Wednesday, 12 May 2010

What some of the docs are saying…

This is totally a CCSVI post. Skip if you're not following.

During the May 6th meeting of the Subcommittee on Neurological Disease of the Standing Committee on Health (quite a mouthful there!), Dr. Kirsty Duncan, a Canadian Liberal MP, questioned President and CEO of the MS Society of Canada on the thing that bothers me most in the talks on CCSVI - how is this vascular issue any different from others?:

*Transcript link below.

"I would like to know why we are treating MS differently. If there is a vein problem in the liver and in the hip region we image and we treat it. I want to know why MS patients are being denied this treatment. I will also recognize that there has been controversy here that there was a death related to a stent but I want to know why MS patients are being treated differently and I will ask Mr. Savoie, please."

Facebook login required:

So, why is it? Regardless of whether MS could be a result of damage due to venous stenosis (abnormal narrowing in the veins) or even a cause of stenosis, why not fix the circulation issue? Removing MS from the picture completely, would vascular specialists not recommend trying to repair any signs of venous stenosis? If I showed up at a clinic, with no mention of MS at all, and I had blocked jugular or azygous veins, would vascular surgeons not recommend repair? And...that's assuming I'd get to the point of being tested! Right now, people with MS are being turned away from testing (doppler ultrasounds) because of all of the controversy surrounding CCSVI treatment.

I know there was a very unfortunate death due to stent travel when attempting this under the umbrella of "CCSVI treatment" and I feel for the life of that person, but is the risk here any stronger than that of any other vascular surgery? Dr. Sclafani (chief of Radiology at King's County in Brooklyn) broaches the dangers of jugular venoplasty and valvuloplasty - the treatments in question - on in a Q and A.

"Q: My question for you is, now that we are beginning to see after-op problems from ballooning the valves. Should folks with pathologic valve problems wait for additional research in this area BEFORE undergoing angioplasty?

Answer: Another tough question, sort of the same question as "should anyone undergo angioplasty before additional research" I do not think that reflux up the jugular vein is really the pathophysiology of this entity. Dr. Zamboni suggests that it the obstruction that is the real problem. This leading to reversal of flow through small vessels not designed to take that kind of flow. I do not think the problem is pressure or reverse pressure. It is flow I worry that these valves are going to be a real bugger, incomplete treatments, and recurrent obstructions. One gets the sense that something will be ultimately needed to fix the abnormal valve against the wall and stop it from restricting blood flow. Perhaps stents are the answer, or some endovenous procedure that resects the valve, or some other technique beyond my imagination at the moment. Surgery on veins, I am told by my vascular surgical colleagues is not without failure. This is all so new. So my answer is rather philosophical. You are all pioneers and are looking for answers at the front of the wave. It it were neurosurgery, I might say, wait awhile. But jugular venoplasty and valvuloplasty is not particularly dangerous. So I think the decision is about how far out into the frontier you want to travel. Me? I would venture forth and look for a solution to some future recurrence or complication when I see it."

Yep, it's all about how far out into the frontier you want to travel...

Oh no, I's all about how far out into the frontier health professionals will let us travel.

No comments:

Post a Comment

Please be respectful.