That was cringeworthy to watch, but really educational!
I see Hepworth and he has diagnosed me with the jugular compression type. He seems knowledgable and on task.
That’s great news nnaeve! I hope you’re able to have surgery soon so you can begin healing.
Great information! Thanks for sharing!
Is that Dr still doing Eagle surgery?
It’s unclear what Dr. Lawton does. He has not been willing to help any of our members who have contacted him recently. He has very narrow parameters for determining what is ES & what isn’t. People w/ CT scans & clear ES diagnoses have been turned away.
You are certainly welcome to contact him, but he hasn’t been added to our list because no one here has seen him for surgery. The video was posted as additional information regarding a particular case of vascular ES where an “outside of the box” surgery was performed to correct the problem. Dr. Lawton did not end up removing that patient’s styloids. It is clear that he fixed the cause of the jugular compression but unclear if that patient will go on to have future problems w/ ES because Dr. Lawton left the styloids in place.
Here is a link to the posts by recent members:
Dr. Hepworth is my daughter’s doctor. He did her sinus surgery and multiple CSF leak repairs. Since her LP’s were still showing high pressure he continued the investigation and found Eagle with jugular compression. We were just informed about it yesterday and were told that the surgery would involve a vascular surgeon and neurosurgeon as well.
We’ve heard from hospital staff that he’s the best and patient’s worldwide come to Denver for his expertise!
I expected as much ie that Dr. Hepworth is your daughter’s doctor. I’m so glad to know that! I hope her surgery helps bring normalcy back to her life.
I had bilateral ES & needed 2 surgeries. Most surgeons won’t do bilateral ES surgery in one fell swoop. I hope she doesn’t need a second surgery down the road but if she does, you’ll all know what to expect from the first time around.
I’m not a big fan of “Caring Medical” and their prolotherapy stuff, but this video about ultrasound measurements of IJVs might be worth watching.
I have some big problems with this video…first measuring the jugular in an upright position is perhaps not super meaningful in the first place because the vein should collapse somewhat with flow diverted to the posterior circulation. Second, a more likely cause of the effect seen with the neck weights (if it’s even reproducible) is compression of the vertebral veins redirecting flow to the jugulars rather than any cervical alignment changes. I previously overlaid someone’s radiographs from a different chiropractor with and without the neck weights, and there was zero detectable change at the C1 level. And whatever point he is trying to make at the end about an osteophyte causing compression doesn’t really make sense…it’s not in contact with the jugular. Just more misinformation dressed up as flashy clickbait from caring medical in my opinion…
One thing though that I find logical, is that based on the neck posture/position, the collateral flow and esp. vertebral venous plexus (valve-less veins) might experience different compressions and different flow volumes, thus requiring more engagement from the IJVs.
The thing is that it’s probably extremely difficult to calculate collateral flow volume, because… There are just too many collaterals overall.
I agree with nature’s findings re postural difference, though I hypothesize that if one has affected collaterals/vertebral venous plexus, the IJVs start being more involved in upright posture too.
Upd: “very possible” as in "I mostly agree with @coldbear "
Yes, there are a lot of variables involved that make it ripe for a real study with large sample sizes and proper statistics. These videos just really bother me when they use unscientific methods that conveniently fit their narrative, without mentioning or considering alternative or confounding mechanisms. I’d give them a bit more benefit of the doubt if they weren’t hawking expensive unproven therapies. Just my $.02 tho!
Even supine, my occipital emissary veins seem to take a ton of the flow with the left one almost the same diameter as my dominant jugular where it leaves the skull. Strap some weights to the back of my neck, and it wouldn’t be too surprising to see flow redirected.
Edit: P.S. not arguing with you at all @vdm , in case it sounds that way. I know we are on the same side here
Absolutely. Based on the original this topic’s video, the IJV is extremely easy to compress and deform. I was surprised the surgeon so confidently pulled/pressed it with the instruments. Probably the tissue is quite strong even for those thin walls.
The video I posted - yep, the point I wanted highlight that even in upright posture there are multiple possible “compression” levels as demonstrated using US, even if that’s not very scientific experiment. It might explain for example why I always preferred looking at the monitor “up” with my neck extended rather than how the “ergonomists” suggest - slightly down. I would feel it not only painful, but also couldn’t properly concentrate. Maybe my collaterals weren’t as good and I always relied on slightly opening up the IJVs while sitting and working
Who knows. Too many variables. Using a scalene muscle to keep the shoulder up vs using rotator cuff muscles probably might make significant difference alone in all the circulatory system.
You’re spending lots today @coldbear, that’s 2 lots of 2 cents worth
He’s a smart to spend it now, in a few months his 2 cents will only be worth 1
I think I am with @coldbear on this one regarding how these folks measure the IJV. One has to be careful here because numerous careful studies has found that IJVs collapse to more than 50% of its supine diameter when upright presumably to regulate ICP. This is a fact now.
In the case of Jugular Vein Stenosis, supine position imaging is preferred as any narrowing would cause the alternate route vie Condylar Veins (lateral, posterior and anterior Condylar Veins) to become prominent in draining the brain and as @coldbear images indicate, you can see the venous engorgement at Condylar Veins which drain into Sub-occipital Cavernous Sinuses (SOCS) which drain into the Vertebral Artery Venous Plexus (VAVP)/Vertebral Venous Plexus (VVPs) which drain into Deep Cervical Vein. In the presence of normal Jugular flow in the supine position (absent of compression and narrowing), you should see all these network of veins at the skull base return to normal sizes.
If IJVs naturally collapse when upright to regulate ICP what are the implications with stenting the IJV. Wouldn’t that lead to low ICP?
Good question. I really do not know and there are no good studies out there that looked into this deeply. Blood flow is more complicated and is affected by many things so studying it will require not only looking at the Vein side of the world but also the Artery side of the world taking into considerations of all forces and postures. Let us hypothesize that your statement is true and it could potentially lead to over-drainage of the brain and low ICP. But what if the brain senses that low ICP and increases the heart rate (via Autonomic Nerve System) to pump more blood through the arteries in order to offset the over-drainage. This we do not know unless you are studying all these systems dynamically and it is even more complicated when you introduce stenting. What is known is that the heart rate increases when upright presumably to offset the gravity pull of the blood so that the net blood flow to the brain remains constant.
Seems like the entire field is understudied. Something I’m also very curious about is the research that is going to come out for astronauts. We already know that long durations in space cause IIH symptoms, and if we’re planning on deep space travel to Mars, it’s only going to get worse.
So I’m curious to see what comes out of NASA trying to solve this issue.
Well they are all interesting studies but humans evolved on the surface of earth and our body systems need gravity to function optimally. I know this discussion goes way beyond this ES blog and I don’t want to hijack the thread for Sci FI but the number of body processes that get affected by gravity goes way beyond the blood circulation (baroreceptor reflex - which regulates the blood pressure). For example, your bone density decreases significantly in space since there are no constant stress brought on by the force of gravity on them. Bones grow with stress that is why weight lifting is good for you to maintain bone density. Your balance system (vestibular system) goes out of whack because there is this fluid in your vestibular system that moves up and down and tells your brain where you are facing, with less gravity this is affected too. These are all effects seen with space travel but one needs to spend years in space to see the full effect of it. It is still tip of the iceberg. For example, what keeps your body together is what is called atmospheric pressure without it, your body might fall apart, that is why astronauts wear pressurized suits among other reasons. It also helps with hearing as sound needs a medium to travel from one place to another. you heard the famous saying, If there is nuclear explosion in space, you would not hear it because it is vacuum and sound does not travel in vacuum. Less oxygen saturation in space because it is a heavy element which is concentrated closer to the surface of the earth due to the pull of gravity and that is why the higher elevations like mountains cause dizziness because the oxygen is less and less as you go up and up. Anyways, enough with this but point being we are creature of the earth and as result are subject to its natural forces.