Another has bone spurs. Others had abnormal veins in the head. All these will lead to stenosis of the jugulars but that is symptom not the cause in these cases.

[Cece]

Still with us, Dr. Sclafani?
We've come quite a ways since June 2010 when everything seemed to hang on the yes/no of an IRB.

Yes cece, i am still here.

I remember that time. The demand for a randomized prospective sham armed placebo controlled was too much at that time. Arrogant demands by righteous scientists who could not see that this was a procedure not a drug and that the process of procedural discovery and proof takes a different methodology

It is very clear to me that we are on the right path, slower but inevitable.

Ok I like the sound of inevitable.
I am here too for the long haul.

Regarding procedural discovery, why did it take ten years for what you were doing saving spleens to become accepted? You refine the technique and then convince other doctors through conferences and papers? Is that what's also happening with CCSVI?

[drsclafani]

"because Vesta's response to you is on the "DrSclafani answers some questions" thread, i want to be very clear that i do not endorse Vesta's commentary because I am dissatisfied with the current evidence and its presentation.

I am not clear as to the relative roles of chiropractic, dental manipulations, muscle entrapments "toxins"in your situation."

Hello Dr. Sclafani:

How do you counsel patients who are considering angioplasty? Dania has reported that her veins were damaged by angioplasty and she has since had good results from chiropractic therapy. blossom is convinced her problems are "skeletal" since her foot drop began after an accident, and angioplasty didn't help and some things were worse. It seems to me one should consider "skeletal" problems before undergoing angioplasty as a basic precaution. Also, Dr Wahl's solution (diet as well as blood circulation stimulation) may alone deal with body tension issues sufficiently to overcome the "blood reflux".

I hope you can help aliki because it appears her condition has worsened after angioplasty. That gives pause to anyone considering the procedure.

vesta
i dont make recommendations based upon internet reports. I use my medical experience and knowledge and search the peer reviewed literature for ideas, recommendations, foundation and growth.

I am not sure what you are meaning by "blood reflux" but diet will not overcome an anatomical problem, although it may help healing.

I think that you should be careful about how you read into aliki's condition and its progression. I am not at liberty to discuss it here but your assumptions are not correct.

DrS

[drsclafani]

I think before considering angioplasty get X rays/scans etc of the neck and have the appropriate doctors and chiros (not just one) view to see if there is more going on than stenosis of the veins. In my case my CSF is pinched because of a spinal issue, cervical lordosis. I know someone who had multiple angioplasties with short term improvements to find that his ligaments in his neck are torn due to a roof falling on him. Another found that he has Eagle's syndrome. Another has bone spurs. Others had abnormal veins in the head. All these will lead to stenosis of the jugulars but that is symptom not the cause in these cases.

dania
i use ultrasound to assess the jugular veins. Almost all patients with MS have valvular stenosis of the internal jugular veins behind the clavicle; many will have azygos valvular stenosis, or renal vein compression. Xrays are not going to show these things. Venography and IVUS will very nicely show the upper jugular veins better than anything else. Opening a skull base compression by manipulation is not going to help someone who also has a valvular stenosis.

That is why i look at the jugular veins rather than a neck and skull xray.

[drsclafani]

Still with us, Dr. Sclafani?
We've come quite a ways since June 2010 when everything seemed to hang on the yes/no of an IRB.

Yes cece, i am still here.

I remember that time. The demand for a randomized prospective sham armed placebo controlled was too much at that time. Arrogant demands by righteous scientists who could not see that this was a procedure not a drug and that the process of procedural discovery and proof takes a different methodology

It is very clear to me that we are on the right path, slower but inevitable.

Ok I like the sound of inevitable.
I am here too for the long haul.

Regarding procedural discovery, why did it take ten years for what you were doing saving spleens to become accepted? You refine the technique and then convince other doctors through conferences and papers? Is that what's also happening with CCSVI?

actually it took closer to twenty years. Trauma surgeons who had a good treatment are not going to follow the advice of an young upstart radiologist who had a lunatic fringe idea when others could not duplicate his results. As my reputation grew, the next objection was that no other IR would come in the hospital in the middle of the night to do this. It took time, teaching other radiologists of the merits while continuing to show surgeons that it worked. Gradually it became mainstream.

it is not quite the same with CCSVI. Surgeons liked the concept and were familiar with vascular approaches to treatments. Neurologists are more medically oriented and generally, in my experience, have a bias against procedures.

[dania]

I think before considering angioplasty get X rays/scans etc of the neck and have the appropriate doctors and chiros (not just one) view to see if there is more going on than stenosis of the veins. In my case my CSF is pinched because of a spinal issue, cervical lordosis. I know someone who had multiple angioplasties with short term improvements to find that his ligaments in his neck are torn due to a roof falling on him. Another found that he has Eagle's syndrome. Another has bone spurs. Others had abnormal veins in the head. All these will lead to stenosis of the jugulars but that is symptom not the cause in these cases.

dania
i use ultrasound to assess the jugular veins. Almost all patients with MS have valvular stenosis of the internal jugular veins behind the clavicle; many will have azygos valvular stenosis, or renal vein compression. Xrays are not going to show these things. Venography and IVUS will very nicely show the upper jugular veins better than anything else. Opening a skull base compression by manipulation is not going to help someone who also has a valvular stenosis.

That is why i look at the jugular veins rather than a neck and skull xray.

Dr Sclafani, no disrespect but I think you misunderstood me. As you said many have stenosis in different areas. Which shows everyone is different. Correct? I presume you were unable to help all you treated and perhaps some you treated had only had temporary improvements. I believe the more information that a patient has of their particular problem the better informed they are to make a decision for their treatment. That is why I said to have Xrays/ scans, "ETC". It would be fantastic if all doctors/chiros etc that would like to help MS patients get together and share/discuss their theories and findings. I would never expect you to look at Xrays of a neck or skull but it would be a good idea for the best person to review them.

I had a ultrasound yesterday by my endocrinologist to look at my thyroid and he said you have no flow in you jugulars. My jugulars are the ones that Dr Hernandez surgically implanted by using a vein from my leg. After temporary improvements they too stenosed.

[Cece]

actually it took closer to twenty years. Trauma surgeons who had a good treatment are not going to follow the advice of an young upstart radiologist who had a lunatic fringe idea when others could not duplicate his results. As my reputation grew, the next objection was that no other IR would come in the hospital in the middle of the night to do this. It took time, teaching other radiologists of the merits while continuing to show surgeons that it worked. Gradually it became mainstream.

it is not quite the same with CCSVI. Surgeons liked the concept and were familiar with vascular approaches to treatments. Neurologists are more medically oriented and generally, in my experience, have a bias against procedures.

So I am getting that duplication of results, reputation, time, teaching, and demonstration of efficacy are what brought it to mainstream. Vascular surgery is closer to interventional radiology in terms of familiarity; neurology is farther away from interventional radiology, so that is a hurdle.

There was a reasonably effective trauma surgery treatment for the traumatized spleen but there is not a reasonably effective treatment for MS by neurologists. Traumatized spleen was an accepted medical condition; congenital outflow obstructions of the jugular or azygous vein seems to not be as accepted as a medical condition. No one calls a traumatized spleen a variant of normal.

It's been hard at times to see that we are indeed on a path and it is leading somewhere. But I am have not been through this before, and there is all the controversy.

[vesta]

"vesta
i dont make recommendations based upon internet reports. I use my medical experience and knowledge and search the peer reviewed literature for ideas, recommendations, foundation and growth.

I am not sure what you are meaning by "blood reflux" but diet will not overcome an anatomical problem, although it may help healing.

I think that you should be careful about how you read into aliki's condition and its progression. I am not at liberty to discuss it here but your assumptions are not correct.

DrS
dania
i use ultrasound to assess the jugular veins. Almost all patients with MS have valvular stenosis of the internal jugular veins behind the clavicle; many will have azygos valvular stenosis, or renal vein compression. Xrays are not going to show these things. Venography and IVUS will very nicely show the upper jugular veins better than anything else. Opening a skull base compression by manipulation is not going to help someone who also has a valvular stenosis.

That is why i look at the jugular veins rather than a neck and skull xray.

Dr Sclafani, no disrespect but I think you misunderstood me. As you said many have stenosis in different areas. Which shows everyone is different. Correct? I presume you were unable to help all you treated and perhaps some you treated had only had temporary improvements. I believe the more information that a patient has of their particular problem the better informed they are to make a decision for their treatment. That is why I said to have Xrays/ scans, "ETC". It would be fantastic if all doctors/chiros etc that would like to help MS patients get together and share/discuss their theories and findings. I would never expect you to look at Xrays of a neck or skull but it would be a good idea for the best person to review them.

I had a ultrasound yesterday by my endocrinologist to look at my thyroid and he said you have no flow in you jugulars. My jugulars are the ones that Dr Hernandez surgically implanted by using a vein from my leg. After temporary improvements they too stenosed."


Dr Sclafani:

First off, I think you shouldn’t be so disrespectful of what you have derisively called the “internet university”.
I do believe that patients need to be “sorted” out before deciding on angioplasty. One can’t ignore the CSF issue and dania’s testimony. You might consider contacting the Chiropractor upright doc (Dr Michael Flanagan) for “ ideas, recommendations, foundation and growth”. If the stenosis is caused by pressure ON the vein, one could well damage the vein without solving the stenosis problem.
Secondly, I believe one needs to consider the body tension factor.
It is well known in scientific research that the act of observation distorts what is observed.
You observe vein stenosis in a patient in a medical setting surrounded by medical paraphernalia. That for me would be a major factor of stress. No doubt in my case, whatever constricts under stress would be shut tight during angioplasty. If massage, or swimming or acupuncture appears to open blood flow and enhance circulation through my brain, I assume that the stenosed veins are thereby opened. If, as you say, the stenosis is a problem with the valve, perhaps I have “sticky” valves, that stress closes them, energy therapies opens them. So maybe I shouldn’t take the risk of angioplasty if I can keep the blood flowing (with effort).
DIET? Food intolerances (toxicity) may well stress the organism thereby closing the valves. You seem to have a mechanical view of the veins. Emotions can alter blood circulation, look at the sex organs. Is it so difficult to believe that stress, and ensuing body tension, can close off brain fluid/blood circulation?
If CCSVI research controlled studies do not take these factors into account I believe they are doomed to failure. And such failure would be our misfortune since it will only enhance the power of the Big Pharma/Neurologist lobby. I believe Dr Zamboni’s “blood reflux” theory is essentially sound but angioplasty is not the only solution. Do please contact Chiropractors or other competent “skeletal” experts to complement your work. And consider how simple body tension may impact the veins,that a shiatsu massage (for instance) might stop an exacerbation by stopping the “blood reflux”.
As for aliki, you are correct, I don’t know the details of her problem. I only know that she asked for your help on this forum on Nov 18, 2012 and I didn’t see your response. Perhaps you are in private communication. I hope things work out for her.
Thanks.

MS Cure Enigmas.net

[drsclafani]

Dr Sclafani, no disrespect but I think you misunderstood me. As you said many have stenosis in different areas. Which shows everyone is different. Correct? I presume you were unable to help all you treated and perhaps some you treated had only had temporary improvements. I believe the more information that a patient has of their particular problem the better informed they are to make a decision for their treatment. That is why I said to have Xrays/ scans, "ETC". It would be fantastic if all doctors/chiros etc that would like to help MS patients get together and share/discuss their theories and findings. I would never expect you to look at Xrays of a neck or skull but it would be a good idea for the best person to review them.

I had a ultrasound yesterday by my endocrinologist to look at my thyroid and he said you have no flow in you jugulars. My jugulars are the ones that Dr Hernandez surgically implanted by using a vein from my leg. After temporary improvements they too stenosed.

Actually, i think that i have been misinterpreted.

While everyone is different, the vast majority of patients with MS have abnormalities that are quite similar. More than 95% of patients have valvular stenosis of one or both internal jugular veins at the lower end of the vein near the clavicle. About fifty percent have valvular stenosis of the azygos vein and almost 25% have greater than 70% compression of the left renal vein. Only about five percent have narrowing of the upper jugular vein or the connection between the jugular vein and the dural sinuses. For me it makes no sense to perform lots of tests unless the prevalence of the problem is high. Thus I would not perform neck and skull xrays nor other tests prior to performing the gold standard of venography. When i find patients with high stenosis I do now discuss the options with them.

I am a board certified radiologist and interpreted countless studies of spine and head xrays in the past. I am comfortable looking at these images. Frankly, I have considerable skepticism of the findings I have been shown.

I try to spend time on this thread discussing CCSVI and answering questions posed by this audience. I hope that I have made patients more knowledgeable and intelligent in this subject. However the goal of this thread has never been to debate with patients the merits of chiropractic and i hope that i have been successful in expressing my skepticism and stopping there. It is not my area of expertise and I dont have much to offer.

One of the most important functions I have chosen is to assess treatments and diagnoses within my expertise. When you were advocating saphenous venous bypass for occluded jugular veins, I urged caution and a wait and see approach. I did not believe that this was going to be a efficacious treatment and I worried about early occlusion of these bypasses. I am so sorry that Dania's outcomes have already led to early high grade stenosis.

We already have a forum for discussion among caregivers. It is called the international society for neurovascular disease. We have had several talks on skull base manipulations, diet, heavy metals, rickettsial and bacterial infections. I look forward to listening to presentations on skull base disease.

DrS

[Hooch]

I would just like to express my thanks to you Dr Sclafani. Although I post rarely I have read this whole thread over the last few years and it has helped me greatly. I would like to add that I have a dear friend that was treated by you twice and is extremely happy with her outcomes.

I too believe that there are other avenues people with MS may need to travel and that various complimentary therapies are going to be needed for most patients.

However, much as we would like it, I do not feel that it is not possible for one doctor - in this case Dr Sclafani - to be able to converse on all these different subjects. He has expertise in vascular surgery and I respect the knowledge that he has acquired over a long and distinguished career.