About Dr. Flanagan

It was in 1982 that I met Dr. Harry Shapiro who was the former curator for the Department of Anthropology at the American Museum of Natural History in New York City, and a leading expert on the design of the human skull, artificial skull deformation and trepination.

It was this relationship that put me on a course that I would never had envisioned. In 1978 I graduated with high honours from Sherman College of Chiropractic with particular focus on specific corrective care of the upper cervical spine, which is the most critical and important area of the spine. Following graduation I spent several years studying Applied Kinesiology and Sacrooccipital Technique, which includes specific pelvic analysis and corrective care procedures for the foundation of the spine, as well as craniopathy which is described below.

The pelvis contains the tail end attachment of the cord. Except for the tail, the brain and cord float within the cranial vault and spinal canal. The human pelvis is complex when it comes to health problems and requires specific analysis and correction. In my opinion, it is just as important as specific upper cervical care. Craniopathy, on the other hand, is the study of the musculoskeletal system of the skull, as well as cerebrospinal fluid flow, called CSF, in the brain and cord.

It was because of my interest in craniopathy that I met Dr. Harry Shapiro through a friend. The doctor became a patient and we had many long conversations regarding the design of the sutures and base of the skull, as well as craniopathy and chiropractic. While Dr. Shapiro was intriqued by basic chiropractic and craniopathic theories, certain craniopathic concepts clearly conflicted with his extensive forensic findings. In particular, he disagreed with issues regarding deformation of the base of the skull and the state of its special joints called sutures. Consequently, he insisted that I use the museum to do my own research.

When I got there he handed me a well used canvas sack with a set of old calipers strapped to the inside. Honestly, I had no idea about how to use them. He then gave me an old monogram he had published in 1928 called, “A Correction for Artificial Deformation of Skulls.” That’s how my chance investigation into the sutures and the design of the base of the human skull got started. It was supposed to be finished in just a few days. Instead, it turned into decades.

I spent several years examining hundreds of normal, pathological and artificially deformed human skulls. It was the artificially deformed skulls from former indigenous people of Peru and Bolivia, however, that started me looking into hydrocephalus. Hydrocephalus, in turn, led to normal pressure hydrocephalus (NPH) and Alzheimer’s, which led to Parkinson’s and later mutliple sclerosis. Early on I recognized the close similarity between narrow angle glaucoma and NPH. Both are related to low pressure drainage issues due to similar causes. The difference is that glaucoma puts pressure on and damages the optic nerve causing blindness. NPH, on the other hand, puts pressure on the brain and causes dementia.

In addition to human skulls, I studied some primate skulls along with bats, whales and giraffes. I studied the later three because of the extreme circulatory challenges to the brain during head inversion and deep dives, which are similar to inversion and Valsalva maneuvers in humans and known to increase intracranial pressure. I was looking for answers and compensatory mechanisms these animals use to control intracranial pressure, and for possible clues as to how humans contend with challenges caused by upright posture. I found plenty of forensic evidence.

I wrote my first paper on the potential role of the spine in venous drainage issues and neurodegenerative diseases in 1987. A Google search for “stenosis Alzheimer’s” will produce an article I wrote for Dynamic Chiropractic in 1990 calling for research into the potential role of venous drainage isssues in the brain and Alzhiemer’s disease. I subsequently published many other papers on similar subjects, including Parkinson’s disease and multiple sclerosis. After three years of additional study, in 1990 I became certified in chiropractic neurology. In additon to my professional publications, I recently published a book called THE DOWNSIDE OF UPRIGHT POSTURE – THE ANATOMICAL CAUSES OF ALZHEIMER’S, PARKINSON’S AND MULTIPLE SCLEROSIS, based on more than twenty years of research.

The book is written as a story to make it easier to digest and remember some important and difficult concepts. It is packed with relevant information. It was written for lay people, as well as physicians and scientists to stimulate further research. It was also written for anyone interested in physical anthropology, upright posture and the human brain. You can learn more about the book by visiting my website at uprightdoc.com. No one has all the answers to the mystery but we have some new and important pieces to the puzzle that may bring us closer to solving it. I will be discussing topics from the book on this blog. It is an important subject that needs further investigation.

96 Responses to About Dr. Flanagan

  1. colleen Roth says:

    Dr. Flanagan,

    I am not a doctor but have a daughter who was diagnosed with MS after suffering head and neck trauma etc. from being hit by a taxi in NYC with not a single MS symptom prior to her accident. Her diagnosis came just over a year later although she showed symptoms with leg weakness being one of them within 6 weeks of her accident but as she had also hit her knees and suffered a hematoma on one of them therefore her orthopedic doctor assumed it was because of the injury.

    I am fascinated by your studies and have been an avid follower of the CCSVI theory and Dr. Sclafani who is an IR and very involved in this possible treatment here in the New York region. He answers questions on thisisms.com and I wondered if you were present at the symposium at the end of July which was attended by various IR’s, Neurologists, patients who had been treated, etc. both researchers and pioneers in this new treatment.

    My daughter has been treated by her chiropractor for the past year or two and he is an Atlas Orthogonist and it seems to help her with severe the neck pain that she gets and she always has the sensation of warm face, blood flowing, tingling and pins and needles during and after her treatment which surely indicates a blood flow change?

    Sorry if this question is somewhat disjointed but my point is that as you have so much to offer I wonder if you would consider being involved in the research (that is if you are not already) with like minded doctors in their discussions and potential treatment of CCSVI etc? I know that all MS patients, Parkinsons, etc. can only benefit from a possible solution to these awful diseases – clearly the 70 years theory of MS being an auto immune disease have not resulted in any kind of cure.

    Sincerely,

    Colleen Roth

    • Motor vehicle accidents generate tremendous forces that can easily exceed and permanently damage the hard and soft tissues of the spine. They can also cause permanent damage to the far more delicate tissues of the brain and cord, especially with severe hyperflexion type injuries that overstretch the cord inside the canal. The tension alone can snap tissues. Dr. Schelling further maintains that whiplash and similar severe types of trauma can cause violent venous back jets of blood and CSF from the entire length of the cord and into the brain. They are tranmitted via the vertebal veins which have no valves to check their flow. Schelling’s explanation is far better at explaining the peculiar characteristic and locations of the lesions in the brain and cord but unfortunately, hyperintensity signals usually portend permanent damage.

      Specific upper cervical care is perfect for reducing the strain in most cases but there are different schools of thought and still depends on the experience and method used by the doctor. Some rely entirely upon leg length tests and thermograms for pre and post checks. Personally I would like to see more monitoring of postural analysis, station and gait, tendon reflexes, upper motor neuron signs and muscle strength and symmetry of range of motion. Some people may have permanent damage to tissue of the upper cervical spine that can block drainage outlet and may need to be drained using Zamboni’s procedure. Some patients may need upper cervical and Zamboni’s procedure. There is much more to this story.

      I enjoy what I am doing and would love to be involved with others. CCSVI has provided huge step forward toward finding answers to many cases of neurodegnerative diseaes. It has opened a whole new door. I will be posting some upper cervical research in the future that is unbelievable based on everything I have learned over the years. What’s more, it is corroborated by phase contrast upright MR angiograms. Things just keep getting better.

  2. jane dandrea says:

    i am a 64 female i was told i have ppms 20 yrs. now. i had a bad fall in 1990. i was very healthy with no hint of any ms problems. when i fell i hit very hard on r. knee and arm stoving everything. it jerked my neck very hard but i did not hit my head. about a week later i would drag my r. leg when tired. i pursued chiro. them saying it was sciatic etc. then started to effect r. hand and arm. i then saw a neuro. about a yr.later and he thought i had rsd beause i was having temperature changes from side to side and r. foot would change colors. after about 2 yrs. i had a spinal tap and they thought i had ppms. i had 1 lesion i think on the cervical. there was something on the brain stem but all agreed they did not look like a ms lesion. the 1 neuro. thought i could have had a spinal stroke when i fell. 20 yrs. later i still have 1 lesion. but i am now in a wheelchair r. side pretty much done and it is starting to effect l. side. i never had visual, thinking, speech swollowing problems. i never had numbness until i had the ccsvi liberation treatment. when i came out of recovery my l. leg was very numb although slightly better it still persist. for the first 10 days my hands and feet were warmer and stiffness was better and overall strength was better but that is gone now. i have always since the fall when tilting my head up and back been able to move better. just lately this is not as prominent but still exist. i wondered if when they ballooned it may have put pressure or something where i already had a problem? i have never accepted or fit the ms criteria but once you’re branded. i also have some spurs which i wanted them to remove but have found no dr. that thought it would cause this and do it. i did have an injury to the back of the base of my skull and neck in the 70’s and had some numbness in in left hand and foot but had traction and that resolved. then nothing until the fall. i really do not have neck pain. but ever since the fall i have an odd feeling at the base of my skull slightly to the r. and at times when in bed i get this odd pain starting right in that spot and radiates up the back of my head. i elevated my bed and it seemed not to happen as much. after the liberation i had one occurance that actually was so bad i worried i was having a stroke. about 4 yrs. ago i tried nucca chiro. after about 5 mo. i was not moving any better and finances and travel i quit. i do have to say it fixed my tmj and took the low back and hip pain away. i just feel everyone is somehow missing something. do you have any suggestions as to where and who to go to. finding an expert like you is like looking for a needle in a hay stack. i live in southwestern pennsylvania. my posture is terrible because of weakness and wheelchair. do you think it may be too late? all the chiro.’s say they can help but never really have. i’ve been snapped, poppod and twisted. my body tells me i need hung by my feet and everything that got stoved up 20 yrs. ago pulled back where it should be. my spine by now i’m sure is a real mess it was bad enough when i started trying to get this fixed 20 yrs. ago. the neuro.’s when i show them the way i can move better when i tilt my head have no answers. i really do not have bad pain but i do have a burning odd sensation in my muscles in my legs that is annoying and my feet are very purple. when i lay flat they become normal. i have never taken any ms drugs or pain medication other than asparin. do you have any suggestions? if i were very rich i would try to find you and get you to treat me as everything you say makes so much sence. i know you said you are retired. any help would be so appreciated.

    • Hi Jane, It sounds very suspicious to me, due to the initial injury in which you landed hard on your right elbow and knee, that you consequently strained your neck and pelvis. The force of the fall on the knee drove the innominate bone of the pelvis backward causing a posterior innominate. In brief, more than likely you have what is called a category 2 strain and sprain of the pelvis that has become very chronic and is disabling the weight bearing joints of the base of your spine.

      A Cat 2 pelvis is a strain and sprain of the sacroiliac ligaments that results in misaligment of the ilia. It is most likely the source of the weakness in your right leg. It can also cause a great deal of pain in the low back, such as when getting up and down from chairs or putting on socks for example. Pelvic problems can also distort the sciatic foramen in the pelvis, which contains nerves and blood vessels to the leg, which will cause numbness and tingling for example. Lastly, pelvic problems undermine the stability of the sacrum which is the platform the spine sits on. This can upset the shouder girdle causing deformation of the thoracic outlets, which can cause the right arm weakness and rsd type symptoms you have. The pelvic problem will also extend past your shoulder and affect your neck, especially the base of the skull.

      In brief, it sounds to me as if you have a chronic pelvic problem casused by the hard fall onto your right knee, which is causing the right leg weakness and further resulting in a thoracic outlet syndrome affecting your right arm. Specific upper cervical care will not fix your problem, nor will basic chiropractic side posture type adjustments. You need specific pelvic correction by a qualified chiropractor who practices sacrooccipital technique using pelvic blocks.

  3. Joy says:

    So appreciative of your straightforward, scientific and well-illustrated piece. Thanks.

  4. Lisa Whittingham says:

    I am fascinated by your work. I too am an MS patient that had an “accident” with a corresponding neck injury prior to diagnosis. I was in a sledding accident as a teen that resulted in a neck injury. Years later came a bout of optic neuritis followed by MS diagnosis. I have always felt there was a vascular component. I have had migraines, which have increased in severity as the disease progressed. When I have a migraine, the veins protrude on my neck and temple so much it scares people. The pharmacist actually told me to see a vascular specialist. But what I really find strange, was midway thru my MS disease, I had a schwanoma located on the cervical spine c1 thru c-4. I had been complaining of neck pain for YEARS. After begging for an MRI, they found the tumor and operated within days. I was told it would have paralysed me sooner than later. Also, heat sensitivity, but even more troublesome is coldness. My feet hurt they are so cold and I am cold when people are hot. I did have angioplasty-Interestingly stenosis on left jugular very severe and that is my worse side. I had instant relief of coldness after angio and no more fatigue, etc. Also, actually gained some mobility, which for secondary progressive disease is quite exciting. But now again, I have neck pain and fatigue again. Could that schwanoma and later surgery have somehow restricted venous flow? I wonder if the schwanoma was the result of the sledding accident? I am curious as to any practitioners you would advise in the southern florida area?

    • Lisa, I hope you got my reply by email. Just in case you didn’t I will reply to your comment here. Your sleighing accident, the Schwannoma and your signs and symptoms of optic neuritis and migraine headaches, fatigue, neck pain and pain and coldness in your feet indicate to me that you should have your upper cervical spine checked. You definitely have pressure on the brainstem and it’s hard to imagine that you don’t have an upper cervical misalignment. Because of the serious nature of your particular conditon you should find a more experienced upper cervical doctor.

      • Lisa Whittingham says:

        Thank You, I did not receive your e-mail. I would like to find an experienced cervical doctor, any suggestions? I hate to just select at random without any referral. Given the constant neck pain, I agree that cervical issues are likely. When I lived in Ohio, I had meridian regulatory acupuncture and every time my neck was worked on I had relief.

      • Drs Flanagan says:

        Hi Lisa, Where do you live? Do you have MS? What are your chief complaints?

      • Lisa Whittingham says:

        I am an MS patient, now living in Pompano Beach (Southern Florida). As I said, I have had angio, little change in disabilty. I have migraines, neck discomfort, left leg drags, I am limited in my walking. I really believe the schwanoma has had an effect on my cervical spine. I did notice changes, small right after the angio, but I wonder if I restenosed.

      • Drs Flanagan says:

        Hello again Lisa, Try Dr. Jeff Middleton, 33 E. Commerce Blvd., Ft Lauderdale (954-771-3685). He has many years of post grad courses in UC. Because it has been so many years and you had the Schwannoma surgery you most likely have permanent damage and scar tissue. Nonetheless, some of your symptoms and response to the angio leads me to believe you can do better. You have an interesting case so keep me informed and let me know if you recieve this email. MFDC

  5. jane dandrea says:

    dr., thank you so much for your time. but i am confused about some things. i follow what you are saying about the knee and shoulder and neck i think. but,due to the injury i had in the 70’s that really wacked the base of my skull and neck could i possibly have 2 different problems? i know you are saying that all this would all strain the neck. but when i had the atlas treatment it did take the low back pain away and fixed my tmj. now that it effecting the left side which started about 2 yrs. ago and it is both arms hands and legs is that how this works? what about when i tilt my head up and i move better? when i put my chin to my chest i can barely move. does that come into play with the thoracic? maybe that is why dr. noda’s treatment for ctos is helpful for some as ccsvi works better for some. please bear with me and in no way am i second guessing you. i have been at this for 20yrs. i just am so happy that finally everything i have been trying to explain and find help for is fitting into the things i kept trying to get someone to really listen and take me seriously and help me. when the first neuro. told me a trauma did not cause ms i told him then i don’t have this ms or the fall woke it up. i kept this up for yrs. trying to get somebody to look at the whole picture. that is why i never took any ms meds because i felt how is a pill gonna help me. i’m not sick i’m screwed up. but it is what is at this point and i’m gonna try to find a chiro. like you say i need. i just wanted to be sure you feel it’s not 2 problems. without one on one with you in an office i know you are doing the best you can with the info. i give. but believe me your knowledge and input is invaluable. i hope it is not too late for me and i hope with this concept of ms others will get the help sooner. so far i have had no luck finding a chiro. like this and any help would be appreciated. i am about 50 miles s. of pittsburgh, pa. thank you again. p.s. you sure you don’t want to start treating and me be your poster “senior?”a person is never too old to dream right.

    • Drs Flanagan says:

      Jane, I don’t recall you mentioning that you hit your head on the floor. There is no doubt you jolted your entire spine in either the one or the two separate falls. Upper cervical adjustments will definitely help with the upper end but falling hard on your knee most likely injured the pelvic joints on the opposite end as well.

      In this regard, the tail end of the spinal cord called the filum teminale attaches to the tail bone on the bottom of the sacrum in the pelvis. The lumbar and sacral plexus of nerves branch off the cord to go to the legs and pass through hard and soft tissue tunnels to get there. Pelvic problems can cause downward traction type irritation to the cord. Moving your chin toward you chest likewise tractions the cord and in certain cases can provoke pins and needle sensations in the arms which is called a Lehermitte’s sign. Pelvic problems also cause deformation of the tunnels for the lumbar and sacral plexus of nerves.

      Upper cervical adjustments are terrific for the neck but it wouldn’t be my method of choice for a possible chronic pelvic strain and sprain problem such as I suspect you have. Do you have a brain scan? MFDC

  6. jane dandrea says:

    dr. flanagan, thank you again. in my first post to you i did mention the neck and base of skull and the aftermath of that which after traction it seemed to resolve most issues. then the fall in 1990 which started this nightmare. but, growing up i did take some wicked falls-once falling through a hayloft landing about 12 ft. below and was knocked out a few minutes. growing up on a farm in the mountains and a little tom boy i had numerous thumps and bumps. we climbed trees played rough and i was always really healthy. as a teenager a car accident that i did actually dent the metal dash of the car with my knee. then as an adult a car wreck that my chest area bent the steering wheel. all these things but never a broken bone and always healthy. but the neck and base of the skull getting hit very hard in the mid 70’s as far as having an effect on my body as far as tingling in fingers and toes “just on the left side”got help with traction but every so often i would feel it slightly.– then 1990 fall, the r. side getting stoved so bad and all this starting. but the odd pressure and dull gnawing feeling at the base of my skull which is just slightly to the r. of the midddle of the base of skull that i got after the 70’s accident became more prominent again and i also started every so often getting this pain that will radiate up the back of my head and wake me. also when i looked up and i could move better started. i did forget to mention that also every once in awhile when i move a certain way like getting out of bed where there is pressure put a certain way on that area in that part of the base of skull and neck i have gotten very dizzy like the whole room is spinning some lasting where a chiro. adj. did help it stop. the most notable was about 10 mo. ago i was trying to get myself sat up in bed and as i held onto the bed trapeze above and my head tilted back further than usual– that with the tugging and pressure in that same area caused a very weird sensation in the base of the skull and caused my whole r. side to draw up-my r. leg “which will normally not do much on it’s own” drawed up to my groin area and my r. arm drew very far to the left like a hug it was like drawing hard and it would not let up. it scared me about to death this was new. i tried moving my head different ways and it would worsen then i kept trying to relax and moving my head slowly and it finnaly let up about an hr. or so later. needless to say i have not tilted my head back that far and tugged again. although the spinning will happen now and then. —i know your only question to me was do i have a brain scan. –the only thing i have are mri’s of i think brain and cervical and they maybe with contrast. the most recent are on a cd taken about a yr. and a half ago. as i recall through the yrs. all the mri’s say no changes still the 1 lesion. i’m not sure what you mean by mfdc. but i will do my best to get one if you say. chiro’s have taken x-rays all saying i have problems top and bottom and in between but they have not helped other than the spinning and the nucca atlas which as i said helped tmj and low back pain. but, i never knew until i got a computer there were so many kinds of chiro.’s. i as many thought there were chiro.’s just some better than others. i apologize for the length of of this but from the beginning of this nightmare i have told every kind of dr. i was around that i just knew the fall did something to me they were missing something something is pressing on something wrong why the temp. changes blood flow etc. and finally it’s coming full circle. i just hope it’s not too late for me but i’ll try anything i can that you suggest. i just hope i can find the right chiro. again , thank you from my heart, that you are willing to consider and look at mine and other peoples problems. i assume you have my e-mail address that was given along with my name. if you would want to communicate anything that way to save some space here. i’ve pretty much gave you most of info. but i don’t want to miss anything because it could mean so much. anything now should be much shorter. anxiously awaiting.

  7. jane dandrea says:

    dr. flanagan, i’m not sure what you mean by mfdc. i have had manny mri’s through the yrs. the latest one about 18 mo. ago i think it is of brain and cervical with contrast. it is on a cd and i have copies. i also have cd of the ccsvi treatment which is probably irrelevant to this i’m sure but thought i’d mention it. tell me what to get and i’ll try my best to get it. thank you

    • Drs Flanagan says:

      Jane, MFDC is just my initials. If you ask your radiologist about and MFDC scan you will have him scatching his head and wondering if it’s something new. Sorry for the confusion. MFDC

  8. jane dandrea says:

    dr. flanagan, sorry, i thought i deleted that long long post as i got carried away. shortened everything and then i realized it got on there too. i promise no more-just short and to the point. i appreciate your time but did not intend to take up so much of it.

  9. Igor says:

    Hi dr.Flanagan
    I just found this excellen site and haven’t had time to read it all, but I definitely will. I have PPMS. My CCSVI treatment will be next week and venogram will show if I have problems with blood flow through veins (at least for azygous and jagulars) and possibly rectify it. I wanted to ask you about your opinion of I.B.T. (Inclined Bed Therapy http://andrewkfletcher.com/) and its influence on blood flow and possible associatio with MS and CCSVI.
    Thank you

    • Drs Flanagan says:

      Hello, I have mixed feelings about IBT which is an old idea that has been used for a variety of conditions from acid reflux and hiatal hernias to circulatory problems. It’s probably a wash as far as benefits are concerned because as you tilt the bed up you increase the demands on the vertebral veins. It’s my contention that upright posture creates circulatory challenges for humans. I studied bats because they deal with the complete opposite, which is prolonged inversion. Humans and bats are built to meet the challenges of upright posture and inversion. But things can go wrong in humans and when they do they tend to show up and get worse in the upright position which poses certain circulatory challenges to the brain. That said, I could be wrong so if it makes you feel better forget the scientific mumbo jumbo stuff and do it. MFDC

      • Dr Flanagan, it is indeed a very old idea, stretching back at least 4 thousand years. In the third Dynasty of the pharaohs reign, beds were inclined by six inches, confirmed by a curator at Boston Museum. Your dismissive comments are somewhat unfounded, although you do state that it is a contention. As for symptoms worsening in the upright position, this would be counter-intuitive when one considers that the human race is being won standing on two legs and we do appear to be a lot smarter than other species. in 1995, a study was conducted to test the theory that people with ms would benefit from avoiding flat bed rest. The results from this study which involved placing blocks under a bed and raising it at the head end by 6″ to produce a slight angle from head to toe, were considerably more than significant.
        It’s interesting that you consider bats hanging upside down. I too have begun to understand why they have powerful wings and feeble hind legs. I also considered how they manage to lower their metabolism and core body temperature to near freezing. IBT is very effective at raising the body temperature and maintaining it while we sleep. A flat bed causes body temperature to drop by 2-3 degrees at around 3.30 am. IBT didn’t.
        I believe you are completely wrong about circulation being compromised by the vertical position.
        Your mention of veins in your second post on this subject is also interesting. Chronic venous insufficiency or varicose veins do not inflate further when the legs are lower than the body on an inclined bed. Quite the opposite, over a mere 4 weeks the veins and surrounding oedema improve, which I agree sounds counter intuitive when working from physiology literature but what if that literature is erroneous?
        You may also want to consider density differences between blood, cerebrospinal fluid and lymphatic fluid flowing down, compared to the fluids flowing up. Again I have argued that there must be a density difference since 1995. Now a published peer reviewed paper from a Polish Researcher has confirmed those predictions in CSF flow.
        I have written to the author, who has agreed with me on the point of a down-flow induced return flow. http://neurores.org/index.php/neurores/article/view/77/81
        I look forward to your reply with interest.
        Best wishes

        Andrew K Fletcher

      • Drs Flanagan says:

        Andrew, It is well known that upright posture exacerbates neurological conditions such as: dysautonomia, orhtostatic hypotension, postural orthostatic tachycardia syndrome, seizures and drop attacks among other things. As far as your comment that I am completely wrong about upright posture comprimising blood flow, it’s obvious that you did not read my book, this blog or my website because you couldn’t be more wrong about what I stated, which is central to my theory. Upright posture increases blood flow due to the siphon effect. It also increase CSF flow. Physical anthropologist Dr. Dean Falk, maintains that the increase in blood flow, as well as cooling capacity led to the increase in size of the human brain (encephalization). Lastly, I am well aware of the density differences between blood, lymph and CSF. The density differences between blood and CSF can cause blockages of CSF pathways following traumatic brain injuries and hemorrhagic strokes due to poor mixing.

  10. Igor says:

    Thank you
    I do use it but not for very long. I was wondering can it make veins restenose after dilatation (after all we spend most of the time upright). By the way, few years ago I did Atlasprofilax treatment, which is some kind upper cervical correction. Do you know about that?

    • Drs Flanagan says:

      Stenosis is a relative term. For example blood pools in the feet and legs when we are upright and veins dilate. We raise out legs to ease the burden. Sleeping likewise relieves the burden. The veins in the hands dilate when they are hanging at your sides and become narrower when you raise your hands overhead. The jugular veins are the complete opposite. They naturaly dilate while we are lying down as blood flow slows down, and they become narrower or stenosed when we are upright due to downhill flow. I am not familiar with that method of upper cervical correction.

  11. jan wexler says:

    Dr Flanagan. I was diagnosed with MS 23 years ago. I led a normal life for the first 17 years. I did notice that I had my head tilted to the left while driving. And in the last few years I have had to tilt my head way back (looking up at the ceiling) in order to walk. To prepare food I had to position my head against a cupboard in order to look at the what I was doing. If I tilt my head down it is like turning off a light switch. Been in a wheelchair for the last 5 months. And in order to stand I must look up. It seems that others with MS cannot look up as they lose their balance. I am the opposite. I had the Liberation procedure done in June. Got improvements (not in my legs) but they disappeared in a week. Had it done again in July. They found I had blood clots in the stent and the other 2 veins were now blocked 99%. Got some improvements but they too did not last. I am worse than ever. The swelling in my body effects my whole body. I use nasal spray in order to breath. My face, eyelids, legs, inside my mouth etc. Diuretics do nothing. I feel like my brain is being cooked. I suck on ice chips all day. In the evening when my body temperature goes down I am stronger. I remember as a teenager (now 57) while playing a game of basketball I got hit with the ball smack in the middle of my face. I use to have a fantastic Chiro but he has retired and the next 2 I tried were terrible. Any thoughts?

  12. jane dandrea says:

    dr. flanagan, am i to understand your recommendation is basically to only seek a sacrooccipital that uses blocks not to do upper cervical too as it could be counterproductive ? and yes, sometimes i can get confused. sorry. thank you

    • Drs Flanagan says:

      If I were working on you I would want x-rays of your neck and low back and I would work on your whole spine. There are other ways to fix the low back but I much prefer pelivic blocks for cases like yours.

      • jane dandrea says:

        dr. flanagan, i appreciate the input and i hope i can find a chiro. that has the same insight and skill you do but yrs. and no luck. what you explain makes so much sence. again anyone you could reccomend in my area please e-mail me. thank you again.

  13. Dear Drs. Flanagan,
    I am the moderator for Healing Parkinsons, an info group on Yahoo for PD. Below is our mission statement. I am very interested in speaking with you if possible. Please contact me at your convenience at my email destinyellen@yahoo.com.
    Please Join us in our fight for recovery from PD. Right now, we are following the growing evidence that PD may start out as a vascular condition of restricted blood and oxygen flow in or out or both to the brain. This condition may come from head/neck/shoulder injury, repetitive motion developing muscle mass, tortuous arteries/veins, restricted space in neck, or environmental exposures. We discuss all therapies that are demonstrating that they can help reduce PD symptoms and possibly lead to a cure. This includes medications, both on and off label like LDN – Low Dose Naltrexone and blood pressure medications such as Isradipine. Therapies; Hyperbaric Oxygen Therapy,Upper Cervical Chiropractic,STS,BPM, Iron Chelation, Stem Cells, Martial Arts and more. Excercise including Cycling, Yoga and more, Loud & Big LSVT, developing surgical options such as; DBS,CCSVI,CTOS and important basic good health practices such as nutrition and supplements, hydration and sufficient rest and sleep.

    Now with the incredible ability to image the brain showing Iron and its relation to PD, MS and Alzheimers we are entering a new era of medical options for neurological conditions.

    The focus of this group is on recovery. Our goal is to share what is working, what isn’t, and why. Things to watch out for like side effects and drug interactions. When we know what is working we can share it with others with PD and maybe even help fund therapies that we discover are working.

  14. Linda says:

    Is there a doctor you can recommend in the Southern California (Los Angeles) area?

    Thanks!

  15. BrainResearcher says:

    Dearest Dr. Flanagan,
    I just finished reading all of the entries on your site. Thank you so so much for sharing the knowledge and insights you have amassed during your years of study and practice. Like most people who stumble upon your site, I am scouring the Internet and medical journals for an explanation for a medical condition. I am at a loss and would like to ask you a question or two.

    Briefly, this past summer my wife had a decompression surgery for Chiari, skull-C3 fusion, and a spinal cord dethering procedure. Priory to the surgeries, her most debilitating symptom was an intense, pressure-like headache in the occipital area worsened by lying down. She would usually awaken at 4am in a panic with an extraordinary headache. For a month or so following the surgeries her headaches were much better, only to return full force. MRA/MRV, various CT scans, MRIs, all interpreted as normal. No occipital neuralgia. A CSF flow study (wish I could remember more specific details about the type of study) was normal. She has hypoplasia and slit ventricles. She has EDS, perhaps the vascular form.

    Diamox reliably helps her headaches within 2 days of starting it, even at a dose of 250 mg once per day.

    Following a lumbar puncture with an opening pressure of 23 mmHg, the neurosurgeon recommended LP shunt with a flow regulated valve. This procedure was performed three weeks ago and was beneficial for the first week. After which the headaches returned. As before, diamox keeps the headaches at bay.

    I found your site while trying to educate myself more about CSF production and drainage. I am trying to understand exactly why diamox is helping her so much, in the hope of identifying the source of the problem and perhaps a more permanent soluation. I am finding myself quite confused given that diamox seems to both decrease CSF production and increase oxygenation of the blood. I understand that both of these things will cause a drop in pressure but for different reasons. My wife is mildly anemic by RBC, HGB, HCT. Low normal range for iron, ferretin.

    In your opinion, is it possible that in patients already prone to high ICP, due to Chiari, small skull, etc, mild anemia could further complicate the problem by requiring additional blood flow to the brain in order to provide it with the oxygen it needs? In other words, could the diamox be working for her by increasing oxygen levels in the blood and decreasing the cerebral blood volume needed to keep the brain firing on all cylinders? If so, then perhaps addressing her anemia might allow her to keep the headaches at bay without the diamox.

    Thank you for taking your time to read this long post. I would be quite grateful for any insights or suggestions you might have. I am a neuroscientist, but not one with any real knowledge about cerebral blood flow and only text book knowledge about CSD production and drainage.

    Kind Regards,
    Aaron

  16. I was suggested this blog by my cousin. I am not sure whether this post is written by him as nobody else know such detailed about my problem. You are amazing! Thanks!

  17. Barbara Bartlik, M.D. says:

    Please recommend an upper cervical chiropractor in Manhattan or New York City for someone with poor posture, chronic neck discomfort probably from carrying heavy bags, narrowing at C6/7 on X-ray, cervical stenosis on MRI, intermittent paraesthesia in the right hand, and, in the past year, protruding veins in both temples, and memory problems. Thank you.

    • Hello Dr. B,

      The two doctors below use a specific upper cervical method called Atlas Ortogonal:

      1) Patrick Kerr, D.C., 20 Park Avenue, Suite 1-B, Phone: (212) 689-1303, Board Certified – R.W. Sweat Foundation, Atlas Orthogonal Instrument
      2) Paul Scarborough, D.C., 285 Lexington Ave., Phone: (212) 532-3220, Board Certification: Atlas Orthogonal

      Dr. F

  18. nick says:

    Dr. Flanagan,

    I’m impressed by your work, by reading you I have begun to understand my disease.
    I’m 50 years old male diagnosed with MS before 11 years. My first symptom was before 19 years, lhermitte sign, after six months of working with my head in flexion, bending. When I diagnosed (8 years after lhermitte sign) I had optic neuritis in left eye (this was the second attack) and the MRI showed lesions only in spinal cord and all above the C7 disk (degenerated, prolapsed, no pressure on spinal cord, as it was written by radiologist). The third attack was bell’s palsy (in left side of my face) and diplopia (when I was looking far) before 2 years, the MRI showed a few new lesions in brain periventricular white matter, the neurologist found positive babinski in left leg, I completely recovered from bell’s palsy in 1 month, from diplopia in 6 months. The visual aquity of left eye is 7/10, I have bladder problems (urgency) since 2006 and the last year fatigue and slight to moderate weakness in arms and legs (no problems with daily activities) and no other important problems from MS. I have never taken MS drugs, neither cortisone for MS, I’m in Swank diet after bells palsy, any suggestion it would be appreciated.

    • Hello Nikos,

      There is a good possibility you have upper cervical problems putting pressure on the brainstem and cranial nerves. I also suspect you have a head tilt due to the optic neuritis. There is a good upper cervical chiropractor in Athens who uses the Kale Brainstem method. His name is Dr. Michael Koontz. You should have him check your cervical spine. If you have problems finding his number let me know.

      Dr. F

  19. nick says:

    Thank you for the quick response and the doctor. I found his number, thank you again.

  20. BCBud says:

    I personally had a 50 lbs roll of rope drop on the back of my neck from a 3 meter height about 17 years before I was diagnosed. I was 15, almost 16 on a Tall Ship excursion. Since the roll of line dropped, I had problems with my legs which for the majority of my youth was diagnosed as impaired muscle development, then RA, then I was recommended to visit mental health. One day in 1999 I woke up 1/2 blind. A year later I was diagnosed with Multiple Sclerosis. I often wondered if the accident that occurred all those years ago affected me in this way. Your website at least confirms that it is possible my thoughts were justified. Thanks for posting it!

  21. Peggy says:

    Hello Dr. Flanagan,
    Could you make a recommendation for an experienced cervical provider in Upstate, NY?
    I’m 41 years old and have RRMS. My main issues are (some) right foot drop and weakened right iliopsoas. Over the past several months I have pretty severe left side lower back pain, as it makes sense to me that I’m overcompensating for my weak right side.
    Thanks-
    Peggy

  22. vincenzo says:

    Dear Dr. FLANAGAN,
    I’m an italian vascular surgeon that study CCSVI and operate jugular stenosis as Zamboni protocol. i’m very interested to buy your book. How can I from Italy?
    ThanK you!!
    Dr. Vincenzo Di Donna

    • Hello Dr. Di Donna,
      The easiest way to get the book in Italy would be through Amazon.com or Barnes and Noble online. Thank-you for your interest.
      Best wishes,
      Dr. Flanagan

      • vincenzo says:

        Dear Dr. FLANAGAN, thanks for the reply. As gis ‘ says I am a vascular surgeon who deals with CCSVI. I find your blog really interesting. I would like to invite you to my next Congress on CCSVI and ALZHEIMER’S that I’m organizzandi here in Italy in Bari. His presence would be greatly appreciated. If the pleasure. My personal email is vidido@vodafone.it if interested in participating in the Congress I write as well. or if I could get there I vuple in America for argument!!!!! Thank you. See you soon

  23. AC says:

    Hi Dr. FLANAGAN,

    Please help me as I am becoming very depressed regarding my condition. So at age 18 I had a swimming accident where I drove my head while swimming full speed onto the concrete end of the pool. The days after that, I can remember brain fog, pin/needle feeling, abnormal temp in body, but no pain. So during the next 8 years I would have occasional aches and sinus and fatigue but I was in a good physical shape so they didn’t really bother me all that much. Fast forward to when I was at age 27, now I am a software engineer, slouched over with bad posture, I slowly start developing more fatigue and then gastro issues, like gastroparesis, acid reflux, gastrisis. Then one day when I moved to my new apartment, I singlehandedly moved all my stuff up three stairs. Days after that I started to develop tinnitus on left ear, sinus pressure, headache, neckache and eventually TMJ issues. Luckily I stumbled upon Dr. Tom Forest of Blair UC Chiro who made put me in care for the past two years. Most of my symtomps were alleviated except for tinnitus but it was largely decreased. So here comes the latest development, I go so complacent because of neck has been doing so well since I was under UC care, I started some new stretching exercises and routine. First I think I strained my shoulder doing some lifting and then I tried to “cure” it by overstretching my shoulder, chest and neck for a days. I think my neck stretching (up-down, left-right flexion) might have done me some damages. I started to feel vertigo, nausea, fatigue, weird body temp regulation.

    I tried to get adjusted by Dr. Forest but I kept going out of alignment for a month, until I tried something calls “prolotherapy” to toughen my ligaments then my adjustment has been holding for a few days now. Even tho I am in alignment but the dizziness, faintyness, fatigue is still there. I guess my question, did I do myself some reversible damage? what else do you recommend I can do ?

    • AC says:

      meant to say ” I guess my question, did I do myself some irreversible damage?”. Another notes, I do not have any pain in my neck, just vertigo, nausea, very fatigue and when I am sleeping I would wake up in the middle of the night with very fast heart beating.

  24. angel carson says:

    Dr Flanagan, I came across your site doing research on spinal fluid flow restriction. My 9 year old was diagnosed with a non malignant brainstem tumor in 09. We opted not to do surgery at that time as it wasn’t bothering him, unfortunately last week that has changed. We took him to the ER and a full set of MRI scans and flow study scans were done and they found he is now having restrictions to is CSF and we were told he didn’t need emergency surgery but would need to speak with his regular neurosurgeon to schedule surgery. Unfortunately he is out of town for another week. All I’m trying to find out is how much restriction is ok? His head hurts all the time, he is having on/off blurred vision, memory issues….. He doesn’t have Chiari malformation although that is what they like to describe his current symptoms as, its the tumor restricting things….. I’m just trying to understand better how the spinal fluid flow and restriction of it can hurt my son…. any help your willing to give on understanding csf I’d appreciate thank you. Angel

    • Hi Angel,
      Blockage of CSF increases pressure acting on different parts of the brain. The parts that are effected depend on where the restriction is located. If the restriction is in the central aqueduct between the third and fourth ventricles, CSF will back up in the lateral ventricles causing them to enlarge and compress the upper brain. If CSF outflow is restricted in the foramen magnum, such as in Chiari malformation or tumor then it will back up in the cisterns and effect the brainstem and cerebellum. You don’t want the pressure to remain high for too long but your son is young and should be able to handle the increase in pressure for a awhile without permanent damage until the surgery is scheduled. Fortunately, there are newer much less invasive endoscopic surgical procedures to remove benign tumors. So hang in there. Don’t rush. Take your time to investigate and discuss the different surgical options. Dr. F

  25. Dr. Flanagan,
    Per the Dr. Rosa upright MRI trauma study, do you think it would it be plausible for there to be a negative pressure above the cerebrum created following a traumatic brain injury/whiplash/concussion due to the inferior displacement of the cerebellar tissue? Also, what would your thoughts be about a side lying inversion AO technique in patients with CTE?

    • Hello Dr. Duffner,
      It is unlikely that intracranial pressure becomes negative above the brain due to whiplash trauma and CTE. It is more likely that pressure goes up due to tissue trauma and edema. Additionally, obstruction to CSF flow through the foramen magnum due to a CTE causes CSF to accumulate in the cisterns and subarachnoid space including the top of the brain where the bulk of CSF flow exits through the arachnoid granulations into the venous lacunae and superior sagittal sinus.

      I am not familiar with side lying inversion AO technique but AO is good for CTE. Much more research needs to be done to find the best approach to upper cervical correction and CTE.

      • Kelly Duffner says:

        I was talking several years down the road when swelling may have subsided. As far as my understanding goes, correcting malrotation will help with CTE symptomatology which may in turn help with CSF flow.

        As for the side lying inversion table, it seems to me that the physics make a great deal of sense to me. You are the expert in this arena and your thoughts would be greatly appreciated.

  26. If there was negative or relatively decreased pressure in the cortical subarachnoid space the ventricles would enlarge to fill the space.

    I am not familiar with “side lying inversion” for correction. Inversion could theoretically temporarily relieve a Chiari or pressure cone condition. Inversion, however, will also distract the AO joint slightly due to the weight of the head. If the cord is tethered distraction of the AO joints could increase the CTE. There is no benefit to prolonged inversion for CTE because it increases intraoccular and intracranial pressure.

  27. Steven Liblick says:

    Dr. Flanagan:

    Recently a report was done about MS and how it might have happend. When i first started experiencing symptoms of MS i had no medical issues prior to that relating to MS. After reading this report is it safe to say that because i was in a car accident when i was 13, now 32 that this along with other events in my life up to this point, that can be the main cause of my MS? any insight you might be able to give me i would really appreciate it! I will be following up with my neuro on this but being it was your report, i just wanted to get your thoughts on this.

    • Hello Steven,
      Whiplash can damage the spine and affect blood and CSF flow going into and out of the brain. It can also cause displacment of the brain inside the cranial vault resulting in chronic tension, compression and subsequent degeneration of healthy tissues. Multiple traumas, such as from sports, work or other causes compound the problem. Unfortunately, most neurologists don’t see the connection of MS to traumatic spine injuries yet. Nonetheless, discuss the issue with your neurologist. You should preferrably have upright MRI scans done and checked for Chiari 1 type displacement of the brainstem, as well as ligamentous damage to the cervical spine. The scans should be reviewed by a radiolgist with expertise in ligamentous injuries of the spine.

  28. Robert says:

    Doctor,

    I believe I have real postural problems that are affecting my health. My memory is bad , I am often tired and when I exercise i can get a pain across my upper mid-section with movement which can last from days to weeks. When this pain occurs …sometimes my ribs on the right side will actually have a small “click” like they are resetting something . It will not do this a lot …just a couple of times. I have had every medical test in the book and passed them all with flying colors. Years ago I had some numbness on my left side and eventually I was given an MRI in a big tube and sent to a Brain surgeon for consultation and he said I had just a bit of a bone in my upper neck that was pushing on the nerve canal up there and that it would probably go away on it’s own. It did – but now I am having “tingling” at the base of my neck bone. When exercising my lower left type of thigh seems to be off kilter for a few days afterward and slightly painfull. . I do not really have much lower back pain.

    My head sits far forward on my body – instead of sitting directly over my mid-body it leans forward at an angle .

    I have been in an automobile accident about 10 years ago where my car was t-boned in an intersection .

    Can you please reccomend a doctor in the greater Seattle KingCounty area – I am willing to drive 50-60 miles if necessary.

    Thank you.

    Impressed by your page by the way .

    • Hello Robert,
      Thanks for the compliment. The postural, memory and fatigue problems you describe, as well as the clicking in the thoracic spine suggest that you most likely have cervical problems that are affecting blood flow through the vertebral arteries to the brainstem. It is also affecting the trapezius and paraspinal muscles in the thoracic spine. Your postural imbalances further strain the extensor muscles on the back that are used for upright posture. Excess tension in the antigravity postural muscles also cause imbalance and dysfunction in the opposing antagonistic flexor muscles in the spine and legs.

      Dr. Johanna Hoeller is a board certified NUCCA upper cervical chiropractor in Seattle. Her phone number is: 206-547-6370. Tell her I recommended you see her and keep me posted on your progress.

  29. Dr Flanagan, thanks for your reply and for the opportunity to shed a little light on why IBT is effective for people with neurological conditions.

    Most of the conditions you mention become obvious when moving from either a sitting posture or horizontal bed rest to a standing position. I would like to learn whether the same problems are mitigated by moving from an inclined bed at 5 degrees head up tilt to the horizontal. I suspect there will be an immediate significant and obvious improvement.

    The siphon effect as you know has been considered by others for many years. The problem is that it cannot be considered as a siphon effect because the circulatory system is semi closed and therefore atmospheric pressure cannot influence the flow of fluids.

    Dr Dean Falk, used Professor Michel Cabanac’s brilliant discovery in bidirectional flow of blood through the foramina / holes in the skull to support her radiator cooling theory. Cabanac points out that there are no valves that can account for the observed reverse direction of blood flow when heat stress through exercise is applied, yet the blood flows in the opposite direction against the force from the heart. Falk’s part of the discovery was noticing that the foramina had migrated from the back of the skull in early man to the top of the skull when we evolved to stand and walk more upright. I have corresponded with Michel Cabanac and the Late Professor Hammel regarding density changes in blood due to the applied heat stress as an explanation for the reversal of blood flow demonstrated by doplar flow. Cabanac is the real unsong hero behind the radiator theory.

    Regarding density of blood, lymph and cerebrospinal fluid, there are density differences between the types of fluids, this is obvious, but what is less obvious and until the paper titled Thermodynamic Approach to Cerebrospinal Fluid Circulation by Leszek Herbowski and Henryk Gurgul, it was generally accepted in medical circles that gravity affects both sides of the circulation equally and therefore cannot influence or disrupt the flow. Now we can see that this is completely wrong, hence my comment, which admitedly could have been worded differently and I appoligise if it sounded a little harsh. My point was that on the side of the circulation that is flowing down when we stand, in the case of bloodflow it would be the arterial side, the blood is more dense due to evaporation taking place from the respiratory tract and skin. The blood that passes through the renal system is less dense due to the filtration of salts and waste and it’s exretion via the bladder. In CSF flow, density changes again take place through evaporation, supplying the downward flowing csf with denser cooler fluid than the upward flowing csf. The lymphatic system is more than likely operating on the same density flow and return.

    Inclined bed makes use of the density changes by affording gravity the means to assist the circulation 24 hours a day instead of sleeping flat which comprimises the flow.

    There are some very damning reports in peer reviewd publications abouit the dangers of flat bed rest, especially prolonged flat bedrest.

    If you could clarify what you meant regarding brain injury and strokes due to poor mixing it would be helpful?

    Kind regards Andrew

    • Drs Flanagan says:

      Andrew,

      I forgot to mention Chiari malformations (cerebellar tonsillar ectopia, pressure cones and dissociation of CSF flow between the cranial vault and spinal canal are likewise aggravated by upright posture.

      As far as the continuing debate among scientists regarding the siphon effect in brain circulation considering the system is a closed one is concerned and therefore not effected by atmospheric pressure, neurosurgeons are the experts who have to contend with real problems not academic arguments. The studies that were done to refute the siphon effect were based on lab models using flexible tubes and reservoirs. They were not actual physiological studies on humans or animals such as the giraffe. What the scientists overlooked is that the dural sinuses are not true veins. Instead they are made of dura mater and lined with endothelium from veins. This makes them stronger and able to stay open under “subatmospheric pressure” associated with upright posture. Normal veins would collapse. The decrease in pressure in the dural sinuses increases cerebral perfusion pressure. Neurosurgeons need to be aware of the siphon effect because it can cause serious problems such as slit ventricles and pressure cones.

      As far Dean Falk, the radiator theory and the emissary foramen migrating to the top of the head are concerned, the ones that migrated toward the top of the head are very small and few in number if any at all. They most likely play only a minor role in brain cooling. Brain cooling is predominantly done by counter current flow through the heat exchangers of the cavernous and suboccipital cavernous sinuses and their connections to the eyes and scalp veins respectively. It is my opinion that the diploic veins also play a role in keeping the brain cooler.

      As for clarification of my comment regarding poor mixing of blood and CSF in traumatic brain injuries strokes is concerned, subarachnoid hemorrhages cause blood to leak into the CSF pathways in the subarachnoid space. The different densities between blood and CSF prevent mixing of the two which makes it difficult to get the blood out of the brain. The thick blood can block the subarachnoid space or the arachnoid granulations and subsequently cause and increase in CSF volume and intracranial pressure.

      Warm regards, Dr. F

  30. Dr Flanagan, with regards to the siphon controversy, have you considered molecular drag? This is where the movement of fluid in one direction causes all of the fluids to circulate, it is not a siphon and will flow inside a closed or semi closed or indeed an open system and has been demonstrated experimentally in both hard and soft wall tubing. Here is a short video showing how solutes migrating under the influence of gravity affects soft wall tubing in the vertical position: http://youtu.be/zNJHChtHklg
    Another short video showing how solute can draw water more than 24 metres vertically in a single open ended tube: http://youtu.be/sz9eddGw8vg
    The last video was conducted to show how trees use gravity to circulate sap to great heights and was witnessed by Forestry Commission scientists and journalists. This simple flow and return flow density driven circulation was why beds were tilted back in 1995. The results with Chronic Venous Insufficiency were unprecedented, with varicosity resolved within 4 weeks of avoiding a flat bed in two unrelated cases at the same time, one of which was a nurse. This led on to looking for more people with Varicose veins, including my mother, who also noted her VV’s improved but she also reported that the sensation and movement in her leg and foot was also restored after 11 years of being unable to move her ankle and feel touch sensation. This prompted an investigation into neurological disorders, deducing that mum had some problems with damaged nerves and that the nerves had some how been restored. So the question was how does CSF circulate and in 1995 following some astonishing results with ms using IBT, the realisation that gravity was also affecting the central and peripheral nervous system beneficially when sleeping flat was avoided and that the spinal decompression effect of the inclined bed was probably helping to release impingements.
    I can see from your clarification of your previous comment that you are considering cross contamination rather than the density difference between the same fluid in the same system.
    For far too many years, I have been calling for a study to test IBT in a way that will be accepted by doctors and consultants. The results are very real, but always will remain anecdotal until such a study is tested. Would you be interested in testing IBT with any of your patients and ask them to keep a journal, beginning with a list of all known symptoms and problems along with diagnosis date and EDSS score?

    Kind regards Andrew

    • Andrew,
      In answer to your question regarding the siphon theory – molecular drag is more of an academic issue. It isn’t that relevant to my theory, research or proposed practical clinical applications.

      As for your comment on the impact of IBT on the central and peripheral nervous system and on spinal decompression – while elevating the head of the bed may be beneficial to improved blood flow through the jugulars it won’t have any impact on blood flow through the vertebral venous plexus (VVP), which is the primary venous drainage route during upright posture. Likewise, it won’t have any impact on the bidirectional flow of CSF between the cranial vault and spinal canal in the recumbent or in the upright position. Blockage of venous drainage and dissociation of CSF flow between the cranial vault and spinal canal are currently prime suspects in the cause of normal pressure hydrocephalus and associated neurodegenerative conditions. The craniocervical spine and spinal canal are key areas of blockage to venous blood and CSF flow that can lead to chronic neurodegenerative conditions.

      In regards to your comment regarding me “… considering cross contamination rather than the density differences between the fluid in the same system” – When it comes down to CSF and blood mixing, it doesn’t matter whether scientists attribute the problem to density, viscosity or polarity differences between blood and CSF. Again, those are academic arguements for scientists. The problem from a clinical perspective is that blood that has leaked into the subarachnoid space doesn’t readily mix with CSF. Consequently, the thicker denser blood can block CSF flow through the arachnoid space or through the arachnoid granulations and into the venous system.

      Lastly, IBT primarily affects the internal jugular drainage routes of the brain. My research is more related the role of vertebral veins in neurodegenerative conditions.

      Warm regards,
      Dr. F

  31. Dear Doctor Flanagan
    I am an Italian professional Organist, harpsichord concert player and conductor of almost 37 years.
    After a big right cervicobrachial pain and block right at the end of September 2012 to the end of November 2012 I discovered a large herniated c6-c7 with hydrosyringomyelia presence of small (about 2 mm diameter and around 1.7 cm long) just below the hernia. There are also a lot of disc deseases and instability of the spine A dear friend, neurosurgeon in Bologna, suggested that the hernia caused this cavity. In January, with a further dynamic MRI they discovered that in head flexion, the disc herniation compresses the cord. In the normal position, it does not cause pressure on the spinal cord and nerve root of C7. The evocated potentials were slightly altered on right arm and both legs.
    I previously suffered with chronic headache disorders, unsteadiness while walking, strong sudden pain in the thoracic area (left side – I thought due to heart problems but always negative even if infrequent), interstitial cystitis defined (when it was not an isolated beating). Some years ago while investigating my brain they descovered a arachnoid cyst in the left fossa , today still unchanged. I consulted the Chiari Institute in New York who has seen my imaging and certainty tied the cavity in the presence of this hypermobility in the cervical spine (mine is adjusted with mild cervical kyphosis)
    I have been operated with titanium cage and graft by Dr. Assietti in Milano.
    Just two days after surgery (19 February) appeared after the second night (I was back at home) very strong tingling in particular every morning after I got up to the fourth and fifth fingers of the right hand, a large and very strong pain in my arm contractures with swelling of the right scalene, trapezium, the scapula. The RMI of 22 March would seem to show the syringe slightly decreased in diameter. But in June the measures are again like before the operation.
    After every stresses (also sexual activity) my right hand coordination and tendons are worsening.
    In the dynamic resonance performed in january in dinamic the filum terminale in the prone position could be seen very well (and therefore probably a little tight) and therefore seemed clearly to the force of gravity to fall down.
    In Barcelona Dr. Royo Salvador suggested a extradural resection of the filim terminale speaking of many and clear signs of occult medular traction syndrome urged.
    I follow with pain on right shoulder and neck, arm and last fingers parestesias and my legs are also instable. Dr. Bolognese has recently also suspected an occult tethered cord or in traction because my lumbar vertebrae are completely in vertical orientation.
    Dr. Salvi here in Bologna has found in the brain AngioRMI a problem to the venous drainage and a strong asymmetry of the transverse veins of the brain and after an ecocolordoppler after the Prof. Zamboni protocol a strong CCSVI with valves anomalies of both jugulars and insufficient venous drainage in the vertebral vein. I am also very scared to have a MS or something even worser because my sympthoms are always deterioring even if they didn’t see any MS lesions in the January brain RMI and in the following spinal MRI’s
    He suggested that this venous drainage deficit could be at the base of the formation of the syringomyelia and now I am suspecting that soon I will have also some evidence of a MS.
    I would like to send you the images of my several RMIs and ask you about your opinion.
    I have tried to understand something about the new studies around upright RMI and trauma as possible causes of MS or other desorders.
    Do you think I have some chances to reverse the syrinx or I am condemned to the worst possible future as a musician?
    I would very interested in the upright RMI but I don’t know here in Italy if they have the hardwares…
    Do you think that a angioplasty could be indicated in my case or dangerous or with too short effects and restenosys?
    Many thanks for your suggestions and help in this complicated case.

    Best regards from Bologna,
    Matteo

    • Hello Matteo,
      You have a very interesting case. The Chiari malformation, syrinx, disc herniation at C6/7, cervical kyphosis, unstable cervical segments and the loss of curve in your lower back, as well as anomolies in the drainage system of the brain all suggest developmental design issues in the skull and spine associated with a dissociation of CSF flow between the cranial vault and spinal canal. I suspect you may have structural issues in the spine that are causing a thoracic outlet syndrome. The thoracic outlet syndrome is compressing nerves and blood vessels in your right arm. The unsteadiness in gait suggests to me that you still have some pressure on the brainstem. I would be happy to take a look at your brain scans.

      Warm regards,
      Dr. Flanagan

  32. Dear Doctor,
    Many many thanks for your answer.
    I would like really to send you also in a server or per post my many RMIs, how can I do?
    Only one thing: no doctor suspected from the images a Chiari, and have connected the syrinx with the disc herniation or for other idiopathic even if the syrinx is really at the place where there is the syrinx under C6/C7 and many doctors told that is possible even if rare to have with a mielopatic compression by a herniated disc to develop a caudal syrinx. So do you suspect a Chiari 0?
    Another thing: I did also a RMI for the outlet thoaric syndrome of the right arm…negative after a radiologist in Bologna. Could I send you these images before and after operation of microdiscectomy? And why after every sexual stress my symptoms go worser? There is risk that even if the disc doesn’t compress anymore the spine the syrinx can increse with sex? The doctors in NY and my best friedn (neurosurger) were sure that the cause of this syrinx could be the compression (perhaps for many years) of the herniation when I flected my head (often playing keyboard instruments)…
    Many thanks for your very important help!
    Warm regards from Bologna,
    Matteo

    • Drs Flanagan says:

      Dear Matteo, The best way to check for a Chiari 0 or a Chiari 1 is in the upright position. Most MRI scans are done supine. Some cases of Chiari 0 and 1 are actually pressure cone conditions caused by intracranial hypotension (low pressure). The low pressure in the cranial vault relative to the spinal canal causes the brainstem to sink into the foramen magnum during upright posture. The syrinx is most likely due to a mild Chiari and made worse by the degenerated disc. Both conditions cause abnormal hydraulic conditions in the spinal canal that can affect the central canal of the cord. Despite the negative findings on MRI for thoracic outlet syndrome, based on your signs and symptoms, I suspect you do have a cervicobrachial or thoracic outlet syndrome. In addition to cervical kyphosis you may have some scoliosis in your spine. Abnormal curves in the cervicothoracic spine such as kyphosis, deform the thoracic outlet. Sex is hard work. You can easily strain the thoracic outlet using your arms or having your neck in unusual positions etc. Sex is also associated with Valsalva maneuvers. Among other things, Valsalva maneuvers increase intracranial pressure. I studied ergonomics in musicians many years ago. Many instruments, such as violin and classic guitar have poor ergonomics. Trumpet and tuba players are exposed to Valsalva maneuvers when they play high powerful sustained notes. Valsalva maneuvers put backpressure on the veins of the thoracic outlet. Except for sitting, playing keyboard is one of the best ergonomic positions. Nonetheless, it can cause tension in shoulders and aggravate the cervicobrachial plexus and thoracic outlet. Flexing your head forward can also increase presssure on the syrinx.

      I will email you with my contact information.

      Warm regards, Dr. Flanagan

  33. Dear Doctor,
    Many thanks again.
    The Chiari is a tremmedous possibility because I am very scared about a decompression operation. And now I don’t know what to do with CCSVI if it’s better to make the angioplastic or not. And all doctors tell I have no Chiari…!
    Moreover reading and searching in Internet I descovered the theories of Dr. Royo Salvador in Barcelona who make an extradural section of the filum terminale in cases of Chiari and Chiari-like syndromes with scoliosis or syrinxes. In September a famous team of neurosurgery in Florence will section my filum extradural (passing through the iatus sacralis) as a first possibility to relax the spinal cord. Morevoer I have a 2.2 diameter in my filum, so something like a tight filum even if not clearly tethered.
    What do you think about CCSVI operation in my case, Chiari surgical decompression and filum terminale resection?
    I look forward to send to you (also per ftp if you prefer) my scans
    Again many many thanks for everything
    Warm regards
    Matteo

    • Drs Flanagan says:

      Dear Matteo, Even if you have a Chiari 0 or 1, you may not need decompression surgery. Furthermore, if you have intracranial hypotension surgery will not help. Dr. Thomas Milhorat similarly cuts the filum terminale in cases of tethered cord syndromes. I don’t think you should have decompression surgery, venoplasty or cut the filum terminale, however until you have a better understanding of the cause of your current condition. While cutting the filum terminale is fairly safe and it may help a Chiari 0 or 1, it will not help the pain in your right arm.

      I will contact you with my information. Warm regards, Dr. F

  34. One question again:
    How can I have opportunity to have a upright RMI? Have I to come to you in US?
    Many thanks
    Best again
    Matteo

    • Drs Flanagan says:

      Let me see what images you have first. If necessary, it will be well worth it for you to come to New York to get an upright MRI and cine CSF flow study.

      Your welcome. I will contact you today. Dr. F

  35. Susan Macafee says:

    Is there any way of getting in contact with you?

  36. Susan Macafee says:

    It is at the beginning on the page “CSF Fountains, Pulsations and Flow”. “More recently in chapter six of Clinical Neurology published by Lippencott in 2006, Dr. Joseph Madson and others elaborated on Dr. Cushings description of CSF flow.”

  37. Susan Macafee says:

    I had tracked down a Dr. Joseph R. Madsen at Harvard and sent an email. In a reply. he asked for the links to the information about the chapter, however, I didn’t hear back from him. Thank you again for the link.

  38. Susan Macafee says:

    I could not find the source (book) you had mentioned and in trying to find the book on the internet, I came across his name, and contacted him regarding trying to find the book.

  39. Susan Macafee says:

    I was wondering if you had the source of the image of the Venous Sinus drainage (3rd image down on CCSVI, Brain Cooling and Blood Flow). Since the background is yellow, it must be from a old book, and out of copyright? Thank you. Susan

    • Hello Susan,
      I apologize for the delay but I had to find where I left my book. It’s one of my favorite old books because of the unusual illustrations. The image is from “The Complete Set of Illustrations of Regional Anatomy, Section II – Head and Neck, by E.B. Jamieson, MD and published by E&S Livingstone LTD., Edinburgh. There is no publication date in the copy of the eigth edition I have. The first edition was published in 1934. The preface states that the eigth edition contained improvements suggested by the author before his death in 1956.

  40. Susan Macafee says:

    Thank you

  41. Sajid says:

    Dr. Flanagan
    I have typical symptoms of cts e.g family history, pain related to median nerve entrapment area, waking up at night due to pain and then getting relieved by shaking, muscular wasting in right hand /weakness and feeling of swollen right hand etc. My doctor insists that it is due to MS. Only one out of three EMG tests suggested CTS. What should I do? Anybody else having the same problem? Pl comment especially constant pain in right hand and muscular wasting.

    • Hello Sajid,
      You need to have thorough tests of your neck, shoulder, arm, wrist and finger muscles as well as circulation in the arm. Circulation can be checked manually or by ultrasound. There is a good possibility that you have a thoracic outlet syndrome. Thoracic outlet syndromes can be caused by cervical, thoracic, lumbar and pelvic misalignments such as those associated with scoliosis. Pelvic twists and tilts affect the spine and the shouder girdle, which can deform the neurovascular tunnels of the thoracic outlet and thereby compress the blood vessels and nerves that pass through the tunnels on their way to the arm.

      • Sajid says:

        Hello Doc,
        Many thanks for your prompt response, There is more to my above history. You are right that I need thorough checkup which in fact I had. Complete blood circulation checkup through ultrasound (Subclavian vein and down below) all normal. Had TOS + CTS surgery about a year ago which relieved 70% of my pain. This right hand pain with puffiness feeling has occurred again. I am sure that if I go for NCS/ EMG, my doc is going to repeat his MS theory again. At this stage, please guide me if there is any other test to diagnose CTS.

      • Hello Sajid,
        Although it is possible, I highly doubt that your very specific signs and symptoms of CTS are due to MS. It is not enough to simply check for CTS and TOS using ultrasound. You need a thorough physical examination of your entire spine starting with checking for leg length discrepancy, pelvic misalignment and scoliosis in the lower spine. You also need to check the alignment and range of motion in the cervical spine and the level of the shoulders, as well as strength in the arm and leg muscles. In addition to standard muscles tests, I like to further check the muscles or the arm and hand with the spine in different strain positions. Any of the conditions of the spine mentioned above can deform the thoracic outlets and cause CTS.

  42. Sajid says:

    Thank you Doc

  43. Tanya says:

    Hi Dr Flanagan,

    I hope you are well. I wondered how I would go about making an appointment with you? We have been discussed my Chiari type 1 on another page here but more has come to light and I would like to see a ‘real expert’ in this field rather that waste time and money visiting lots of people claiming they can help me! I believe you are in NY? I will start saving :-)
    Could you please email me your details and prices for coming to see you.

    Many Thanks
    Tanya Forgan

    • Hello Tanya,
      I have my issues but all things considered I am doing fairly well. Thanks for asking. I am in upstate New York. I will email you with my contact information.

      Your welcome.
      Dr. Flanagan

  44. lina correia says:

    Hello dr, I. Was just diagnozed with cerrebeller tonsillar ectopia 4mm. After 4 long years of suffering with severe headaches on the front of my face and crazy pain on the back of my neck and feeling of severe dizziness and ready to pass out…every doctor seemed to have given up on me…I was to the point where I had almost given up but all I can think of is my 11 yr who needs me…so after yrs and yrs of asking for an mri with contrast I finally had to beg for it and this is what they came up with…it is getting worse than ever for me to function..I feel really sick like I want to pass out ..the pain in my head and back is too much to handle and I can bearly make it to work…pls help me..what r my options now that I no what this is and what r the best doctors in boston ma that I can call right away to help me…I don’t no how much longer I can go on like this..I keep getting the run around from my doctor.

  45. lina correia says:

    I would really appreciate that..did u need my phone #

  46. I will contact you by email. If necessary, I will give you my phone number.

  47. Dear Dr. Flanagan,
    I have a very complicated case and would love to speak with you. I have been to dozens of doctors and had many tests done. I am contemplating on going to New York for an upright mri and csf flow study. I have not been able to find a doctor as knowledgeable as you to confer with. It is so frustrating to feel so ill and to see any specialist it seems there is a 2 month wait with no solution or proper diagnosis. Please help me. Is there a way I could contact you and I would be happy to pay for a consultation. Thank you, Theresa

  48. Dr Irving DC says:

    How do we purchase a copy of you book in the uk, the PayPal will not work and the buy book tab takes me to a trainer site.

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