I was intending to revise the « After Diagnosis » post in keeping with my current understanding. I will do so, but first I need to rethink my own situation. I really don’t have an MD with whom I can discuss my problems. I need to huncker down and find a classical Homeopath. (In France they are called Unicists meaning one prescribes one remedy at a time which corresponds to the totality of symptoms. French Homeopaths in general don’t follow that protocol. Their multiple small dose remedies don’t work, at least for me.)
What has led me to this decision? Another Bladder Infection. And an awareness of what triggered it.
I was doing just fine when a bladder infection presented itself a month ago. I blasted it with an antibiotic recommended by my Acupuncture doctor. That helped, but I could tell the infection wasn’t gone and the drug made me sick. So I asked myself what had triggered the crisis? The answer. A jealous female aggression. (I can’t see anything to be jealous of, I’m the age of her mother and handicapped. Except her children and her husband like me. Give me a break.) The remedy is Staphysagria. So I took 3 grains at the 15CH strength. That helped, it boosted my mood which is a sign the remedy is correct. The following day I obtained the 30 CH and began to take 3 grains several times a day. And gradually the infectious symptoms disappeared.
As an explanation, we are all besieged by germs, viruses, nasties everywhere, all the time. So why does one become vulnerable, under what circumstance? An emotional stress event, even apparently a minor one, can open the door to illness. That is the fundamental idea behind Homeopathic treatment.
Staphysagria in my case describes a female who will put up with a lot so as to keep the peace. I was the responsible elder daughter who repressed my own anger. and aggression, partly out of fear. And I can see I’ve repeated this dynamic in my French relations. ( I was far more confident and assertive in my American life. Actually language may be partly the problem. English I can master, French I can speak, but not master.) (Censored)
Anger is Mars, War, Infection, Accidents. Reflecting on my decline since I came to France every phase corresponds to a repressed anger (Mars) event. Instead of projecting aggression outwards, it turns inwards. Accident, Infection. From the point of view of the individual, murder is healthier than suicide. Better to fight than to submit.
So a week ago Monday my husband offended me in front of some guests, I can’t fight back without making a scene which would be offensive to them. Tuesday another bladder infection. (I was “pissed off.” Appropriate symbolism.) I had stopped taking the Staphysagria (which was probably a mistake). I really need some knowledgeable advice and a Doctor I can contact in an emergency to nip these infections in the bud. I will doubtless suffer this susceptibility for the rest of my life and I abhor antibiotics. My best option is to find a competent classical (Hahnemann) homeopath whose treatment will strengthen me. Another advantage, the appointments are quite long in order to ascertain all the details of the person and current events so that hopefully I can find an interlocateur who will LISTEN.
And the physical, structural defect? After my first MS healing I continued to be troubled by bladder infections which I came to consider a more serious problem than the MS. Except now I believe they may be the SAME PROBLEM – CCSVI. In other words, restricted venous blood flow.
Dr. Sclafani writes “The Nutcracker and the May-Thurner syndrome are clinically manifested obstruction of the left renal vein and left common iliac vein that are caused by compression of these veins between two structures”
He has said that many MS patients exhibit this disorder. Though located far from the brain, the disrupted fluid flow impacts the entire vascular network including, for example, the jugulars.
It may be that this defect is at the origin of all my “congested” pelvic problems (bowel, bladder, ovarian).
But how am I to find out? Presumably these conditions can be treated by venoplasty with the insertion of a stent. Since the intervention doesn’t involve veins leading from the brain, it would seem possible to find an interventional radiologist in France willing to perform it. Even though the condition may be another manifestation of MS venous pathology, I probably shouldn't even mention MS since that means trespassing on another's territory - the Neurologist..
I’m going to quote a very long entry from Thisisms.com by Pukai posted Oct 2, 2014 which cogently illustrates the frustration for an MSer of being properly diagnosed and treated. While Germany is a highly industrialized, advanced society, Pukai (Marcus) was obliged to pay out of pocket to come to be treated by Dr Sclafani in New York. (I have emphasized certain passages.) How long will it take for MSers to be properly diagnosed and treated? Another generation of Doctors? Maybe two?
From Thisisms.com. Under CCSVI,” Dr. Sclafani answers some questions”
Pukai Oct 2, 2014
“Nutcracker Syndrome - CCSVI - Midline Congestion Syndrome - Venous Back Jets
As I already wrote in my first post Thursday last week, in 2013, during my first treatment of stenosed jugular vein valves on both sides in Brooklyn, a severe Nutcracker syndrome was diagnosed.
With IVUS, Dr. Sclafani found a compression of the left renal vein between the aorta and the superior mesenteric artery (SMA) which accounted for approximately 90% stenosis of the lumen. A pressure gradient of 6mm between the vena cava inferior and the area behind the compression close to the kidney (the hilar region) was measured - normally, there is no gradient at all (or a maximum of 1mm). As a consequence, instead of flowing into the vena cava inferior and then directly to the heart, there was reflux of left renal vein blood downwards into the gonadal vein and into the scrotum and upwards into the hemi-azygo-renal trunk and the hemiazygos vein.
Lacking a stent of sufficient dimensions to safely deploy it at that moment, I was offered the opportunity to return after the weekend for additional stenting of the left renal vein. But after thoroughly discussing this situation with my wife, who accompanied me, and Dr. Sclafani, I decided
to defer stenting until I saw the outcome of the angioplasty of jugular and azygos veins.
There were two main reasons for this decision:
Firstly, I had read about all the "main" areas (jugular and azygos veins) of the CCSVI treatment mentioned in the Zamboni studies, and I was prepared for some findings. I have to admit that I had not really addressed the Nutcracker subject at that time.
I had made the experience that getting adequate diagnosis and treatment of CCSVI in Germany was impossible. Being engaged in this field as someone with a MS-label had the characteristics of some kind of underground fight because of reasons far away from help for patients or the search for medical insight. And - of course - no way to get support from your medical insurance at all. Based on this background, for me, the decision to get treated by Dr. Sclafani -far away from home and "out of the pocket" - was the only logical one.
On the other hand, the condition described above as Nutcracker syndrome for me was clearly a vascular problem with indisputable pathological clinical symptoms even for somebody not diagnosed with MS: For example, reflux of blood into the gonadal vein and scrotum leads to painful varikozele and can impair fertility. Both of these symptoms had been part of my problems in the recent past without any of the doctors in charge even thinking of Nutcracker. Now, with Dr. Sclafani's gold-standard diagnosis, I thought that it would be possible to get the Nutcracker stenting done in Germany and take advantage of reimbursement of costs by the medical insurance company and of an unproblematic aftercare close to my home. This was naive and a big mistake, as I had to find out during 2013.
When I asked Dr. Sclafani if he could name someone in Germany who knows about Nutcracker syndrome and who perhaps can help me to find an interventional radiologist for treatment, he recommended to contact Professor Dr. Thomas Scholbach, the author of the study titled "From the nutcracker-phenomenon of the left renal vein to the midline congestion syndrome as a cause
of migraine, headache, back and abdominal pain and functional disorders of pelvic organs " from 2006. (http://www.ncbi.nlm.nih.gov/pubmed/17161550)
For me, getting to know Dr. Scholbach was another stroke of luck. He is a paediatrician and ultrasound specialist. At that time, he was Head of the Clinic for Paediatrics and Adolescent Medicine in a hospital in Chemnitz. I sended him an email describing my case, including the CCSVI background of my treatment in Brooklyn. He immediately answered my mail via telephone and told me that he was very interested in this subject since having read the first Zamboni papers. My bad experiences with doctors in the past concerning CCSVI in mind, I was totally surprised.
Dr. Scholbach explained to me that the idea of pathological effects of CCSVI outflow problems is very plausible to him and seems to fit to his own studies and hypothesis connected to the Nutcracker syndrome (NCS), which he had coined "midline congestion syndrome" in 2006, not knowing about Zamboni' s study yet.
Interestingly, his approach to this venous cause of several sometimes misdiagnosed symptoms or diseases mistakenly called "idiopathic" comes from the descriptions of symptoms given by ill children and adolescents in his hospital practice. During his medical examinations of the patients with colour doppler ultrasound in the past, he has found more than 1000 cases of left renal vein compression, which is a remarkable basis for a correlation between symptoms described and outflow disturbances caused by NCS.
Before he startet the ultrasound examination of my abdomen and kidney area, he asked me about my symptoms. Besides the other well known typical "MS"- symptoms, I mentioned my long term problems with back pain and this strange and debilitating problem of a balloon-like feeling in my upper abdomen, connected with increasing weakness in my legs when trying to move faster.
I was totally flabbergasted when Dr. Scholbach told me that all these clinical symptoms are common in young Nutcracker patients. Sometimes - that' s my understandind of his explanation - during childhood and adolescence developmental changes of the venous pathways prevent from pathological and debilitating problems otherwise following a Nutcracker phenomenon found in early years. Laying on the treatment table, unhappy moments of my life came into my mind:
-Since I was a small boy, I very often suffered from abdominal pain in different areas. Doctor's explanation was sensitive stomach and bowel as a stress reaction to my difficult family situation - my mother suffered from progressing "MS" since having given birth to me. For everybody this diagnosis of an "idiopathic symptom" was convincing. I learned to live with it.
- When I was 12 years old, I had to give up playing in my highschool soccer team due to heavy back pain in the lower vertebral column. Orthopaedic diagnosis was a sliding vertebra. 8 years later, another orthopaedist didn't find any signs of this bone malformation. But I still had those back pain attacks. Before Nutcracker stenting, back pain in the lower vertebral column had become more and more frequent and enduring. Today, it is almost gone. Have this been signs of NCS? Did my mother eventually suffer from venous malformations, too?
During my appointment with Dr. Scholbach, he confirmed Dr. Sclafani's diagnosis of a severe NCS using colour-doppler ultrasound (CDUS). But in addition, he was able to make visible a large so called "tronc-réno-rachidien" or hemiazygo-left renal trunc, a venous connection between the renal vein and the veins of the epidural plexus, which is not developed in every individual. In my case, he could prove pulsating reflux of renal blood directly into the spine through a "trou de conjugaison" (where spinal nerves leave the spinal column). This is exactly that pathophysiological mechanism described in the 1970ies by Aboulker in France when he examined and treated patients suffering from paresis. Operative interruption of this connecting vein had lead to massive improvement of the symptoms.
(You can download this text from Aboulker from this site here: https://www.wuala.com/pukai/literature/
You have to draw the mouse pointer into the area under "Actions" and click the left arrow for download. Clicking on the title only will show you a blurred preview. I hope it works!)
Dr. Scholbach recently wrote a comprehensive essay for patients about Nutcracker syndrome and other venous compression syndromes like May-Thurner and pelvic congestion, for example. It is very informative, written clearly, contains an anatomical introduction, a of lot of descriptive illustrations and an overview of symptoms found connected with those venous malformations.
You can download this text from this site here, too: https://www.wuala.com/pukai/literature/
During last year, when my walking ability became more and more worse, I had to find out that Nutcracker syndrome is scarcely known among doctors in Germany. It is almost impossible to get a thorough examination of this malformation here (the exeption Scholbach proves the rule) , and that there is no experience in stenting the renal vein at all (I am happy if someone will contradict me!).
So, again, I was very happy to get the stenting done by Dr. Sclafani in early 2014.
From a scientific point of view, waiting one year between the CCSVI treatment with ballooning of the known veins without stenting the Nutcracker compression and repeated CCSVI treatment including the stenting procedure seems to offer additional insight - at least in my case. Long time "handicaps" vanished not until stenting:
An urologist examined my varicozele and testicles short time before the second treatment in Brooklyn. He diagnosed a second-degree varicozele. This diagnosis was confirmed by doctors at the University Hospital in Münster. A ligature of the vein was proposed to perhaps increase quality of spermiogram. They didn't know about the interventional kind of Nutcracker treatment.
Six weeks ago, the local urologist did the ultrasound again and attested the remission of the varicozele for one degree. It's only a slight one-degree varicozele now. Does not seem to be a placebo effect to me. Seems to be restored bloodflow of the left renal vein. I told him about my treatment in Brooklyn, and he was the first doctor here in Germany who really expressed congratulatons for this decision and treatment.
Dr. Scholbach repeated the ultrasound examination this summer, 6 months after stenting. He found the stent completely free, it's lumen excellently filled and with brisk perfusion. Direction of bloodflow of the gonadal vein is normal again - blood flows from the scrotum into the stented renal vein again! And - what is most exciting for me: there s no more blodflow directed through the tronc-réno-rachidien into the spinal canal any more!
And I am able to start jogging again without increasing paralysis of my legs.
There are still a lot of problems left concerning "qualtiy of life". Officially, I suffer from "MS" for 17 years now. Nobody looked at a venous connection of inflammatiory lesions in my nervous system for a long time. -
Last of all, I will ask a question about a connection between NCS and Dr. Schelling's idea of so called "venous back jets" and spinal lesions in MS.
Dr. Sclafani mentions in a former post ( chronic-cerebrospinal-venous-insufficiency-ccsvi-f40/topic10680-7980.html#p217031 ), the existance of NCS in a patient with CCSVI will probably have a boosting effect on symptoms.
Dr. Schelling states in his essay;
"In view of the many striking parallels, both as to lesion patterns and tissue changes, between the remote effects of spinal concussion and spinal multiple sclerosis, vehement endogenous subarachnoid fluid shifts might be expected to play a preeminent role in disease genesis. If sufficiently intense, such fluid displacements could actually damage the spinal cord partially or in its entire length, conforming to the zones of insertion of the denticulate ligaments and of other particularly tough anchorages of the spinal cord to the dural sac. The question arises as to which mechanism actuates such intense endogenous shifts of spinal subarachnoid fluid -- shifts which are continually repeated and thereby tend to become intensified.
In comparing arterial as against venous conductivity, and the intensity of the pressure-dependent blood-displacements in the arteries as against the veins, the volume-displacements within the craniovertebral space, which are effected by local veins, can be expected to be far more effective than those of arterial vessels. This conclusion is corroborated by the results of studies on arterial and venous cerebrospinal fluid displacements, which show that far the most intense (endogenous) cerebrospinal fluid shifts are due to venous back-jets rushing back from veins inside the abdomen into veins encompassing the lowest part of the spinal dural sac (cf. Plate XIV, figg. C, D) (39,111). There are individuals who have shown subarachnoid fluid shifts so vehement as to be likened to "plunger strokes" (136).
Continually subjecting the spinal cord, in short-term repetitions, to this intrinsically self-aggravating mechanism, venous back-jet induced subarachnoid fluid displacements from the lower spinal canal may gradually become so intensified as to eventually be injurious. Dragging the spinal cord headwards, such intense subarachnoid fluid shifts may be capable of injuring the spinal cord by means of abrupt tensile impacts exerting their effects specifically along those fibrous structures which represent the spinal cord’s most stressed anchorages to the dural sac.
Both specific spinal cord patches and brain plaques, though differing essentially as to form and structure, thus become understandable in terms of one and the same causative mechanism, namely vehement, specifically localized venous regurgitation into the craniovertebral space. " ( http://www.ms-info.net/evo/msmanu/956.htm#level_5_2 )
Is it possible that pulsating inflow of blood from the left renal vein into the spinal canal via the tronc-réno-rachidien forced by a Nutcracker compression fits exactly into Dr. Schelling's description of "venous back-jets rushing back from veins inside the abdomen into veins encompassing the lowest part of the spinal dural sac" ?
Thank you for taking your time and reading this long post -
-Marcus”
And thanks to Marcus for this wonderfully informative post.
Tags: Multiple Sclerosis, MS, CCSVI, Dr. Sclafani, Nutcracker Syndrome, May-Thurner Syndrome, Homeopathy, Staphysagria, Dr. Schelling, Dr. Scholbach
What has led me to this decision? Another Bladder Infection. And an awareness of what triggered it.
I was doing just fine when a bladder infection presented itself a month ago. I blasted it with an antibiotic recommended by my Acupuncture doctor. That helped, but I could tell the infection wasn’t gone and the drug made me sick. So I asked myself what had triggered the crisis? The answer. A jealous female aggression. (I can’t see anything to be jealous of, I’m the age of her mother and handicapped. Except her children and her husband like me. Give me a break.) The remedy is Staphysagria. So I took 3 grains at the 15CH strength. That helped, it boosted my mood which is a sign the remedy is correct. The following day I obtained the 30 CH and began to take 3 grains several times a day. And gradually the infectious symptoms disappeared.
As an explanation, we are all besieged by germs, viruses, nasties everywhere, all the time. So why does one become vulnerable, under what circumstance? An emotional stress event, even apparently a minor one, can open the door to illness. That is the fundamental idea behind Homeopathic treatment.
Staphysagria in my case describes a female who will put up with a lot so as to keep the peace. I was the responsible elder daughter who repressed my own anger. and aggression, partly out of fear. And I can see I’ve repeated this dynamic in my French relations. ( I was far more confident and assertive in my American life. Actually language may be partly the problem. English I can master, French I can speak, but not master.) (Censored)
Anger is Mars, War, Infection, Accidents. Reflecting on my decline since I came to France every phase corresponds to a repressed anger (Mars) event. Instead of projecting aggression outwards, it turns inwards. Accident, Infection. From the point of view of the individual, murder is healthier than suicide. Better to fight than to submit.
So a week ago Monday my husband offended me in front of some guests, I can’t fight back without making a scene which would be offensive to them. Tuesday another bladder infection. (I was “pissed off.” Appropriate symbolism.) I had stopped taking the Staphysagria (which was probably a mistake). I really need some knowledgeable advice and a Doctor I can contact in an emergency to nip these infections in the bud. I will doubtless suffer this susceptibility for the rest of my life and I abhor antibiotics. My best option is to find a competent classical (Hahnemann) homeopath whose treatment will strengthen me. Another advantage, the appointments are quite long in order to ascertain all the details of the person and current events so that hopefully I can find an interlocateur who will LISTEN.
And the physical, structural defect? After my first MS healing I continued to be troubled by bladder infections which I came to consider a more serious problem than the MS. Except now I believe they may be the SAME PROBLEM – CCSVI. In other words, restricted venous blood flow.
Dr. Sclafani writes “The Nutcracker and the May-Thurner syndrome are clinically manifested obstruction of the left renal vein and left common iliac vein that are caused by compression of these veins between two structures”
He has said that many MS patients exhibit this disorder. Though located far from the brain, the disrupted fluid flow impacts the entire vascular network including, for example, the jugulars.
It may be that this defect is at the origin of all my “congested” pelvic problems (bowel, bladder, ovarian).
But how am I to find out? Presumably these conditions can be treated by venoplasty with the insertion of a stent. Since the intervention doesn’t involve veins leading from the brain, it would seem possible to find an interventional radiologist in France willing to perform it. Even though the condition may be another manifestation of MS venous pathology, I probably shouldn't even mention MS since that means trespassing on another's territory - the Neurologist..
I’m going to quote a very long entry from Thisisms.com by Pukai posted Oct 2, 2014 which cogently illustrates the frustration for an MSer of being properly diagnosed and treated. While Germany is a highly industrialized, advanced society, Pukai (Marcus) was obliged to pay out of pocket to come to be treated by Dr Sclafani in New York. (I have emphasized certain passages.) How long will it take for MSers to be properly diagnosed and treated? Another generation of Doctors? Maybe two?
From Thisisms.com. Under CCSVI,” Dr. Sclafani answers some questions”
Pukai Oct 2, 2014
“Nutcracker Syndrome - CCSVI - Midline Congestion Syndrome - Venous Back Jets
As I already wrote in my first post Thursday last week, in 2013, during my first treatment of stenosed jugular vein valves on both sides in Brooklyn, a severe Nutcracker syndrome was diagnosed.
With IVUS, Dr. Sclafani found a compression of the left renal vein between the aorta and the superior mesenteric artery (SMA) which accounted for approximately 90% stenosis of the lumen. A pressure gradient of 6mm between the vena cava inferior and the area behind the compression close to the kidney (the hilar region) was measured - normally, there is no gradient at all (or a maximum of 1mm). As a consequence, instead of flowing into the vena cava inferior and then directly to the heart, there was reflux of left renal vein blood downwards into the gonadal vein and into the scrotum and upwards into the hemi-azygo-renal trunk and the hemiazygos vein.
Lacking a stent of sufficient dimensions to safely deploy it at that moment, I was offered the opportunity to return after the weekend for additional stenting of the left renal vein. But after thoroughly discussing this situation with my wife, who accompanied me, and Dr. Sclafani, I decided
to defer stenting until I saw the outcome of the angioplasty of jugular and azygos veins.
There were two main reasons for this decision:
Firstly, I had read about all the "main" areas (jugular and azygos veins) of the CCSVI treatment mentioned in the Zamboni studies, and I was prepared for some findings. I have to admit that I had not really addressed the Nutcracker subject at that time.
I had made the experience that getting adequate diagnosis and treatment of CCSVI in Germany was impossible. Being engaged in this field as someone with a MS-label had the characteristics of some kind of underground fight because of reasons far away from help for patients or the search for medical insight. And - of course - no way to get support from your medical insurance at all. Based on this background, for me, the decision to get treated by Dr. Sclafani -far away from home and "out of the pocket" - was the only logical one.
On the other hand, the condition described above as Nutcracker syndrome for me was clearly a vascular problem with indisputable pathological clinical symptoms even for somebody not diagnosed with MS: For example, reflux of blood into the gonadal vein and scrotum leads to painful varikozele and can impair fertility. Both of these symptoms had been part of my problems in the recent past without any of the doctors in charge even thinking of Nutcracker. Now, with Dr. Sclafani's gold-standard diagnosis, I thought that it would be possible to get the Nutcracker stenting done in Germany and take advantage of reimbursement of costs by the medical insurance company and of an unproblematic aftercare close to my home. This was naive and a big mistake, as I had to find out during 2013.
When I asked Dr. Sclafani if he could name someone in Germany who knows about Nutcracker syndrome and who perhaps can help me to find an interventional radiologist for treatment, he recommended to contact Professor Dr. Thomas Scholbach, the author of the study titled "From the nutcracker-phenomenon of the left renal vein to the midline congestion syndrome as a cause
of migraine, headache, back and abdominal pain and functional disorders of pelvic organs " from 2006. (http://www.ncbi.nlm.nih.gov/pubmed/17161550)
For me, getting to know Dr. Scholbach was another stroke of luck. He is a paediatrician and ultrasound specialist. At that time, he was Head of the Clinic for Paediatrics and Adolescent Medicine in a hospital in Chemnitz. I sended him an email describing my case, including the CCSVI background of my treatment in Brooklyn. He immediately answered my mail via telephone and told me that he was very interested in this subject since having read the first Zamboni papers. My bad experiences with doctors in the past concerning CCSVI in mind, I was totally surprised.
Dr. Scholbach explained to me that the idea of pathological effects of CCSVI outflow problems is very plausible to him and seems to fit to his own studies and hypothesis connected to the Nutcracker syndrome (NCS), which he had coined "midline congestion syndrome" in 2006, not knowing about Zamboni' s study yet.
Interestingly, his approach to this venous cause of several sometimes misdiagnosed symptoms or diseases mistakenly called "idiopathic" comes from the descriptions of symptoms given by ill children and adolescents in his hospital practice. During his medical examinations of the patients with colour doppler ultrasound in the past, he has found more than 1000 cases of left renal vein compression, which is a remarkable basis for a correlation between symptoms described and outflow disturbances caused by NCS.
Before he startet the ultrasound examination of my abdomen and kidney area, he asked me about my symptoms. Besides the other well known typical "MS"- symptoms, I mentioned my long term problems with back pain and this strange and debilitating problem of a balloon-like feeling in my upper abdomen, connected with increasing weakness in my legs when trying to move faster.
I was totally flabbergasted when Dr. Scholbach told me that all these clinical symptoms are common in young Nutcracker patients. Sometimes - that' s my understandind of his explanation - during childhood and adolescence developmental changes of the venous pathways prevent from pathological and debilitating problems otherwise following a Nutcracker phenomenon found in early years. Laying on the treatment table, unhappy moments of my life came into my mind:
-Since I was a small boy, I very often suffered from abdominal pain in different areas. Doctor's explanation was sensitive stomach and bowel as a stress reaction to my difficult family situation - my mother suffered from progressing "MS" since having given birth to me. For everybody this diagnosis of an "idiopathic symptom" was convincing. I learned to live with it.
- When I was 12 years old, I had to give up playing in my highschool soccer team due to heavy back pain in the lower vertebral column. Orthopaedic diagnosis was a sliding vertebra. 8 years later, another orthopaedist didn't find any signs of this bone malformation. But I still had those back pain attacks. Before Nutcracker stenting, back pain in the lower vertebral column had become more and more frequent and enduring. Today, it is almost gone. Have this been signs of NCS? Did my mother eventually suffer from venous malformations, too?
During my appointment with Dr. Scholbach, he confirmed Dr. Sclafani's diagnosis of a severe NCS using colour-doppler ultrasound (CDUS). But in addition, he was able to make visible a large so called "tronc-réno-rachidien" or hemiazygo-left renal trunc, a venous connection between the renal vein and the veins of the epidural plexus, which is not developed in every individual. In my case, he could prove pulsating reflux of renal blood directly into the spine through a "trou de conjugaison" (where spinal nerves leave the spinal column). This is exactly that pathophysiological mechanism described in the 1970ies by Aboulker in France when he examined and treated patients suffering from paresis. Operative interruption of this connecting vein had lead to massive improvement of the symptoms.
(You can download this text from Aboulker from this site here: https://www.wuala.com/pukai/literature/
You have to draw the mouse pointer into the area under "Actions" and click the left arrow for download. Clicking on the title only will show you a blurred preview. I hope it works!)
Dr. Scholbach recently wrote a comprehensive essay for patients about Nutcracker syndrome and other venous compression syndromes like May-Thurner and pelvic congestion, for example. It is very informative, written clearly, contains an anatomical introduction, a of lot of descriptive illustrations and an overview of symptoms found connected with those venous malformations.
You can download this text from this site here, too: https://www.wuala.com/pukai/literature/
During last year, when my walking ability became more and more worse, I had to find out that Nutcracker syndrome is scarcely known among doctors in Germany. It is almost impossible to get a thorough examination of this malformation here (the exeption Scholbach proves the rule) , and that there is no experience in stenting the renal vein at all (I am happy if someone will contradict me!).
So, again, I was very happy to get the stenting done by Dr. Sclafani in early 2014.
From a scientific point of view, waiting one year between the CCSVI treatment with ballooning of the known veins without stenting the Nutcracker compression and repeated CCSVI treatment including the stenting procedure seems to offer additional insight - at least in my case. Long time "handicaps" vanished not until stenting:
An urologist examined my varicozele and testicles short time before the second treatment in Brooklyn. He diagnosed a second-degree varicozele. This diagnosis was confirmed by doctors at the University Hospital in Münster. A ligature of the vein was proposed to perhaps increase quality of spermiogram. They didn't know about the interventional kind of Nutcracker treatment.
Six weeks ago, the local urologist did the ultrasound again and attested the remission of the varicozele for one degree. It's only a slight one-degree varicozele now. Does not seem to be a placebo effect to me. Seems to be restored bloodflow of the left renal vein. I told him about my treatment in Brooklyn, and he was the first doctor here in Germany who really expressed congratulatons for this decision and treatment.
Dr. Scholbach repeated the ultrasound examination this summer, 6 months after stenting. He found the stent completely free, it's lumen excellently filled and with brisk perfusion. Direction of bloodflow of the gonadal vein is normal again - blood flows from the scrotum into the stented renal vein again! And - what is most exciting for me: there s no more blodflow directed through the tronc-réno-rachidien into the spinal canal any more!
And I am able to start jogging again without increasing paralysis of my legs.
There are still a lot of problems left concerning "qualtiy of life". Officially, I suffer from "MS" for 17 years now. Nobody looked at a venous connection of inflammatiory lesions in my nervous system for a long time. -
Last of all, I will ask a question about a connection between NCS and Dr. Schelling's idea of so called "venous back jets" and spinal lesions in MS.
Dr. Sclafani mentions in a former post ( chronic-cerebrospinal-venous-insufficiency-ccsvi-f40/topic10680-7980.html#p217031 ), the existance of NCS in a patient with CCSVI will probably have a boosting effect on symptoms.
Dr. Schelling states in his essay;
"In view of the many striking parallels, both as to lesion patterns and tissue changes, between the remote effects of spinal concussion and spinal multiple sclerosis, vehement endogenous subarachnoid fluid shifts might be expected to play a preeminent role in disease genesis. If sufficiently intense, such fluid displacements could actually damage the spinal cord partially or in its entire length, conforming to the zones of insertion of the denticulate ligaments and of other particularly tough anchorages of the spinal cord to the dural sac. The question arises as to which mechanism actuates such intense endogenous shifts of spinal subarachnoid fluid -- shifts which are continually repeated and thereby tend to become intensified.
In comparing arterial as against venous conductivity, and the intensity of the pressure-dependent blood-displacements in the arteries as against the veins, the volume-displacements within the craniovertebral space, which are effected by local veins, can be expected to be far more effective than those of arterial vessels. This conclusion is corroborated by the results of studies on arterial and venous cerebrospinal fluid displacements, which show that far the most intense (endogenous) cerebrospinal fluid shifts are due to venous back-jets rushing back from veins inside the abdomen into veins encompassing the lowest part of the spinal dural sac (cf. Plate XIV, figg. C, D) (39,111). There are individuals who have shown subarachnoid fluid shifts so vehement as to be likened to "plunger strokes" (136).
Continually subjecting the spinal cord, in short-term repetitions, to this intrinsically self-aggravating mechanism, venous back-jet induced subarachnoid fluid displacements from the lower spinal canal may gradually become so intensified as to eventually be injurious. Dragging the spinal cord headwards, such intense subarachnoid fluid shifts may be capable of injuring the spinal cord by means of abrupt tensile impacts exerting their effects specifically along those fibrous structures which represent the spinal cord’s most stressed anchorages to the dural sac.
Both specific spinal cord patches and brain plaques, though differing essentially as to form and structure, thus become understandable in terms of one and the same causative mechanism, namely vehement, specifically localized venous regurgitation into the craniovertebral space. " ( http://www.ms-info.net/evo/msmanu/956.htm#level_5_2 )
Is it possible that pulsating inflow of blood from the left renal vein into the spinal canal via the tronc-réno-rachidien forced by a Nutcracker compression fits exactly into Dr. Schelling's description of "venous back-jets rushing back from veins inside the abdomen into veins encompassing the lowest part of the spinal dural sac" ?
Thank you for taking your time and reading this long post -
-Marcus”
And thanks to Marcus for this wonderfully informative post.
Tags: Multiple Sclerosis, MS, CCSVI, Dr. Sclafani, Nutcracker Syndrome, May-Thurner Syndrome, Homeopathy, Staphysagria, Dr. Schelling, Dr. Scholbach
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