Hi Isaac, based on my own experience I agree that my brain was not happy after operation only on right side. It felt like had a jet hose turned on at back of left skull. Horrible. Had to lie down to open JV & reduce pressure. Still only at day 10 after left side op but hoping that will fix issue. Some people are born with only one JV and others survive with one after surgery requires removal & medics told me they cope. But for me only fixing one side did not allow me to cope. D
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Thank you stuuke. Tomorrow is the next try in a very large and well known radiology. I bet they can do it, especially when I show the ES worksheet in advance, but I’m still excited, too. Bets are accepted… 
Like the Dude Lebowski wanted to get his carpet refunded in the movie, I will try to get proper scans. This mood helps and not taking doctors too serious on this topic anymore, exept few experts of course. - I thought the last phlebologist is such a clown with his embarrassing measurements and doctors letter - big recommendations while having no clue. Yet I’m only smirking like the Dude at them. Much more effective than arguing.
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Hi @TheDude, is it possible to post the worksheet you mentioned above? I never heard of that in uk. Thanks. D
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@TheDude - It is interesting that after gaining much info from this forum, reading research papers, & learning through experience, we can pretty clearly tell when a doctor really isn’t familiar with how to take care of us or do testing properly. 
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Of course, here it is. (It was taken before surgery in Denver) :
That should be standard procedure for every ES patient in my opinion.
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Thanks for sharing. D
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Do you know the type of ultrasound device used to take the readings? I ask as I’d like to see if I can get my UK medics to do this for me soon. Thanks. D
Also did someone mention that you can measure fluid velocity in JVs using ultrasound or did I just read about that in a research paper posted by members? Thanks. D
It is a regular duplex-ultrasound to measure the velocities, nothing special. They just have to choose venous program there.
I’m sitting in the radiology right now.
Now they are becoming a bit stressed here. They never did ultrasound of IJV and 4 doctors had to discuss the case first. 2 hours of waiting later they wanna give it a try, very soon, hopefully… I’m excited and not so confident like I was yesterday.
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Good luck! 
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I agree this type of ultrasound is called Carotid Duplex ultrasound here in Canada and I had to convince the technician to take measurements on IJV when I did it back 2021. It is typically done for Carotid and Vertebraal arteries.
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Thanks. So on measurements do medics think the wider the measurement the better the IJV is working? Are narrower measurements used to identify possible IJV compression? Just trying to understand how they/we use the data from the ultrasound scan. D
I think both the diameter and the velocities are important. Typically velocities are usually a good marker for narrowing if measured correctly as the diameter of IJV can vary from person to person. IJV should typically be less than 60 cm/s (an ideal number and depends on the area of IJV measured). The narrower the IJV, the higher the speed. Arteries have higher speed limit since they are under much more pressure (less than or equal150 cm/s for Carotid if I remember it well). These peak systolic velocities correlate well with the cross-sectional area of vessels.
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The velocity is physically connected to the pressure. Means when you have high velocities you can assume there is also high pressure above…
Btw: Now it might have worked out and they did proper measurements here. The ultrasound examination felt almost same like in Cherry Hill, CO. Left side has still high velocity, close to carotid bulb it measured abt. 74 cm/s. Right side where i recently had surgery looked better.
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Here are the images taken today for the ultrasound interested friends:
Right side
Proximal, base of neck proximal, base of neck at SCM at SCM at carotid bulb at Carotid bulb at C1 at C1 Compression test Vasalva maneuver
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I can only see a peak systolic velocity of 74 cm/s for the left IJV based on the slide below. I know you said there was 90 cm/s for the peak systolic speed. Am I missing something here. Also, the US appears to have been done in Carotid Phase ( Carotis Allgemein in German) appears on top right corner of the captured screens. Roughly translates to Carotid In General in English. Not an ultrasound technologist but I do not think they make a difference in terms of speed measurement (proper probe placement is more important I guess).
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Thank you for your reply, @KoolDude . I agree with your velocity observations. It was just my quick look on the diagram while I was still in exam room. Looked like 90 to me but you are completely right with 74 of course.
I was also surprised by the “Carotis” annotation because they said that they finish all carotid exams and set the device to venous before doing my exam. So maybe it was just the wrong annotation, but I’ll check that.
Also diffrent from US exam was my position during the ultrasound. Today i was more lying on my back with reclined head while in Cherry Hill, CO they had me lying on my side, when I remember that right.
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Ok I see. I really I do not know how the differences of frequencies of the sound wave generated by the US device affects how the vessel velocities are ultimately calculated. I know that they use Doppler effect where if the blood is moving towards the probe, it has higher frequencies than the generated sound frequency where if the blood is moving away, it has lower frequencies than the generated frequency from the device. If the frequency generated is the same as the frequency of blood it means, the blood is not moving at all (stationary). This is how they tell the direction of blood flow ( towards the probe or away from the probe) I am sure they factor this in their final calculation of the velocity.
Consider my 2 slides below. The first one (left IJV) was done in venous phase (top left label says - Vasc Venous) and it has standard generated frequency of 13 Hz ( 13 cycle per second) where the second image ( right IJV) was done in Carotid phase (top left label says - Vasc Carotid) and has standard generated frequency of 23 Hz (23 cycles per second). So the standard generate frequencies are different for the 2 phases (venous vs carotid). I remember there was a long formula for calculating velocities using the angle of the probe, the velocity of the sound in soft tissue and velocities of the generated sound wave by the ultrasound. I can’t remember well but those were the major variables.
Left IJV
Right IJV
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…it is like an ambulance siren that sounds diffrent when it comes closer or is driving away from one.
Thank you very much again for the explanantion and examples @KoolDude . The frequencies were helpful. Looks like mine were taken with 13 Hz, too. A little bit below “Carotid Allgmein” you can see 13B/s. I think she used carotid mode and changed that manually.
Your images are impressive but I’m very sorry for your high speed. Can’t imagine how you could still do all your brilliant observations and research. Hope you are doing better now.?
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