Dr. Teri Jaklin
NEW PATHWAYS; TRANSFORMING LIFE WITH MS
Burlington Art Centre
A symposium that looks at many aspects of dealing with life with MS and education people with MS in a bigger way - sharing this information with a view to making it better.
The webpage is http://www.newpathways.ca
The facebook page is http://www.facebook.com/groups/245983115508190/
People requesting information regarding accommodations, Teri tells us that The Burlington Waterfront Inn is right down the street and is very nice.
SYNERGY HEALTH CANADA TOURS
Synergy Health Concepts from Costa Mesa California provided us with 2 information sessions in August. One was in London and the other in Barrie, Ontario. Both were a great success.
Along with Dr. Michael Arata, Dr. Bill Code and Dr. Teri Jaklin also presented us with pertinent information regarding CCSVI and JVH ( Jugular Venous Hypertension) .
NOW AVAILABLE -
To view the video presentations, please follow the links below
Dr. Michael Arata
Dr. Bill Code
Dr. Teri Jaklin
Many thanks to these three for sharing their knowledge, their time and their understanding with so many of us.
Rhode Island Vascular Institute and CCSVI Foundation, Patient Information Session on CCSVI.
VASCULAR ACCESS CENTERS
James F. McGuckin, Jr., M.D
Bio - Chief Executive Officer and Founder of Vascular Access Centers. Dr. McGuckin’s research interests include: Cardiovascular Systems, Endoscopy and Endosurgery, Peripheral Arterial Disease, Limb Salvage, Percutaneous Oncologic Therapy and therapy related to the End Stage Renal Disease population. He is currently researching recanalization of Central Venous Occlusion using RF ablation. He holds 39 patents and has over 170 pending patents. Dr. McGuckin double majored in Mechanical Engineering and Pre-Medical from the University of Notre Dame in 1983, and received his M.D. from Hahnemann University in 1987, General Surgery in 1988, Masters Degree in Bioengineering at the University of Pennsylvania in 1990, Diagnostic Imaging in 1995, and completed his Fellowship in Interventional Radiology at the Hospital of the University of Pennsylvania in 1996. (Photo - Dr. McGuckin & Dr. Zamboni )
1) How aggressively do you treat stenosis? Are the veins/valves simply stretched, or are they 'disrupted?’ Angioplasty causes a controlled tear in the lining and the wall of the blood vessel, leading to plastic deformation and therefore disruption of the stricture/web/stenosis/valvular irregularity, resulting in an increase in diameter of the vein. Increased diameter leads to increased flow, which leads to decreased venous pressure. We disrupt all narrowings via angioplasty.
2) How do you choose balloon size/pressure? Balloon size is chosen to match the patient’s anatomy. You would be surprised how different people are on the inside. Some big men have very small vessels, and some tiny women have the opposite. So, the venogram gives the correlative picture upon which the balloon size is chosen. It's very important to treat these narrowings with high pressure angioplasty because some of these lesions are extremely resistant. Our goal is to use the largest balloons that the anatomy will tolerate at the highest rated burst pressure of the balloon, with prolonged inflation. I am working in the laboratory on low pressure, large vessel dilation systems.
3) What is the prevalence of problems with valves in the patients that you treat? Do you routinely do valvuloplasties? Most patients have valvular disorders causing stenoses. All these stenoses get valvuloplasty.
4) What is your philosophy/experience with stents? At what point would you insert a stent? Stents are an incredibly important tool in minimally invasive medicine because they enable holding open a vessel that re-narrows after a successful angioplasty. I recommend stents, however, only at times of failed angioplasty, dissection/rupture of the vessel, when recanalizing an occluded vessel, or intra-stent stenosis which also has failed angioplasty. I think it has received a lot of bad press because of mishaps, but I can assure you that it is generally very safe, and when appropriately sized and delivered, an invaluable tool. It would be a mistake to restrict its usage in the proper setting. However, we have to keep in mind that many CCSVI patients are young and we should be extremely cautious in their use in this population.
5) Will you treat a patient for whom there is little apparent stenosis? Yes. I have seen amazingly thin webs and synechiae in the azygous, iliac, and jugular systems that would be easily missed by a non-invasive study. I've seen false positive and false negative MR venograms and therefore, venography remains the gold standard.
6) If a clot forms, is this usually an emergency situation? Is there a doctor at the VAC Center in Tukwila at all times who can deal with it? Or can this be treated by most vascular/coronary doctors? How much time would a patient have to get treatment? Is it like a blood clot leading to the brain (not away from it)? All VAC physicians performing CCSVI procedures are capable of treating vessel thrombosis. The presentation of each patient is unique and the treatment performed at that time is based on their overall condition. Fortunately, the incidence of thrombosis is very low with our techniques. Clots rarely form in endovascular procedures, but when they do, the clot can be removed, broken up, or dissolved in rapid fashion. If a clot were to occur, it would be in a vein leading away from the brain and the other veins draining the brain would typically compensate. While this is an important condition to resolve, it is not typically life-threatening.
7) How often does severe restenosis occur? Could this be an emergency situation in some cases? Is there a doctor at the VAC Center at any time to deal with this? My analogy for stenosis is as if a bridge on your commuter path were being narrowed inch by inch, day by day. Commuters would learn of the impending slow-down and would learn to take alternate routes as the commute worsened. The body does the same thing when stenoses occur and these alternate routes are called collaterals. The original presenting symptoms may return when a recurrent stenosis develops. When we treat the underlying stenoses successfully, typically these collaterals will regress, thereby possibly improving the symptoms. Restenosis in venous therapy is common, but fortunately treatable & most often does not pose an emergent threat.
. 8) What kind of follow-up do you have? Do you check for restenosis? How often? I think the best indicator of the patients' vascular health is the monitoring of their own symptoms. If the symptoms present at the time of treatment recur over a prolonged period, it is likely that restenosis has occurred. Vascular Access Centers has received approval from the IRB to participate in the Hubbard Registry. We adhere to the follow-up protocol established in this registry.
9) What kind of blood thinner do you use? Is any kind of follow-up needed for this? Would it be a good idea to get a blood test to see the ability of the blood to coagulate (can't remember the right term here)? No anti-coagulate is used during the procedure unless a stent is required. A typical patient is given a loading dose of Plavix the day of the procedure and then will remain on Plavix 75mg and ASA 81mg daily for 2 months. If patients have issues with these medications they will be adjusted accordingly. If a stent is required, I recommend long-term Plavix therapy.
10) Generally, what have the results been for VAC? What is the rate of restenosis? Our positive results are approaching 80%, but we inform the patients about the "rule of thirds" - 1/3 of patients see dramatic improvement, 1/3 of patients see some transient improvement, and 1/3 of patients see little to no improvement at all. Restenosis is a process that typically occurs at 6 months to 12 months post-procedure, so I do not have an accurate assessment thus far. I can say, in patients that I have treated that have been seen elsewhere, that restenosis is typically w/in existing stents or stenoses are being discovered that were never treated.
11) In the case of restenosis, is there a reduced charge for treatment? Charges vary based on treatment
12) Who are the other IR's who perform angioplasties in Dr. McGuckin's absence? Would he be available in an emergency situation? How quickly? Other IR physicians at VAC include Dr. Robert Worthington-Kirsch, Dr. Mario Moya, Dr. Jorge Salazar, and Dr. Daniel Simon. Treatment of CCSVI is an elective procedure and scheduled at a time that works mutually for the physician and patient. This is an outpatient procedure and patients typically travel the following day. To date, we have not seen any neurologic complications post-procedure
13) How many patients has VAC treated to date? Over 200
14) What other techniques are you using - i.e. cutting balloons, using blood flow in the azygos to diagnose stenosis, etc? When high-pressure angioplasty fails (which is very uncommon), we use a cutting balloon technique to achieve maximum dilation and resolve the underlying pathology.
15) Is VAC part of Dr. Hubbards registry? If not - why not? Yes, we were approved by the IRB to participate in The Hubbard Registry in March of 2011. Dr. Hubbard has personally inspected several of our sites.
16) Have you seen any MS patients who DIDN'T have CCSVI? No
8) What veins are you actually testing/treating? Iliac, IVC, Renals, SVC, Brachiocephalic, Azygous, Jugulars. A few patients on rare occasions have required arteriographic study prior to venous intervention because of the complex underlying pathology from their condition.
9) I'd like to hear an overview of your impressions of CCSVI, how you relate it to MS, & what is your impression of this discovery? Budd-Chiari is a similar disease process effecting the liver and causing fibrosis from iron deposition. The treatment here is promoting venous drainage from the liver. The treatment of opening the venous drainage of the brain in CCSVI patients makes sense from this perspective. While I think MS has multiple etiologies, the vascular component can often be treated successfully.
10) Anything else you think is important? I think that patients need to understand that the procedural risk is very low and treatment typically takes less than an hour and a half, however, the benefits can be amazing. If I had MS, I would seek out the Liberation procedure.
Multiple Sclerosis as Defined by the Allopathic Medical Profession
M.S. Is a progressive degenerative disease of the central nervous system including the brain, the optic nerve and the spinal cord. It is characterized by many areas of inflammation and scarring of the myelin sheaths in the brain and spinal cord. These are wrappings , composed of a fatty substance that insulate the nerve fibres throughout the body. “Sclerosis” means hardening of tissue, and “Multiple” simply indicates many areas of hardening. The bodies immune system malfunctions and produces antibodies that attack the myelin sheaths. Consequently, the sheaths are damaged and these areas develop scarring which leads to “distorted communication” or lack of between the nerve endings. The disease typically follows a pattern of periodic flareups called “exacerbations” followed by periods in which symptoms diminish, called “remissions”
The cause remains unknown, but there has been speculation which relates the illness to hereditary factors, environmental and food allergies and viruses which cause the onset.
Although doctors have not clearly identified the source of the illness and there is no specific treatment, there are many prescriptions that are written for M.S. Which are stated to slow the progression or alleviate symptoms. It is important to be aware of what is offered and the side effects that can result from the medications currently prescribed.
“Corticosteroids” (Steroids) – to apparently reduce inflammation
“Prednisone” - taken by capsule form – to reduce inflammation and lessen onset
“Methylprednisone” – to reduce symptoms and slow progression
These all cause weight gain, bloating, headache, and are hard on the kidneys
“Glatiramer” (Copaxone) – Designed by pharmaceutical companies to “block the immune system” to disable it from attacking the myelin. This is given by injection and there is no proof that this is effective. The side effects with this are obvious, - it leaves a vulnerable system.
“Interferons” such as Betaseron, Avonex, and Rebif - “Appear” to slow rate of M.S. Symptoms but it is not the case with all patients and doctors are aware of the lack of success with this medication.
'Mitoxantrone” (Novatrone) – is an immunosuppressant” again used to stop the immune system from attacking the myelin sheaths but it is extremely dangerous as it is harmful to the heart.
The immune system is also left depleted and therefore open to various other illnesses and viruses.
“Natalizumb\' (Tysabri) – designed to work by interfering with the movement of “potentially damaging” immune cells from the bloodstream to the brain and spinal cord. Doctors are aware that this drug increases risk of “progressive multifocal leukoencephalopathy” a brain infection that is usually fatal. This is the most outrageous of all, since M.S. is most often a long term debilitating illness, but not necessarily fatal.
The advice that I would like to offer anyone stricken with M.S. or any other disease for that matter, is to take a very pro-active approach to maintaining and improving your own state of health by researching and being aware of all options available to you. The following is an outline of the vitamins and nutritional supplements that I personally take, as someone diagnosed with this unpredictable illness. There is no known cure or cause for M.S. at the present time but the following has certainly shown to greatly improve symptoms.
Calcium/Magnesium/Zinc – Liquid Formula – 1500 – 2000 mg. Daily Evening – as it is best assimilated before bed and magnesium has a calming effect and also promotes deep sleep
Deficiency of these is noted and could be a predisposition to developing M.S. Calcium is also the chelating agent for Iron, (binding agent that flushes Iron from the system)
Co-Enzyme Q10 – 90 – 100 mg twice daily – morning and noon if possible – improves circulation and tissue oxygenation, depleted in M.S. Sufferers
Co-Enzyme A – 90 – 100 mg twice daily – strengthens immune system, detoxifies by actually removing toxins from the body, increases energy and processes fats
Gamma Linoleuc Acid – 1,000 mg. - twice daily – controls M.S. Symptoms
M.S.M. - 1,000 mg – often taken for arthritis, helps to keep cell walls permeable, allowing water and nutrients to flow freely into cell walls and toxins to flow out. Pain relief.
B Complex Liquid – 100n mg. - two times daily – maintains healthy nerves, promotes red blood cell production, supports immune function, B6 and B12 – prevent nerve damage by “maintaining the protective myelin sheaths” while Choline and Inosital stimulate the central nervous system and also aid in protecting the myelin sheaths.
Vitamin D – Liquid drops – 400 mg twice daily – aids in Calcium absorption, and vitamin D is known to be deficient in people with M.S.
Amino Acids – 750n mg. - suggest “Aminomax” by Foodscience – twice daily - supports brain function and muscle metabolism
Grape Seed Extract – 50 – 75 mg – twice daily – powerful antioxidant and anti-inflammatory
Potassium – 1,000 mg daily – needed for normal muscle function and regulates heart beat
Selenium – 300 mcg daily – immune system stimulant – deficient in M.S. Sufferers
Vitamin A – 10,000 mg daily – strong antioxidant
Vitamin C – 3,000 mg. Daily – Promotes production of antiviral protein interferon, antioxidant and immune booster
Vitamin E – 200 i.u. Daily – important for circulation, destroys free radicals, protects the immune system, improves condition of veins.
Chromium Polynicotinate – 200 mcg daily – improves blood sugar metabolism, aids in breaking down fat and supporting lean muscle mass, encourages weight loss. Blood sugar problems worsen M.S. Symptoms, so this is important
Ginko Biloba – 60 – 100 mg daily – morning – Antioxidant for nerves, improves circulation, has been used for years to treat people with Alzheimers and is now used by Alternative Practitioners to improve debilitating M.S. Symptoms which are cognitive
Lecithin – 1200 mg. - twice daily – Protects the cells, clears arteries of fats and plaque, protects the myelin sheaths and supports heart health. Lecithin actually prevents the breaking down of the myelin sheaths of the nervous system.
Horse Chestnut – 300 mg. Daily – improves circulation and has been used for years by the Alternative Practitioners to treat varicose veins
Spirulina – 1 potency – take twice daily – morning and noon if possible Very high source of protein, helps regulate blood sugar, highly digestible food source with many properties, cleanses and heals the entire system, good for hypoglycemia, curbs appetite This important sea algae also contains iodine, so those who have allergies to shellfish do not take this but Cholerra or Greens Plus is a good substitute.
Aspirin – 80 mg – daily formula – this improves circulation and is an anticoagulant so those that are already on blood thinners should not take this.
Drink at least six to eight glasses of quality (not with chlorine) water daily. Avoid foods high in fat, uncomplex carbohydrates, sugars and glutens. Limit coffee, tea and chocolate as they all dilate the blood vessels and circulation problems are obvious in M.S.
Take yogurt or Acidophilus daily, to keep bowels regular, and cleanse the kidneys and liver by taking Milk Thistle and Dandelion drops in water once a week.
Much of my research has been taken from newly published books such as “Prescription to Nutritional Healing” by Phyllis Balch, CNC and “Prescription for Natural Cures” by Mark Stengler ND and James F. Balch MD
I highly recommend these books for everyone to aid in maintaining a healthy lifestyle.
Stay as active as possible. Swimming and aquafit are great choices, as well as a nice brisk walk. I wish everyone the warmest regards and hope that this is helpful.
BA – Psych Major, FBIH, DiHom,
Certified Fitness Instructor