Understanding jugular venous outflow disturbance, 2018, Zhou et al.

@GloriaDG

This sounds similar for the subgroup of patients who were in the hereditary hypercoagulation state group presented for ME years ago, that they needed a different treatment approach because the 'trigger' that caused thickening of blood resulted in some form of injury to the vascular system.

 

The first post says Stugeron was suggested because it is a vasodilator.

No, that is highly unlikely. Rheological properties are unlikely to be of importance in the large venous vessels of the head. Rheology becomes important in very small tubes such as capillaries.

I am not aware that there are any long term sequelae on blood vessels from Dengue of relevance here. The idea that Dengue was relevant appears to be a pure speculation on a single case.

But that is precisely the problem. You are not making it up yourself but you are repeating pseudo physiology described to you by someone who does not understand real physiology. I have repeatedly come across people studying what they thinks physiology for decades who have failed to understand fundamentals. 95% of doctors misunderstand fluid physiology. Most think that oedema occurs in heart failure because of raised venular pressures and in nephrotic syndrome from low albumin levels and neither can be true. Bad physiology is the rule, not the exception. Fluid physiology was something I specialised in for a decade. Other people on the forum here are more knowledgeable than I about some other areas of physiology. I think you will find a general agreement that an awful lot of physiological studies are flawed.

 

But how do we know that blocking these receptors is the reason why cinnarizine works in Meniere? My line of thoughts led to relating the way that Meniere was associated with CCSVI in that study, with the effects of PTA treatment and with the fact that Cinnarizine could work in Meniere in the same way this doctor suggested it worked in this Dengue ME patient, considering CCSVI as common denominator.

Because both Stugeron and Pentoxifylline have the same hemorrheologic property.

 

Stugeron is prescribed in Meniere's disease because of vertigo and nausea because it belongs to a group of antihistamines that help those symptoms in general. So the use in Meniere's has nothing to do with venous stenosis.

 

But didn't we say that the PTA treatment didn't work? And why relate Stugeron to an obscure speculation about venous stenosis when the common value of this group of drugs in conditions with vertigo and nausea has been known since before I was a medical student fifty years ago?

 

My bad, I didn't see that. Well, it's not about vasodilating properties anyway.

Based on what evidence are you stating this?

"Someone who does not understand real physiology" how do you know?
This doctor I'm referring to is a vascular surgeon whit decades of experience in his field and 10 years of experience in the CCSVI research field. Ultimately he is a medical professional just as much as you are, while other people in this forum are not. From my point of view, it's his word against yours.

 

It's on Wikipedia:
https://en.m.wikipedia.org/wiki/Cinnarizine
"Cinnarizine inhibits the flow of calcium into red blood cells, which increases the elasticity of the cell wall, thereby increasing their flexibility and making the blood less viscous.[9] This allows the blood to travel more efficiently and effectively through narrowed vessels in order to bring oxygen to damaged tissue.[9]"

 

We said that PTA is not effective in treating or preventing progression in Multiple Sclerosis. That was a study of the efficacy of PTA in alleviating Meniere symptoms.
Are you sure that in these fifty years the understanding of pharmacodynamics of this class of drugs hasn't advanced or broadened?

 

The definition of hemorrheology:
hemorrheology
[he″mo-re-ol´o-je]
the scientific study of the deformation and flow properties of cellular and plasmatic components of blood in macroscopic, microscopic, and submicroscopic dimensions and the rheologic properties of vessel structure with which the blood comes in direct contact."

Also, Pentoxifylline is used to improve blood flow through arteries too, so it's not just about capillaries:
https://www.rxlist.com/consumer_pen...m#what_is_pentoxifylline_and_how_does_it_work
Pentoxifylline belongs to a class of drugs known as hemorrheologic agents. It works by helping blood flow more easily through narrowed arteries. This increases the amount of oxygen that can be delivered by the blood when the muscles need more (such as during exercise) thereby increasing walking distance and duration.

 

Because I am a physiologist, amongst other things. When I see theories that misuse physiology the mistakes are apparent to me. I have pointed out some of the problems. There is a list as long as my arm of others but I am not sure it is worth wading through.

I absolutely agree, but the story about venous stenosis we have been presented with so far looks to be full of holes and so far we have not seen any evidence to validate it. It is just a theory. If this chap had some evidence then it would be interesting to discuss but I have not seen any yet. 'His word' is as far as I can see baseless speculation. 'My word' is pointing that the theory does not add up and there is no evidence. Judging by the post quoted by Mij lots of other people are sceptical too. The real problem is that if his idea was true all sorts of other things would occur that nobody has observed. What matters most in science is the things that theories predict and don't happen.

Newton's law of viscosity.

 

Is there actually any evidence for this and a known mechanism? There may be but I have had difficulty tracking it down. The most obvious thing would be altering red cell rigidity, but that would only be relevant in capillaries and venules.

 

I found some studies suggesting that Pentoxifylline works by reducing red cell aggregation. That would make sense. I would expect that to become relevant for vessels of calibre less than 1mm - so narrow arteries and certainly arterioles might be included. I don't see it being likely to be relevant to venous sinuses.

 

So that would be likely to be relevant to very small vessels only - down at the 10-20 micron calibre.

 

Ok, so you're saying that we shouldn't be believing everything that neurosurgeons and other surgeons or psychiatrists theorise and recommend as treatment within their own field of specialty, but we should take your word for it, on an online forum, without you providing any citation of evidence that backs up what you're saying, just because physiology is your field of specialty?

 

But Pentoxifylline is used to improve arterial blood flow too, and arteries seem to be big blood vessels to me. https://www.rxlist.com/consumer_pen...m#what_is_pentoxifylline_and_how_does_it_work