MAGNIMS consensus recommendation: Measure brain and spinal atrophy in MS

Readers of this blog have already learned about the importance of monitoring their gray matter.  Volume loss, or the shrinking of tissue, is also referred to as atrophy and neurodegeneration.  I explain this process in more depth here: link  The MRI measurement of atrophy has been proven to be more indicative of MS progression, when compared to white matter lesions.  (The fact that we still use a seventy year old mouse model to measure white matter lesions for MS drug efficacy boggles the mind.)  This paper advises that MS specialists look at other MRI markers to understand how treatments might be impacting loss of tissue and MS progression.

A consortium of international MS experts published this review earlier in the year, right before COVID, and I missed it.  It was not sponsored by any specific drug company.  The MAGNIMS study group (Magnetic Resonance in Imaging in MS) was comprised of MS experts from seven countries.  I highly recommend discussing this research with your doctor, to make sure you understand how your own gray matter is doing.  

link to MAGNIMS study in Nature

The authors discuss lifestyle factors which impact brain volume. I like to call these factors "the things we can change."   There are things we can do today to maintain our gray matter.  The heart brain connection is real, and vascular health impacts our brains.

Many lifestyle factors, including physical activity124, influence estimates of brain volume. A higher level of alcohol intake has been associated with a higher rate of brain atrophy over a 6-year period115 and with a specific pattern of regional involvement of the white matter and grey matter125. A similar effect has been described for cigarette smoking and substance abuse (for example, marijuana use)115,126. Many systemic conditions, such as diabetes, chronic kidney disease, hypertension, obesity and vascular conditions can also accelerate brain atrophy115,127,128.

Please notice the mention of vascular conditions.   All of this is new.

I've written about how Jeff's gray matter atrophy was reversed thanks to vascular and lifestyle intervention.  This post is from 2018 Celebration!   Jeff's good health continues in 2020, and he is still hiking, biking, composing, and active.  He's also down to his high school track star weight (178!) and has built up muscle tone.  He remains my inspiration.  Our goal, God willing, is to stay healthy and active, and live to see the end of this pandemic.  We work on managing the things we can change--by eating whole foods, moving every day, getting sunshine, staying connected to family, praying, meditating, making music, laughing, helping others, and letting go of the factors beyond our control.  I've mentioned the serenity prayer before.  link Written in the trying 1930s by Reinhold Niebuhr, American theologian, it is a reminder to take each day at a time, especially as we face difficult times. 

Here is to getting through this- with renewed health-- physically, emotionally, spiritually.

with love from smokey California,

Joan

Living in a post truth world

Hello dear readers,

I hope that you and your families and friends are surviving this most challenging time.  Please let me know how you are faring in the comments.  I've thought about our group members many times, praying that you've been able to stay sane and somewhat healthy, safe at home.

Jeff and I remain well.  We continue to follow The Endothelial Health Program, more rigorously than ever.   Exercise, sleep, sunshine, lots of fruits and veg, time in nature, laughter, meditation and music are helping us stay healthy and sane.  We are in touch with our family via Facetime and phone calls.  Work, meetings, and social interactions now happen on Zoom.  We get outside every day for exercise, recreation or yard work, while maintaining social distancing and mask wearing in public.   We have several family members who have lost their jobs.  I retired and took my studio singing pension early at 58.  Thankfully, Jeff continues to compose and has several projects in the works.  You can hear his beautiful music on the new Netflix documentary Athlete A. 

We realize how fortunate we are not to have to work outside our home to make a living. We are deeply aware that this has been an extrememly difficult time for all, most especially our front line workers, service workers, hourly wage earners, as well as our underserved minority communities, and those with underlying chronic illness and disabilities.

This kind of unrelenting stress and anxiety is hard on people with MS.  So is not able to see your doctors or physical therapists, get massages, treatments, or visit with friends.  It's hard not to go to a religious group gathering,  a family event like a wedding, or simply go outside for a change of scenery.  All of these situations are impactful, and can affect your health.  In the midst of this, I hope you are able to find activities that bring you a bit of sunshine and joy.  I've seen many MS friends taking joy in gardening, listening to music, enjoying family, and being in nature.

Over the years, you all know I've handed out a lot of unsolicited advice. I've tried to back up the medical advice with peer-reviewed and published science, not just anecdotal stories. That's why I always include links to medical journals in my posts.   I've joked about being your bossy Mom, and telling you how to eat or stay active.  But this time of forced stillness has given me the opportunity to ask myself WHY I have felt it so important to share all that we learned to help Jeff heal.  

So much of what we click, hear and read today is about identity and narrative.  There are thousands of falsehoods, conspiracy stories, invented tales, all created to mislead society.  I've been horrified to see what people are being persuaded to believe, especially in regards to this current pandemic.  Experts, researchers and scientists who have trained and have insight are being discounted for heresay, anecdotal evidence, and downright dangerous advice.  This has happened throughout human history, when experts and intellectuals have been portrayed as "the elite," in order to sow discord in society.   A rise in populism around the world has put us in a very dangerous situation, where the average citizen no longer believes in scientific evidence.  Whether flat earthers, QAnon, anti-maskers, climate deniers; all deny scientific evidence in favor of a belief system that makes sense with a chosen story.

Believe me, I get the irony.  Jeff's healing experience has been thrown in the heap of anecdotal evidence and heresay.  The entire CCSVI investigation has been portrayed as quackery, and the vascular connection to MS and benefit of lifestyle intervention is still downplayed, even though the research began in medical journals and continues to be published.  But I contend that our understanding of lifestyle and vascular intervention in the healing process of MS continues to build evidence, and is based on the earliest scientific discovery of the central vein sign, discovered by Rindfleisch in 1863, and still seen today a a reliable biomarker in MS.  Inflammation in MS occurs around cerebral veins.  That's the truth.  We still do not know why.  https://ejrnm.springeropen.com/articles/10.1186/s43055-020-00185-3

So, who am I to even comment on any of this?  I'm surely not an expert, I have no medical degree or training.   I should have shut my trap years ago, not gone up against MS specialists or challenged my husband's neurologist.  I certainly should not have written or shared anything online.  I have participated in the exact same narrative creation and populist rhetoric I find so abhorrent today.  I have spun a tale, and sowed confusion.  I am exactly part of the problem.  Ironic, huh?

I would suggest readers follow the ongoing work of the International Society of Neurovascular Disease, for continued research into the heart/brain connection.   These researchers are continuing to advance the science behind CCSVI, vascular contributions to dementia, and the impact of lifestyle on the heart brain axis in all diseases of neurodegeneration, including MS.   https://isnvd.org

Also keep your eyes on the work being done at UCSF at The Gladstone Lab.  Researchers there are honing in on toxic blood particles found in the MS brain, and linking the clotting protein fibrinogen to inflammation and decreased myelin repair.   

https://gladstone.org/news/overcoming-obstacles-promote-repair-multiple-sclerosis

Do we get to pick and choose our truth?  Or is there an ultimate reality, beyond our personal narratives?   Our dear friend, theoretical scientist Brian Greene, has a brilliant new book Until the End of Time, in which he attempts to explain the emergence on life on earth.  Simple, right?   Brian's own life work helps me put things in perspective.  Evolution and entropy are tensions bound by gravity.  Gravity is the real, measurable force which binds us all--stars and humans alike.  There is mathmatical truth in gravity. As Brian states, "Life is physics, orchestrated."   Listen to Brian explain it, better than I ever could. 

 https://www.youtube.com/watch?v=YXfMN3mZa0Y   

But even in this truth, Brian admits we still do not have scientific proof as to WHY humans are conscious beings.  I have a theory on this, as a religious person who believes in a creator God, but I don't have an equation.

I would submit that even in this unknowing, there is still a core of scientific fact. I cannot chose to ignore the rules of gravity, even though I might not like them, or don't completely understand them.  There are so many brilliant people like Brian, experts and reseachers, who will spend their lives exploring topics we can never understand.  These exceptional minds are working on COVID19 today.  Do we ignore them, simply because they work in difficult concepts?  I may not know the mathematical formulae which prove gravitational force, but I still live in a world governed by gravity.  I may not like the fact that I have to wear a mask or distance myself right now, but I trust the trained epidemiologists exploring the corona virus. 

Listen to the experts.  Believe the smart people. Think critically.  Question when individuals spout out theories formed "in my gut," as opposed to in a lab.  When we get on an airplane, we all want the most experienced captain in the cockpit, not the most charismatic one.  We want our surgeon to be the one who's the most well-trained, not the one who entertains us.  

Most importantly, don't listen to me.  Find your own team of doctors and specialists who you trust, who can take care of you, who will tailor your lifestyle program to suit your needs.   That's the truth.

Here's hoping we all get through this,

Joan 

COVID-19, nitric oxide (NO) and your endothelium

You will be seeing more in the press on nitric oxide (NO), the 2 atom gas which is being trialled to treat patients in COVID-19.  Those who have read my blog for the last decade will know all about NO.  Healthy levels are the hallmark of a healthy endothelium.

Nitric Oxide (NO) is shown to kill the corona virus, as it engulfs invading viral particles in the human body.  This was demonstrated in the SARS outbreak.  https://pubmed.ncbi.nlm.nih.gov/15650225/

These new science stories will not be addressing the fact that we make our own NO in our bodies every single day, and that NO is the marker of endothelial health.  Instead, they will write about viagra.  Clickbait?  Perhaps.

Healthy levels of NO mean healthier erections.
link to published science "The Penis as a Barometer of Endothelial Health"

This is why you'll see viagra trialled to help COVID-19 patients.  It boosts nitric oxide levels (which boosts bloodflow to the penis as well as other parts of the body)   I know....I haven't written that before, because, well....TMI?   But we're well beyond that now...

Here is a good summation of how nitric oxide (NO) is being trialled to treat COVID-19, from the LA Times  link

Pre-existing endothelial dysfunction might be the reason older people, those with cancer, heart disease, diabetes, or autoimmune disease are more susceptible to COVID-19 virus replication, organ failure and cellular death. They do not have a robust population of immune cells, specifically T helper cells. Their endothelial cellular lining has broken down, and they have endothelial dysfunction.  This also means they have less available nitric oxide in their bodies.
link

The FDA has granted permission to use inhaled nitric oxide (NO) as a treatment for those with COVID-19.  Here is a Newsweek article, published today:
https://www.newsweek.com/what-nitric-oxide-how-gas-that-gave-us-viagra-could-help-treat-coronavirus-patients-1496520

But these treatments will not be available to us just yet, and they are being trialled on patients who have already contracted COVID-19.  

The good news:  You can heal and strengthen your own endothelial cells and increase nitric oxide availability. At home. Today.  You don't even need a little blue pill :)

Here is the Endothelial Health Program I developed for Jeff in 2008, to boost his nitric oxide levels and to heal his endothelial cellular layer.  http://www.ccsvi.org/index.php/helping-myself/endothelial-health

And here it is, in simple English

1. Movement. Daily cardiovascular pursuits are essential and healing. Shear stress, created by an active heart pumping flowing blood over endothelial cells, maintains EC integrity by increasing nitric oxide release. Inactivity allows endothelial cells to die. 

2. Stress reduction. The acts of deep breathing, the practice of meditation, yoga, prayer, all reduce endothelial cell damaging cortisol and increase healing, vasodilating nitric oxide.

3. Liver health. Decreasing liver damaging toxins--like alcohol, plastics exposure, chemicals, pesticides, heavy metals, drugs--and increasing liver protecting flavonolignans (like silymarin) and antioxidants found in fruits and vegetables, maintains endothelial cell health.

4. Sunshine and Vitamin D supplementation.  Skin makes vitamin D when exposed to ultraviolet B (UVB) rays from the sun. Because of sunscreen and our indoor lives, many people are not receiving enough of this potent hormone. And our circadian rhythm is affected. Vitamin D creates endothelial cell health by increasing nitric oxide. UV rays release nitrates from the skin, creating vasodilation. 

5. Sleep. Sleep deprivation creates endothelial dysfunction and cell death.

6. Eating whole, organic foods. Eating a diet of whole foods (unprocessed foods; foods that retain the natural state) provide ample levels of nutrition, vitamins and antioxidants. Antioxidants bind with free radicals to minimize the damage they cause to the endothelium. Vitamins B and C are hugely protective of endothelial cells. A lack of B vitamins increases homocysteine, which kills endothelial cells.

7. Eating healthy fats. Increasing omega 3 (DHA) fats found in fish, olives, flax seed, avocados, walnuts, etc. and decreasing transfats and highly saturated animal fats improves endothelial cell health. 

8. Probiotics and gut health. The endothelial cells of the gut's lining communicate with the rest of the body and rely on "good" bacteria. 

9. Essential minerals. Magnesium, calcium and zinc are all important in the preservation of endothelial cells.

10. Anti-inflammatory food sources, spices and herbs. Curcumin, Salvia, Ginko, and Garlic are all shown to decrease inflammation and regulate blood viscosity, preventing hypercoagulation, allowing for better shear stress. 

11. Reducing glucose and gluten. Sugary baked goods, simple breads, pastas and snack foods are damaging to endothelial cells. 

12. Smoking cessation. Please quit...smoking kills endothelial cells.

13. Laughter, joy, community, purpose, loving relationships. All of these things increase nitric oxide and improve endothelial health. 

Again, I am NOT a doctor. And you should consult your own doctors on best practices for YOU.Let me know how it goes.
Jeff and I are at home, thankful to be together, and still thankful for his health.

Stay well!!!

Joan

Thank you, Joan Embry

We have lost a brilliant, courageous and loving woman.  Joan Embry was deeply devoted to her family, as well as a movement for people with MS.  Joan passed away on April 1 (unexpectedly and unrelated to COVID-19)

As a trained nurse and nutritionist, Joan Embry worked tirelessly with her husband, Ashton Embry, to create a program which might help their son cope with his multiple sclerosis diagnosis.  Out of the love and concern for their son Mathew, the Embrys created Direct-MS, a proactive charity formed in 1998, with the goal of "providing information and strategies that could help reduce symptoms and even slow or halt disease progression."  DIRECT-MS link

The Best Bet Diet was a cornerstone development of the Embrys, based on scientific research compiled by Ashton Embry.  Matt quickly incorporated this diet over 20 years ago, and he credits his successful, progression-free life with MS to this program.  Here is Matt talking, enthusiastically and obviously wonderfully healthy, about the diet that changed his life.
 The BEST BET/MS HOPE DIET

This program would eventually be the inspiration for Dr. Terry Wahls program, as well as many others.  It was a post about the Best Bet Diet on an MS bulletin board regarding vitamin D that sent me off to PubMed to explore the connection with my husband's diet, exercise and sunlight exposure; as related to his vascular problems.  This eventually became The Endothelial Health Program.  I would learn years later that it was Dr. Roy Swank who was the grandfather of this approach to healing with MS, as he had noted the vascular connection and impact of diet decades earlier.  Dr. Swank was also the inspiration behind the Best Bet Diet.

The Embrys were at the very beginning of the empowered patient movement on the internet.  We would eventually connect over Dr. Zamboni's research into the venous system and CCSVI in 2009, after my husband had been treated at Stanford University.  The Embrys were curious about this research, and would begin the Canadian exploration into the vascular connection.  Matt would eventually be treated for CCSVI.

But the cornerstone of Direct-MS is the diet.  And as we all know---it's one thing to eliminate foods, but quite another to find foods and recipes that will keep us satisfied and fit into our lifestyles.  Dr. Swank was well-aware of this problem, and worked with his patients to create his program, as did the Embry family.

In the last year of her life, Joan was updating recipes and working on The Best Bet Cookbook, which Direct-MS, incredibly generously, gives away for free on their website.   You can download a free pdf of the book here:     The Best Bet Cookbook

The Embrys have never put profit or personal gain ahead of their message.  They have always been tireless advocates for better living for those with MS.  The few times we had together, in person, at The Canadian Neurovascular Health conferences or at our home for Matt's filming of Living Proof, were highlights in my advocacy work.

I can think of no better tribute to the Embry Family at this time, than to share their good news of hope and healing---by contributing to their charity, by downloading the Best Bet Cookbook,  or by watching, or rewatching, Matt's beautifully made documentary film, Living Proof https://www.seelivingproof.com

Please join me in lifting the entire Embry family up in prayer and intention, however you practice this in your own life.

As Jeff and I go out to work in the garden today, to harvest greens and soak up the sunshine, we recognize how fortunate we are to have so much, in the midst of global suffering and hardship.  We will say a prayer of gratitude, which includes the gift of the Embry family.  We deeply recognize the importance of family, food, health, love, connection and hope.

All of the things Joan Embry held precious in her own life.

Thank you, Joan.

Thank you, Anne.

Dear Anne,

I love and admire you.  I hope you knew that.  I think I told you, but now I'm not sure.  I love your boundless energy, your keen sense of justice, your brilliant mind, your ability to translate difficult concepts into language we can all understand.  I admire how much you care about other human beings, and advocate for the sick, the poor, the marginalized, those without a voice.  I relish reading anything you write.  I will continue to read and re-read your book and articles and e-mails.  I so wish there would be more.
Link to Macleans articles
Link to "The Meaning of Wife"

I simply can't imagine the world without your clarion voice, your wit, your tenacity.  I can't imagine how your closest friends and family will cope with the loss of your presence in their lives.  How they will deal with your much too soon, unbearable passing.   I just heard from your friend, in a grief stricken voice mail (oh, I've had to make those phone calls when my brother died, and it's simply unbearable.) I do remember meeting him in Rochester with you, when you came from Toronto to see us and talk to us about Jeff's CCSVI treatment.  It was such a joyous time for us all--it felt like rebirth.  Springtime budding in Rochester, music, good food, laughter, hope.

And there have been the conferences together, e-mails, and phone calls.  Difficult times full of controversy and medicalese and renewed and then dashed hopes.  The last two years, I was so frustrated, and I know you knew that.  I lashed out at you, angry that you were simply writing the truth.  I felt betrayed, and we talked, and you forgave me.  I'm so glad we made amends.  Just as I'm glad that I did the same with my brother, before I lost him.  You inspired me to keep writing, to not give up. But you also knew that, for my own sanity, I had to step back.

You dug in and included the history of the vascular connection to MS in your writing about CCSVI.  Everything you wrote was always sourced with links to publications, quotes from doctors, a balanced approach to telling the story.  link  link  link

Thank you for interviewing Dr. Michal Schwartz and for getting her research out into the larger public.  link   You knew it was her research that first inspired me to look at immune cells as protective for the brain, and we bonded over the fact that a brilliant woman had, no surprise, been dismissed by so many powerful men for questioning dogma.  link 
And over time, her theory is being proven, again and again. Someday, boosting specific immune cells and combining lifestyle and vascular intervention may well end neurodegenerative disease.  
link to Professor Schwartz's research

You called us the "impatient patients"....which was simply a perfect description of the frustration that grew out of CCSVI clinical trials halted or mangled, and the influence of pharma.  But many of us  knew it wasn't over.   link

Which is why it's hard for me to grasp your passing.  There's still more to the story, many more truths for you to write.  So much more.  Dammit.

Thank you for everything.  I learned so much from you, Anne.
Love to all those who loved you.
May we advocate for others, in your memory.

May we heed "the urgent call for compassion as the last-gasp remedy for systems on the brink—politics, health care, civil society, the planet itself." (written, as only you could say it, Anne.)

The World is broken-and human kindness is the only solution, by Anne Kingston

Joan

Endothelial Health goes mainstream...

.... and you can stream a new documentary to learn more.

Thanks to my son and daughter in law for the head's up on the documentary, THE GAME CHANGERS    https://gamechangersmovie.com

Presented by James Cameron, Arnold Schwarzenegger, and Jackie Chan  — a revolutionary new film about optimum health and strength.  You can view it now on Netflix.

My family told me I needed to watch it, because it was documenting what I have been harping on for years.  My son saw me change his Dad's diet and lifestyle, and has heard me discussing this topic for over twelve years.   Mainly, the importance of endothelial health, and how eating plants full of anti-oxidants and phytonutrients increases nitric oxide availability, helps endothelial cells, and increases blood flow to all of our body, most importantly our brains.   

Nutrition is a very large componant of my program, which also includes physical activity, good sleep, sunshine, meditation, probiotics, minerals, smoking cessation, and laughter.   Each and every one of these measures is known to increase nitric oxide, which relaxes our blood vessels and increases blood flow.  This is how we can combat the hypoperfusion, or slowed and restricted cerebral bloodflow, seen in MS, Alzheimer's, dementia and Parkinson's.  These are things we can do for ourselves.  

link to the program

This new movie is focused on elite athletes who utilize plant-based diets to achieve optimum strength and endurance.  And while I do not specifically advocate a vegan lifestyle in The Endothelial Health Program,   I suggest that people with MS favor whole foods and plants, to increase nitric oxide. (There are conflicting views on animal protein within the field of experts, and I DO NOT go into the weeds on this topic.)  My approach has always been to look at positive environmental measures people with MS can take to feel better.   And eating more plants will help accomplish that goal.

In the film, Dr. James Vogel, co-chair of the NFL subcommittee on Cardiovascular Health, discusses the importance of eating plants to increase available nitric oxide and increase blood flow.  He even speaks of the endothelium, and uses the image shown below. (YES!)

Truly, The Endothelial Program works.  Jeff remains on it.   He's still jogging, biking, writing music, traveling, living life, with no MS progression, no new lesions, and a reversal of his gray matter atrophy.  His most recent MRI shows continued healing of his brain, now 13 years since his diagnosis.

With the help of our vegan son and daughter in law, we have learned how to incorporate even more plants into our diet, boosting nitric oxide and reducing inflammatory foods.   Like jackfruit (google it!), legumes, tempeh, and lots more greens.

My hope for all of us, as we begin a new decade, is that we can take care of ourselves, our families, our communities, and discover that there are many things we can do to improve our own health and the health of our planet.

Be well,

Joan 

China continues to lead the research

New research from neurosurgeons in Beijing looks at how the veins impact brain health.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6932895/

As most of you know by now, the arterial side, or blood flow delivery, receives all of the research.  We have scans for the carotid arteries which are routinely given for stroke and cognitive dysfunction in aging populations.  But this new resarch looked specifically at how jugular venous stenosis impacted cerebral perfusion, or the amount of blood flow exiting the brain.

It has seemed obvious to most of us that consideration of venous health must be determined in diseases of neurodegeneration.  Sadly, this is not so in western neurology.  North American and European neurology remains content to ignore venous health.

Hypoperfusion, or slowed blood flow, remains a constant finding in people with multiple sclerosis.
http://www.ajnr.org/content/early/2018/01/11/ajnr.A5504
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416892/


In this new research, Chinese neurologists studied those with cerebral venous stenosis (CVS) as well as patients with arterial stenosis (CAS) and those who had both arterial and venous stenosis (CAVS)

From the publication:

Cerebral venous stenosis (CVS) mainly results from extracranial venostenosis (internal jugular vein stenosis, IJVS) and intracranial venostenosis (cerebral venous sinus stenosis, CVSS) [4–7]. Previous publications have described its typical clinical manifestations such as headache, noise, visual impair, sleep disorder and dysphrenia [4, 8]. It can be confirmed by magnetic resonance venography (MRV), computed tomography venography (CTV) and digital subtraction venography (DSV) generally, however, the presentations of brain tissue and perfusion-metabolism status are not fully known. Furthermore, since covered by CAS, some venous stenosis may be misdiagnosed. As for these patients, only treating on arterial stenosis is far from adequate, in contrast, restoring the patency of venous outflow is the key to relieve the refractory neurological symptoms. The aim of this study is to describe the clinical characteristics and imaging findings in CAS, CVS and CAVS, in attempt to further aid the differentiation of these disorders in the clinical settings.

Cerebral arterial stenosis (CAS) plays an important role in chronic cerebral circulation insufficiency (CCCI) [1–3]. Persistent reduced cerebral blood volume and flow cause ischemia and hypoxia in the brain tissue, leading to various brain dysfunctions [1]. Chronic cerebrospinal venous insufficiency (CCSVI) has also been confirmed to contribute to neurological deficits and impose a significant impact on cerebral arterial circulation to some extent [4–9]. In theory, CCSVI plays a causative role in pathogenesis of CCCI as well. Venous outflow disturbance may raise the pressure in arterio-venous anastomoses and affect the blood flow (CBF) and volume (CBV) in the arterial system subsequently [4–6]. Advanced neuroimaging can confirm vasculopathic diagnoses, but clinicians often neglect to further explore the disorders as they related to venous vasculopathy. This leaves many patients with rather severe venous stenosis-related ailment untreated and in a great deal of suffering.

And what did they find?

Neurological impairments including sleep disturbance, hearing disorder, visual disorder, headache, tinnitus, tinnitus cerebri, dry or puffy eyes, neck discomfort, dizziness, anxiety or depression and nausea or vomiting were commonly seen in CVS and CAVS group. The incidences of subjective memory decline were almost same among three groups.

It is now eleven years since Jeff was treated for his severe jugular venous stenosis.  His previous symptoms of headache, fatigue, heat intolerence, dizziness, sleep disturbance, and sleep apnea have remained resolved.  He is able to jog, work, engage in outdoor activities, travel, live life.  He has had no further white matter lesions, and his gray matter atrophy has reversed.  His brain continues to heal, as many lesions have shrunk or disappeared.  For this, we are thankful.

I am also thankful that the ISNVD continues to study venous stenosis and MS diagnoses.  I am thankful for the Chinese researchers who are helping their patients, and looking at how treating venous stenosis heals the brain. 
Here are a few of their publications on treating jugular venous stenosis, and outcomes.
https://journals.sagepub.com/doi/10.1177/0300060519860678
http://www.ijcem.com/files/ijcem0042381.pdf
https://onlinelibrary.wiley.com/doi/full/10.1111/cns.12859

I am not hopeful for North American and European research, however, as the MS drug companies are forecast to be a $40 billion dollar industry by 2026.   link

Stay well, keep moving, get UV rays, eat whole foods, engage in community, remain positive and keep your eyes on the horizon.

Joan

Here are some of the images from the Chinese publication



Here is my husband's MRV from Stanford 5/09, prior to his stenting treatment to open his jugular veins.  Notice the curly collateral veins running alongside the pinched jugulars.  This is what venous stenosis looks like.  He did not have an MRV after treatment, but he did have his cerebral blood flow transit time measured and his hypoperfusion was reversed.