A discussion developed recently on the site ThisisMs.com among the Interventional
Radiologist Dr. Sclafani, his patient Dania, and Vesta (yours truly) concerning
the suggestion by Dania and Vesta that MS patients be examined and treated for
Cerebrospinal Flow (CSF) problems before considering Angioplasty. The
exchanges ended June 22, 2013 as follows: (See CCSVI thread, “Dr. Sclafani
answers some questions” page 520 through 522.)
(Both dania and vesta recommended that Dr Sclafani contact the Chiropractor Dr Michael
Flanagan for his views. His take on CSF issues follows.)
Vesta wrote on June 22, 2013
"Dr Sclafani:I think you are missing our point. I believe it may be easier and
less expensive to check out and treat CSF problems BEFORE angioplasty. See if
such treatment works. A practical and financial question which may be medically
advantageous as well. We have to live with and pay for the conséquences. This
is not to doubt your dedication, expertise or competence. It's just survival.
Dania wrote June 22, 2013
"Thanks Vesta. That is my point of view, exactly. I guess I was not articulating it very
well. It is not being argumentative. Just an opinion and my experiences. If my
experiences helps anyone, so much the better. I completely drained my retirement funds. If I had known what is my particular problem I would have done everything differently."
The details are worth relating, and dania’s conclusion above worth considering.
Aliki (location Greece) wrote to Dr Sclafani on June 9 2013
“Reading all these about the muscle and the ccsvi I was wondering if my case is one of
those who have that problem . After the second angioplasty in America by you ,
there are many days that I feel a pain in my neck even that 9 months have passed
.I think it is a muscle pain and maybe this has something to do with my veins
and the fact that I have done 2 times the ccsvi procedure and the vein have a
restenosis . I have lost the one vein because of a clot and now the second does
not answer to the angioplasty . How can I learn if I have a muscle problem?”
Vesta wrote on June 9, 2013
“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. "
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 wrote on June 9
“Dear vesta, thank you very much for your answer . I was wondering who should I ask in
order to learn if this happens to me and if this happens what should I do ?”
Dr. Sclafani wrote on June 17, 2013
“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."
Aliki wrote June 18
“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”
Dr. Sclafani wrote June 18
“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 wrote on June 18
"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 wrote on June 18
“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.”
Sclafani wrote June 18
“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.”
Sclafani wrote June 18
“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.”
Dania wrote June 19
“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.”
Vesta wrote June 19
“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. »
Dr Sclafani wrote June 20
“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.”
Four former patients , apparently fearing an attack on Dr. Sclafani, wrote letters of
praise for Dr. Sclafani.
Hooch June 20
Saint Louis June 20
Ada June 20
Robni June 21
“Dr Sclafani addresses a piece of the puzzle, and his help does not stop when you
walk out his door! I still have contact and ask for advise for my next
steps!! BTW..July 1st i have an upright MRI scan to identify possible
problems with the upper spine and CSF.....”
Dr. Sclafani to Robert June 21
“Thanks Robert
Please let me know what your Upright MRI shows. I would like to
correlate it with what your venogram looks like. It would be a great opportunity
to compare the two modalities.”
Dania to Dr S June 21
“This is what I meant. Have as much info as possible.”
Sclafani to Dania June 21
“thanks dana, glad to see that we have some common ground. I was debating against the
point of view that patients should be evaluated for malalignment prior to
venography. If i were sold on it I might do that, but at this point i havent
bought in that it is a general common association.”
Dania June 21
“Dr S there could be more than misalignment. Eagle's syndrome, bone spurs in the
neck stopping blood flow. Those patients need surgery to correct their problem.
Angio does not help. Being a Canadian, we must pay out of pocket for any
procedure. X rays and scans are not as expensive as angio. Or an upright MRI to
see if it is a CSF flow problem. Again angio is not the best solution. I do
encourage you to talk with Dr Flanagan. Maybe the best solution is correcting
CSF flow plus angio to correct blood flow. Do both. »
Sclafani June 21
“dania i think you are missing my point. Angio and IVUS are quite good at showing
stenoses, regardless of where they are located. Significant stenoses of all
causes, including those caused by bone spurs, misalignments and so forth are
best seen by angio and ivus, not xrays which can only show the bones. In
addition, my experience indicates to me that these upper lesions are just not
that common. The overwhelming percentage of patients have no problems with the
jugular vein except where it enters the chest. I am not arguing that these
other things do not occur, it is just that they are not common. and even if
present, they are almost always going to be accompanied by valvular stenosis of
inferior jugular bulb. No point in treating upper lesions without also
addressing the lower lesions. In addition, xrays and scans are not going to help
find the azygos vein stenosis present in about half of patients nor in showing
the compression of the left renal vein that is present in 25%.
So my clinical judgment is that angiography and IVUS are the key and the starting
point. If they fix the problems then great, end of story. if they don't then i
would consider these other options but would prefer more and better data than i
have seen so far.Thanks for the discussion, Dana. »
Dania to Dr S June 21
“I agree that angio and IVUS are excellent at showing stenoses. All I am trying to
convey is that for some stenosis might be caused by a problem with CSF flow. I
also think that, perhaps, if angio is performed when the patient's disabilities
are minor and they keep themselves healthy and exercise regularly they are more
likely to keep their improvements. For me I did very well for 18 years. No meds.
But I use to go to the gym 5 times a week and weight train. Heavy weights. I
could leg press 400 pounds. I was 5'6" weighed 120 lbs. It was when I stopped
going to the gym that my condition declined.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117722/
http://link.springer.com/article/10.100 ... rue#page-1 »
Vesta June 22
“Dr Sclafani:
I think you are missing our point. I believe it may be easier and
less expensive to check out and treat CSF problems BEFORE angioplasty. See if
such treatment works. A practical and financial question which may be medically
advantageous as well. We have to live with and pay for the conséquences. This
is not to doubt your dedication, expertise or competence. It's just survival.”
Dania June 22
“Thanks Vesta. That is my point of view, exactly. I guess I was not articulating it very
well. It is not being argumentative. Just an opinion and my experiences. If my
experiences helps anyone, so much the better. I completely drained my
retirement funds. If I had known what is my particular problem I would have
done everything differently.”
Dr Michael Flanagan wrote after having read the above June 25, 2013
8:52 am
Thanks for the interesting discussion.
I understand Dr. Scalfani's point as to
why he prefers angio and IVUS for determing venous flow problems due to stenosis
and faulty valves. Angio and IVUS are certainly much better at assesing those
types of stenosis and blood flow problems. On the other hand, angio and IVUS are
not the preferred method of diagnosing stenosis of the spine and obstruction to
CSF flow as a result of increased venous pressure in the VVP due to spondylosis,
stenosis and scoliosis of the spinal canal. Spondylosis, stenosis and scoliosis
affect the design of the canal, which affects hydrodynamics and CSF flow in the
cranial vault and spinal canal. The faulty hydrodynamics get worse during
upright posture. X-rays and upright MRI are much better than angio or IVUS for
determining these problems.
The other point is that angio and IVUS don't
rule out potential structural causes of obstruction to venous flow into the VVP
during upright posture. Venous blood preferentially drains into the VVP during
upright posture, not the IJs. The upper cervical canal is a key point of
obstruction. Angiograms also expose patinets to much more radiation than basic
x-rays of the spine and MRI so it makes more sense to get them first to rule out
and fix potential structural problems first, espeically if they obviate the need
for further more invasive intervention. Treating underlying structural problems
may also help improve the durability of venoplasty and stents when necessary.
Certain structural problems may also help surgeons better choose between
venoplasty versus shunts, such as in a case like CurIous associated with
cervical kyphosis and deformation by the transverse process of atlas. I further
suspect that venous insufficiency in the azygous and iliac veins can similarly
be caused by structural issues sucha as spondylosis, stenosis and scoliosis of
the lower spine due to their impact on myofascial tunnels and pressure
gradients.
June 25 9:28 am
Structural issues in the spine that affect blood and CSF flow in the cranial vault and
spinal canal are far more common and likely a cause of MS, as well as other
neurodegenerative diseases than problems in the jugular veins or TMJ for that
matter. It makes sense that lesions are often found in the area of spondylosis,
bone spurs and stenosis. Spondylosis, stenosis and scoliosis alter the design
of the tunnel of the spinal canal. When you change the dimensions and design of
a tunnel or pipe you alter the flow of fluids through it. It's basic physics.
Although he is a leading expert geotechical engineer and thinks in terms of
stone and soil stability so much so that it takes time to sink in like water
passing through thick clay, even, my tunneling expert brother gets it. I just
have to speak slowly and repeat myself many times.
10:53 am
Hello Vesta,
The VVP is the Vertebral Venous Plexus. Upright posture increases
blood flow in and out of the brain which required modifications to the basic
drainage system used by mammals. During upright posture, the human brain
primarily switches over to the occipital marginal sinus, emissary and accessory
venous system that drains into the VVP inside the spinal canal and around the
spine. The accessory veins and outlets are the lowest drainage points in the
posterior fossa.
June 26, 2013
Vesta,
I think that violent venous and CSF backjets due to trauma such as whiplash as proposed by Dr. Schelling is a possible cause of the supratentorial, periventricular and perivenular lesions seen in MS. Chronic ischemia, edema and increased CSF volume due to poor drainage are other causes. Lesions can also be caused by autoimmune-inflammatory conditions and infections.
Tags: Multiple Sclerosis, MS, CCSVI, Angioplasty, CSF, IVUS, Stenoses, Blood Reflux, Chiropractic, Venography
Radiologist Dr. Sclafani, his patient Dania, and Vesta (yours truly) concerning
the suggestion by Dania and Vesta that MS patients be examined and treated for
Cerebrospinal Flow (CSF) problems before considering Angioplasty. The
exchanges ended June 22, 2013 as follows: (See CCSVI thread, “Dr. Sclafani
answers some questions” page 520 through 522.)
(Both dania and vesta recommended that Dr Sclafani contact the Chiropractor Dr Michael
Flanagan for his views. His take on CSF issues follows.)
Vesta wrote on June 22, 2013
"Dr Sclafani:I think you are missing our point. I believe it may be easier and
less expensive to check out and treat CSF problems BEFORE angioplasty. See if
such treatment works. A practical and financial question which may be medically
advantageous as well. We have to live with and pay for the conséquences. This
is not to doubt your dedication, expertise or competence. It's just survival.
Dania wrote June 22, 2013
"Thanks Vesta. That is my point of view, exactly. I guess I was not articulating it very
well. It is not being argumentative. Just an opinion and my experiences. If my
experiences helps anyone, so much the better. I completely drained my retirement funds. If I had known what is my particular problem I would have done everything differently."
The details are worth relating, and dania’s conclusion above worth considering.
Aliki (location Greece) wrote to Dr Sclafani on June 9 2013
“Reading all these about the muscle and the ccsvi I was wondering if my case is one of
those who have that problem . After the second angioplasty in America by you ,
there are many days that I feel a pain in my neck even that 9 months have passed
.I think it is a muscle pain and maybe this has something to do with my veins
and the fact that I have done 2 times the ccsvi procedure and the vein have a
restenosis . I have lost the one vein because of a clot and now the second does
not answer to the angioplasty . How can I learn if I have a muscle problem?”
Vesta wrote on June 9, 2013
“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. "
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 wrote on June 9
“Dear vesta, thank you very much for your answer . I was wondering who should I ask in
order to learn if this happens to me and if this happens what should I do ?”
Dr. Sclafani wrote on June 17, 2013
“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."
Aliki wrote June 18
“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”
Dr. Sclafani wrote June 18
“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 wrote on June 18
"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 wrote on June 18
“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.”
Sclafani wrote June 18
“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.”
Sclafani wrote June 18
“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.”
Dania wrote June 19
“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.”
Vesta wrote June 19
“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. »
Dr Sclafani wrote June 20
“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.”
Four former patients , apparently fearing an attack on Dr. Sclafani, wrote letters of
praise for Dr. Sclafani.
Hooch June 20
Saint Louis June 20
Ada June 20
Robni June 21
“Dr Sclafani addresses a piece of the puzzle, and his help does not stop when you
walk out his door! I still have contact and ask for advise for my next
steps!! BTW..July 1st i have an upright MRI scan to identify possible
problems with the upper spine and CSF.....”
Dr. Sclafani to Robert June 21
“Thanks Robert
Please let me know what your Upright MRI shows. I would like to
correlate it with what your venogram looks like. It would be a great opportunity
to compare the two modalities.”
Dania to Dr S June 21
“This is what I meant. Have as much info as possible.”
Sclafani to Dania June 21
“thanks dana, glad to see that we have some common ground. I was debating against the
point of view that patients should be evaluated for malalignment prior to
venography. If i were sold on it I might do that, but at this point i havent
bought in that it is a general common association.”
Dania June 21
“Dr S there could be more than misalignment. Eagle's syndrome, bone spurs in the
neck stopping blood flow. Those patients need surgery to correct their problem.
Angio does not help. Being a Canadian, we must pay out of pocket for any
procedure. X rays and scans are not as expensive as angio. Or an upright MRI to
see if it is a CSF flow problem. Again angio is not the best solution. I do
encourage you to talk with Dr Flanagan. Maybe the best solution is correcting
CSF flow plus angio to correct blood flow. Do both. »
Sclafani June 21
“dania i think you are missing my point. Angio and IVUS are quite good at showing
stenoses, regardless of where they are located. Significant stenoses of all
causes, including those caused by bone spurs, misalignments and so forth are
best seen by angio and ivus, not xrays which can only show the bones. In
addition, my experience indicates to me that these upper lesions are just not
that common. The overwhelming percentage of patients have no problems with the
jugular vein except where it enters the chest. I am not arguing that these
other things do not occur, it is just that they are not common. and even if
present, they are almost always going to be accompanied by valvular stenosis of
inferior jugular bulb. No point in treating upper lesions without also
addressing the lower lesions. In addition, xrays and scans are not going to help
find the azygos vein stenosis present in about half of patients nor in showing
the compression of the left renal vein that is present in 25%.
So my clinical judgment is that angiography and IVUS are the key and the starting
point. If they fix the problems then great, end of story. if they don't then i
would consider these other options but would prefer more and better data than i
have seen so far.Thanks for the discussion, Dana. »
Dania to Dr S June 21
“I agree that angio and IVUS are excellent at showing stenoses. All I am trying to
convey is that for some stenosis might be caused by a problem with CSF flow. I
also think that, perhaps, if angio is performed when the patient's disabilities
are minor and they keep themselves healthy and exercise regularly they are more
likely to keep their improvements. For me I did very well for 18 years. No meds.
But I use to go to the gym 5 times a week and weight train. Heavy weights. I
could leg press 400 pounds. I was 5'6" weighed 120 lbs. It was when I stopped
going to the gym that my condition declined.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117722/
http://link.springer.com/article/10.100 ... rue#page-1 »
Vesta June 22
“Dr Sclafani:
I think you are missing our point. I believe it may be easier and
less expensive to check out and treat CSF problems BEFORE angioplasty. See if
such treatment works. A practical and financial question which may be medically
advantageous as well. We have to live with and pay for the conséquences. This
is not to doubt your dedication, expertise or competence. It's just survival.”
Dania June 22
“Thanks Vesta. That is my point of view, exactly. I guess I was not articulating it very
well. It is not being argumentative. Just an opinion and my experiences. If my
experiences helps anyone, so much the better. I completely drained my
retirement funds. If I had known what is my particular problem I would have
done everything differently.”
Dr Michael Flanagan wrote after having read the above June 25, 2013
8:52 am
Thanks for the interesting discussion.
I understand Dr. Scalfani's point as to
why he prefers angio and IVUS for determing venous flow problems due to stenosis
and faulty valves. Angio and IVUS are certainly much better at assesing those
types of stenosis and blood flow problems. On the other hand, angio and IVUS are
not the preferred method of diagnosing stenosis of the spine and obstruction to
CSF flow as a result of increased venous pressure in the VVP due to spondylosis,
stenosis and scoliosis of the spinal canal. Spondylosis, stenosis and scoliosis
affect the design of the canal, which affects hydrodynamics and CSF flow in the
cranial vault and spinal canal. The faulty hydrodynamics get worse during
upright posture. X-rays and upright MRI are much better than angio or IVUS for
determining these problems.
The other point is that angio and IVUS don't
rule out potential structural causes of obstruction to venous flow into the VVP
during upright posture. Venous blood preferentially drains into the VVP during
upright posture, not the IJs. The upper cervical canal is a key point of
obstruction. Angiograms also expose patinets to much more radiation than basic
x-rays of the spine and MRI so it makes more sense to get them first to rule out
and fix potential structural problems first, espeically if they obviate the need
for further more invasive intervention. Treating underlying structural problems
may also help improve the durability of venoplasty and stents when necessary.
Certain structural problems may also help surgeons better choose between
venoplasty versus shunts, such as in a case like CurIous associated with
cervical kyphosis and deformation by the transverse process of atlas. I further
suspect that venous insufficiency in the azygous and iliac veins can similarly
be caused by structural issues sucha as spondylosis, stenosis and scoliosis of
the lower spine due to their impact on myofascial tunnels and pressure
gradients.
June 25 9:28 am
Structural issues in the spine that affect blood and CSF flow in the cranial vault and
spinal canal are far more common and likely a cause of MS, as well as other
neurodegenerative diseases than problems in the jugular veins or TMJ for that
matter. It makes sense that lesions are often found in the area of spondylosis,
bone spurs and stenosis. Spondylosis, stenosis and scoliosis alter the design
of the tunnel of the spinal canal. When you change the dimensions and design of
a tunnel or pipe you alter the flow of fluids through it. It's basic physics.
Although he is a leading expert geotechical engineer and thinks in terms of
stone and soil stability so much so that it takes time to sink in like water
passing through thick clay, even, my tunneling expert brother gets it. I just
have to speak slowly and repeat myself many times.
10:53 am
Hello Vesta,
The VVP is the Vertebral Venous Plexus. Upright posture increases
blood flow in and out of the brain which required modifications to the basic
drainage system used by mammals. During upright posture, the human brain
primarily switches over to the occipital marginal sinus, emissary and accessory
venous system that drains into the VVP inside the spinal canal and around the
spine. The accessory veins and outlets are the lowest drainage points in the
posterior fossa.
June 26, 2013
Vesta,
I think that violent venous and CSF backjets due to trauma such as whiplash as proposed by Dr. Schelling is a possible cause of the supratentorial, periventricular and perivenular lesions seen in MS. Chronic ischemia, edema and increased CSF volume due to poor drainage are other causes. Lesions can also be caused by autoimmune-inflammatory conditions and infections.
Tags: Multiple Sclerosis, MS, CCSVI, Angioplasty, CSF, IVUS, Stenoses, Blood Reflux, Chiropractic, Venography
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