Ventricles and Veins

Chronic cerebrospinal venous insufficiency, called CCSVI is new term coined by vascular surgeon Dr. Paulo Zamboni of the University of Ferrara, Italy that perfectly describes the thesis of my new book based on more than twenty years of research. CCSVI has gotten a lot of attention lately because Zamboni attributes the cause of multiple sclerosis to CCSVI due to stenosis of jugular venous drainage routes of the brain. His surgical liberation procedure uses venous balloon angioplasty, and if that fails, stents to open the narrow veins.

Apparently Zamboni and others have been having significant success, so much so that research is currently underway around the world, including the University of Buffalo in New York. Justification for the liberation procedure is based on ultasound scans showing evidence of venous stenosis. There are so many people in Canada afflicted with MS, who are looking for better options that there were long waiting lists for both the ultrasound exam and the angioplasty.

While the term CCSVI is new, the role of extracranial venous drainage issues in causing neurodegenerative diseases is not. I have been writing about it for well over twenty years now. That’s why I chose a picture of the ventricles and venous drainage system of the brain for the cover of my book. It is precisely what the book is about. In contrast to Zamboni, however, my research began with anthropological studies, and rather than MS, it started with normal pressure hydrocephalus (NPH) and Alzheimer’s. In fact, if you do a Google search for “stenosis Alzheimer’s” you will find an old article I publishied in Dynamic Chiropractic in 1990 calling for epidemiological studies into the role of venous drainage issues in Alzheimer’s. What’s more, MS is just the tip of the iceberg and aging baby boomers, Alzheimer’s and Parkinson’s diseases are the iceberg.

The key difference between Zamboni’s theory and mine is that Zamboni believes the problem is primarily caused by stenosis of veins in jugular routes. In contrast to Zamboni, I believe the problem primarily occurs in the vertebral veins as they pass through the upper cervical spine and base of the skull. Moreover, it is my opinion that mechanical strains of the upper cervical spine and base of the skull are far more likely to cause CCSVI due to deformation and compression of vertebral venous outlets rather than venous stenosis in jugular routes.

93 Responses to About CCSVI

  1. interesting views doctor. thank you.
    what in your opinion may cause the formation of lower spinal cord demyelinating lesions?

    • Dear Sir,
      I have read your history on your blog. Your question I take it refers to lesions in your lower cervical spine. My impression is that you are a fairly young male, which puts you in a high risk category for many types of serious cervical trauma. With that in mind, because of the location of the lesions in your lower cervical spine and lack of them in your brain, I would like to know if you had any type of sports or other similar flexion injuries to your cervical spine?

      MR hyperintensity signal usually indicate permanent damage. What you want to do is prevent progression. You should get your upper cervical spine checked by a well seasoned highly qualified upper cervical doctor. Among other things, besides drainage issues, a large part of the arterial blood supply to the cervical cord passes through the vertebral arteries on their way up into the brain through the foramen magnum. The anterior and posterior spinal arteries then branch off and pass back down again back through the foramen magnum. That makes the blood supply to the cervical cord particularly susceptible to compression from upper cervical subluxations. You may also have Chiari and other issues, which can affect major motor pathways, so it is well worth getting and upright MR as well, along with an MR angiogram. Talk to your doctor.

  2. Dear doctor, thank you for your reply.
    Yes i am male, 35 yo and i was dxed with demyelinating disease 18 months ago after a nasty left eye optic neuritis bout. My first symptom goes back in 2005 though but no “specialist” back then recommended an MRI.
    I used to ride motorbikes from childhood and i had an accident or two but my cervical spinal cord was not affected as far as i know.
    On the other hand, i was also into heavy bodybuilding for the last 12 years up until my diagnosis something that may indeed affected my cervical spine. What do you think?
    You see, in all my MRIs, radiologists always commend on something they see in the base of my cervical spinal cord. The thing (until know) is that no neuro ever had something to say about it so i didn’t think it was important. Not that i thought everything else the have told me is.
    I will try to translate from Greek the findings sometime next week for you cause i am in holidays at the moment but i seriously doubt that i ll do a good job. Even in greek, it s difficult for me to get what they are talking about apart from that there is a problem in my cervical spinal cord.
    “well seasoned highly qualified upper cervical doctor” you say and i hear you. I wish i can find one in Athens because know that the “liberation” treatment didn’t gave me the relief i needed i have to look further. I will make sure that this will thoroughly be investigated.
    One other finding that makes me worried is mucus visible in MRI probably due to chronic nose problems even though i cant imagine how something like this could lead to demyelination in the cervical cord. It feels like it could trigger that feeling i have in my brain though or even in eye problems. But that’s a long shot.
    All i know for sure is that i dont have MS as neuros discribe it. Something is triggering the destruction of my CNS and it’s not my immune system that does it. Especially not after a bombed it with a 3 month regime of Campath 1-H only to get worse in the following months. Even though i have antinuclear antibodies 1:320 i think that this kind of reaction is secondary to something that is seriously and chronichaly wrong.

    What you describe is a logical explanation and its the first thing i am going to investigate in the next couple of months along with nose problems. There s got to be a reason why whatever disease i have likes to attack my cervical spine.

    Thank you for your help. I will send you further info once i get back home.

    • Sir, It is highly unlikely that body building caused your current condition. It is far more likely motorbiking did. In fact it is hard to imagine that it isn’t the source of your current condition. Your MR indicates that you probably caused permanent damage to the cord. That doesn’t mean that you can’t get considerably better. Furthermore, if the condition is not fixed the brain and cord can still degenerate much further due to impaired blood flow. In contrast to an upper cervical fracture, such as from a hangman’s noose, which will kill you instantly, an upper cervical subluxation slowly strangles the life out of the brain and cord.

      If you cannot find an upper cervical doctor in Greece, you should consider Rome where doctors Marceca and Mandolis are doing research along with Dr. Stephen Conicello, who is using upper cervical correction to treat MS patients. If that doesn’t work and you need someone closer, please let me know and I will see what I can do but please don’t delay. You have nothing to lose getting your upper cervical spine analyzed and corrected, but you have potentially a lot to gain.

  3. Judy says:

    Dear Dr. Flanagan,
    You have written a very good article. It is important to note, however, that Dr. Paolo Zamboni has not used stents, nor does he condone the use of them without proper study. Dr. Zamboni is very firm on NOT using stents as there are complications that can occur. So far, they have not developed an actual stent for use in CCSVI.

    Dr. Marian Simka in Poland, Dr. Lachezar Grozdinski in Bulgaria, Dr. David Simkin in Albany NY and Dr. Michael Dake, as well as a few others have used stents to treat CCSVI. I am uncertain about Dr. Salvatore Sclafani. The doctor I am seeing also uses stents, but does not do so in the lower jugular and azygous veins. He is very well credentialed at a major university and is less public until an IRB approves they study he is doing with their MS center.

    There are a whole lot of different views on how to properly treat CCSVI with different types of balloons, stents or no stents. These discussions have been recorded, as well as many other seminars and lectures on the topic of CCSVI. They may be found at the following locations; I am certain you would be very interested:

    There is a lot of misinformation out there about Dr. Zamboni. Please do fact check on what each doctor supports and believes. Misinformation has been very detrimental to Zamboni’s hypothesis and treatment of CCSVI. Misinformation also is out there on how the Doepp and Sundstrom “studies” were done as well as that of Dr. Zivadinov in Buffalo.

    Like yourself, I truly believe CCSVI is the tip of the iceberg regarding many other diseases. I’ve always found the autoimmune system to be blamed for any medical condition that they cannot explain.

    I do appreciate your thoughtful article very much. I meant the information regarding Dr. Zamboni and stents with the best of intention. I urge you to verify what I said above for yourself. I DO hope you find all the recorded lectures and symposiums very helpful. The discussion is quite heated and interesting.

    Please do feel free to contact me if you wish information on my own doctor who will be treating me for CCSVI.

    Thank you very much for your site.

    • Thanks for the correction Judy. I will check into the info you sent. It’s hard to keep up with the flood of information. From what I have read, the venous balloon angioplasty has issues as well. For one they don’t always stay open and some require a second surgery and a stent, which is probably why some surgeons prefer to use the stent in the first place to avoid the possibility of a second surgery. Balloon angioplasty can also weaken blood vessel walls. What’s important, however, is that the procedure is being used to improve venous drainage and doing so successfully. The surgical procedure is still new and most likely will improve over time. Upper cervical chiropractic care on the other hand, is close to one hundred years old, well seasoned and likewise still improving. There is much more to this story.

      • Judy says:

        Indeed there is! I truly believe vascular issues are the very beginning of understanding MS and the other diseases you mentioned. Thank you very much for creating these pages. I’ve been lucky that I have been seen, counseled and am being treated by some amazing doctors. I’ve bookmarked your site and will add it to my Really News MS CCSVI site.

        I really think you will enjoy the two YouTube video pages I posted. This stuff is fascinating and so are all the players! 🙂

  4. Judy says:

    Sorry the HTML did not work properly.

    I was trying to link



    The Really News site just has a whole lot of resources. Please edit so that it is not one entire link.

    I apologize and i don’t know why it ended up that way.

  5. Thank you very much. I will certainly look up for a specialist to help me with this ASAP.
    I ll get back to you when i know more.


  6. Mattia says:

    Dear Uprightdoctor

    Thank you very much for your web site. Your theory is very interesting.
    I have MS since 2008, and I was liberated in Katowice in July 2010. The US exam showed no flow in the left jugular vein, maybe a membrane occluding the vein, but then in the venography there was nothing special to be seen, apart of mild stenosis (they say that the catheter may have moved the membrane while entering). Anyway they ballooned my jugulars.
    What is interesting, is that now I’m feeling significantly better (numbness, back-pain, fatigue, etc), and I wonder how mild stenosis and a (supposed) membrane can have caused me MS; your explanation of angioplasty working as siphoning reducing blood pressure in the head make in this case sense to me.
    Moreover, also your theory of trauma causing impairment in the drainage from the skull make sense to me; before having symptoms of MS I had hernia problems, and a chiropractor I was used to go to, turned several times my head in such a way I was impressed how dangerous it could have been to me. Maybe something went wrong with that treatment.
    Best Regards and thank you in advance for a reply.

    • Hi Mattia,
      Thank you for your comment. I am glad to hear the venous liberation procedure worked so well in your case. It is highly unlikely, however, that the chiropractor caused your MS symptoms.

      Without an MRI its hard to tell where the venous blockage is
      occuring in the brain. You could simply have venous stenosis in the jugular as Dr. Zamboni suggests. You could also have a Chiari type condition, or you could have back pressure against the vertebral veins in your upper cervical spine. On the other hand, some people simply have genetic design flaws. I have studied many skulls where people had an extra large internal jugular vein on one side of the brain and a comparatively much smaller, sometimes nearly absent jugular route on the other side. In fact, that is how Dr. Schelling got started in MS research. While studying skulls he noticed large discrepancies in jugular openings in MS patients.

      Even the best upper cervical care can’t correct drainage capacity issues caused by an undersized internal jugular vein due to genetic design issues. That’s why Dr. Zamboni’s treatment offers hope in many types of cases. We are just scratching at the surface. Much more research needs to be done. In the meantime, it pays to get your upper cervical spine checked to make sure it is not the cause or in anyway contributing to the burden on a backed up drainage system in the brain.

  7. Mattia says:

    Dear Uprightoctor
    Thank you for your reply. I agree with you, when you say that we are just scratching at the surface.
    In 3-6 months I’m having my control exams for CCSVI; I’ll use this time to try to find out a good chiropractor in order to let him evaluate my exams too.
    I hope to read other interesting information on your site soon.
    Best Regard

  8. costume national says:

    Dear doctor, i saw on orthopedist yesterday who “gave me a look”. This is how i can only describe the way he examined my MRIs and neck. He ordered an x-rays set of my neck in 3 positions. Head straight forward, head up and head down.

    The obvious part is that he didn’t examine my MRI thoroughly. I am saying this because after he took a glimpse of it without light behind it, he started reading the writings of the radiologist who wrote the report.

    The funny part was when he said: well, it s not serious (which i cant argue with at this point) because if it was there would be “efthiasmos” of the cord. (Greek word is ευθειασμός)
    That word hit me cause i remembered that it was mentioned in the report of the MRI i had last year, just not in the most recent.
    When i told him that there IS “efthiasmos” whatever this means, he was like : “but they dont write it in the report!!!”
    Well, i though the reason he told me to bring the films along with the report was for him to see for himself but i guess i was wrong. Hopefully today i will see a chiropractor for further discussing this matter. I am planning to inform you for any further developments especially when i have the x-rays results.

    My cervical cord’s MRI’s keywords (concerning my cervical cord’s status) are as follows (in latin characters) :

    “efthiasmos” of the cervical spinal cord. sounds like “straightening”. does this make ane sense to you?
    disk between C5-C6 is slightly pushing the inside of the “notieos” shack.

    Sorry for the “essay”. If writing all these in your blog bothers you feel free to delete and we can communicate via e-mail.

    Thank you very much.

    • Hi Sprios,
      Staightening of the cervical spine means you have a loss of the normal lordotic curve, which should arch forward toward your chin. You also have a degenerated disc at the C5/6 level which is pressing on the thecal sac which is the outer covering of the spinal cord. The loss of forward arch in your neck and the degenerated disc further suggest to me that you have had cervical trauma most likely related to motorbiking. Furthermore, while pressure on the thecal sac doesn’t directly press upon the cord, the thecal sac does contain vertebral veins so that disc herniations anywhere in the spine can cause venous back pressure and congestion. In the low back lumbar disc herniations are known to cause neurogenic claudication resulting in numbness and tingling in the feet for example.

      That said, I believe you have a strong case for a possible upper cervical subluxation and you have nothing to lose getting it checked out and corrected. The x-rays the orthopedist took didn’t do anything to rule out upper cervical subluxations. The chiropractor will take special x-rays, one of which will be through your open mouth to see the condyles of the skull, C1 and C2 called atlas and axis, as well as the foramen magnum and spinal canal.

      I hope you got my email regarding the chiropractor just outside of Athens. Please let me know what type of upper cervical care he uses and how long he has been in practice.

      • costume national says:

        He ordered the xrays but i didn’t have the time to do it.
        Thank you very much and please try to sent that chiropractor’s details one more time because i didn’t receive your email yet for some reason. i will certainly visit him once i got his details.

        either one of these should work.

        i will be waiting with agony for that mail.

  9. costume national says:

    Doctor Flanagan, i received your e-mail. Thank you VERY much for the information and your precious advice.

  10. Your welcome. Please keep me informed.

  11. costume national says:

    Dear Dr Flanagan,
    i am happy to report that your predictions could not be closer to the truth. The doctor you sent me to, found a serious misalignment of my C2 which has probably occured due to a motorbike accident back in 2000.
    I dont know match of course but the xray didn’t leave any doubts even to my untrained eyes and he told me that this was the second most serious problem of this kind he has ever seen until now.
    He suspects that it might put pressure to the brainstem but before going ahead with adjusting the damn thing (which is giving me pain every know and then if you can believe this) he want to consult with Dr Conicello in Italy.
    He is most caring and descent and i must say that i got a good feeling about this.
    It may turn out as wishful thinking but i feel that spot in my body as the core of my problems for some reason. Hopefully i ll be helped somehow.

    I will definitely keep you posted and so will my doctor.
    There are really no words to express my gratitude here.

    ps: i am afraid to have my upper cervical spine adjusted.

    • Drs Flanagan says:

      Hello Spiros, Dr. Koontz was obviously able to get some great x-rays. Your C2/axis misalignment is impressive. Considering the degree of misalignment, you most likely have a Chiari type conditon tugging on your brainstem and putting pressure on what are called the pyramidal tracts, which affects muscles, and is probably the cause the weakenss you feel in your arms and legs. It is also without a doubt the source of your CCSVI.

      As far as being nervous about getting your neck adjusted, the symptoms and consequences of not getting the problem fixed are so bad that you even contemplated suicide. You also took far greater risks every time you got on your motorbike, and took even greater risks still when you underwent anesthesia and the surgical liberation procedure.

      Dr. Koontz has highly trained, skilled and well seasoned hands just like any surgeon. The difficulty for the doctor will be in determining the best line of correction to apply the force to get it fixed. You may start to feel some improvement early on in treatment but it will take several months at least to get a misaligment as bad as yours to reposition itself. So stick with it, be a patient patient, and don’t be nervous. You have nothing to lose and potentially a lot to gain.


      • costume national says:

        There is not a single doubt that i am going forward with this. Full speed… and all the way…

      • Drs Flanagan says:

        Great. There may be some permanent damage. Only time will tell. But you are young and your vitality is very strong so I strongly uspect you will do well.

        If nothing else Dr. Koontz should be able to get rid of that constant neck pain you have due to that ten pound bowling ball, called your head, which is sitting way out of postion on your neck. It is putting a tremendous strain your neck muscles on a daily basis, never mind all the delicate tissues housed inside the skull and upper cervical spine.

        Good luck and get it fixed. MFDC

    • costume national says:

      Dear Doctor Flanagan

      Yesterday i found out (actually i saw) that apart from the axis my atlas is misaligned also. Dr Koontz consulted on my x rays with Dr Conicello and another Dr from the states and decided to start with adjusting my atlas (C1) even though the problem is not as serious as the problem with my axis (C2). Because of its greater importance in the anatomy of the spine, the adjustment he did hopefully will help with my axis misalignment. If not, he will go ahead and try to fix it.
      All i can say at this point is that the crack i heard when he pressed that bone was not something i would have expected.
      Dr Koontz is the most caring physician i have met since my battle with MS started.
      For now, i cannot feel any difference but hopefully i will in the not too distant future.
      I should notice that right after the adjustment, the scanner Dr Koontz uses to see nerve stimulation showed an improvement. On Tuesday we ll know if this improvements lasted or not.
      I ll keep you posted since i believe that other patients might have cervical trauma that may contribute to their MS progression.

      Best regards,

      • Drs Flanagan says:

        You have to give the procedure some time. A misalignment such as yours cannot be corrected overnight. You also have pressure and swelling inside the skull that is reaching all the way up to the otpic nerve. It takes time for the irritation to subside. MFDC

  12. Shye says:

    Dr Flanagan,
    I am at the TIMS site frequently, and have posted about my recent experience with Atlas and C1 adjustments–had taken years of severe pain (and all the accruing ills of motor, mind and eye problems) and visits to all sorts of drs–allopathic, osteopathic and chiropractic–until this one chiro did the right movement for the atlas–incredible relief. And yes, I had had severe trauma to neck and head. All fits in with your approach.
    But this chiropractor has taken a leave for marriage and maternity, and I am at a loss, despite being in NYC, trying to find another who will do the Atlas movement. I am much better, but the Atlas still rotates slightly off kilter, and has negative effects. I would greatly appreciate anyone in NYC that you have contact with and make referrals to. (you can email me privately if that is your preference).
    Many thanks for sharing your healing knowledge.

    • Shye says:

      forgot to mention–
      My MRI shows large bulge (forget technical term used) at C5-C6
      lots of brain lesions (none in spine)
      severe TMJ (via special type of xray)
      x-rays thru mouth show rotated Atlas
      flattened neck via x-ray

  13. Lora Gill says:

    While reading Sprios’s posting, I thought I was reading my own history as well as present condition. Except for the motorbikes, and I‘m, let‘s just say, older than he is.
    I believe I had two traumas that could explain my current situation. One was an automobile accident I my 20’s where I hit the windshield with my head hard enough to shatter it and my mouth hit the steering wheel with enough impact to knock a bottom front tooth out, root and all, and sheer or break the top half of two adjoining teeth.
    It was a few years later that I started to see a Chiropractor for back & neck pain. Years later, I developed problems with my legs and feet. When I was a good patient and went regularly, adjustments seemed to help my symptoms. But I have been an inconsistent and symptom driven patient I’m afraid.
    Then in my late 40’s I had my first bout of Optic Neuritis and my Multiple Sclerosis diagnosis followed.
    In my late 40’s I was thrown from a horse and landed on my head in a pile of shale. We were far back in the Bob Marshall Wilderness of Montana and even though my head could have used stitches, I chose to clean the wound up and wrap it tightly with an Ace bandage and not to ride back out, but to continue our week long trip. (On a different horse, mind you!)
    After that, I have noted significant loss of balance, loss of sensations, numbness, in all four extremities, well heck, like I said, I mirror allot of Sprios’s symptoms. I’m still ambulatory, but I’ve started to need the wall’s allot. My balance is getting very poor and I feel as though my legs are becoming crippled and the bottom of my feet feel like they are rounded instead of flat.
    I met with Prof. Michael Dake, on March 3, 2010 for CCSVI evaluation and had both an MRI & MRV performed. I have my 2 CD’s from the scans and here are excerpts from the write up I was sent.
    “As we discussed in our office consultation, some areas of anticipated abnormality involving the valves located in the jugular veins at its confluence with the subclavian veins are implied from findings noted on your scans. Of note, the valve cusps are prominent bilaterally. These findings are associated with prominent collaterals bilaterally, extending from the lateral neck into the subclavian veins peripheral to the jugular confluence. These collateral veins are more prominent on the right side than the left. Of note, there is mild to moderate flattening of both jugular veins, but this is again more prominent on the right than the left. Intracrainially, the left transverse sinus does not opacify. However, variant anatomy with prominent occipital sinuses is noted.
    In summation, there is bilateral evidence of jugular obstructions with multiple collaterals noted more prominently on the right side. In addition, findings infer the possibility of valvular abnormalities as the cusps of both jugular valves appear very prominent.”
    I want to take advantage of the advise you gave Sprios and get my upper cervical spine checked by a well seasoned highly qualified upper cervical doctor here in Montana and then a referral to a well seasoned highly qualified Chiropractor.
    Do you have a recommendation in the Missoula, Montana area for either specialist? If not, I will be in the Napa, California area for an extended period of time, which is fairly close to Stanford, CA as well as San Francisco, CA. Anyone in those areas you would recommend?

    • Drs Flanagan says:

      Hi Lora, You have quite a history of head and neck trauma. As for Spiros, it’s amazing he even survived the accident that violently snapped his upper cervical spine and the myelin tracts of the cord within it. Similarly, it is amazing you’re still standing.

      I’ll try to find an upper cervical doctor for you later today. I am not sure about Missoula, Montana but there is a good there is one in California in the San Francisco or Stanford area. If you don’t hear from me within two days please get back to me again.

    • Drs Flanagan says:

      Hello Lora, There is a chiro in Missoula who does UC. His contact info is: Dr. Kevin B. Kreig, 1070 North Russel St. Missoula, phone #(406-541-8888) and website (wwwkriegchiropractic.com). There are several doctors in the San Francisco are but I like the followin one as she use both knee chest and atlas orthagonal. She is obviously continuing her education. Her contact info is: Dr. Sandra Roddy Adams, Specifically Yours, 915 Irving St., San Francisco, 94122 phone #(415-566-1900) and website (specificallyyourchiropractic). I don’t know these doctors but check them out. Please let me know when you recieve this email. MFDC

  14. Shye says:

    Dr Flanagan,
    I posted on 18 Sept, and wondering if you could check the post, and again, if you could refer me to a chiropractor in NYC.
    Many thanks

    • Drs Flanagan says:

      Hi Shye, I did reply by email directly. Maybe it didn’t go through. The only UC DC in NYC that I know about is Dr. Patrick Kerr. His phone # is 212-689-1303. He uses the Atlas Orthogonal Method, which isn’t my favorite because it uses a sound wave instrument. I’m old school though and biased towards hands on methods. Nonetheless, they have been getting great results so give him a call and see if it works for you. Please let me know when you recieve this email. MFDC

  15. Lora Gill says:

    Dr. Flanagan,

    Thank you so much for getting back to me so fast, with the two Doctor’s names. I’m am currently in Montana so have made my initial appointment with Dr. Kevin Kreig in Missoula.

    I told the receptionist I was referred by you, but could you please provide me with you contact information. Also would you be willing to consult with Dr. Kreig once he has completed his diagnostic workup on me? Do you think he might be interesting in viewing the two CD’s I have from Stanford, the MRI, MRV and reading Dr. Dake‘s findings?

    Of your numerous writing pertaining to MS, CCSVI and Upper Cervical conditions on the web , is there any particular writing that I can print out that you feel would be helpful for me to take to Dr. Kreig?

    Again, thank you so much, and I’ll definitely get back to you after my appointment this Wednesday 9/29/10.


    • Drs Flanagan says:

      If he wishes to, the doctor can contact me at uprightdoc@earthlink.net. It shouldn’t be necessary for the doctor to consult with me regarding his particular method but if you don’t mind I would like to see upper cervical x-rays if he can digitize and email them to me, and I would also like to see your MRI, MRV and Dr. Dakes finding’s. I can’t think of any post in particular that he should read. All UC chiropractors should read them all. Send me info if you like and keep me posted on your progress. MFDC

  16. Shye says:

    Thanks Dr Flanagan,
    (i never got your email)
    I had called this Dr Kerr a number of months ago–he was great, discussed my case, even though I had said would probably not see him because he did not take any insurance, and his fee a bit high. The upshot was, he said that he gets results, but that hands on can get the same–but that many people afraid of hands on to the neck (and I have found many chiros to be likewise!), and many chiros no good at it (which I have found).
    I also prefer hands on–that way, other problems in back, shoulders, etc adressed also.
    One Chiropractor I saw last year used a ProAdjuster–the initial use of this released an incredible amt of energy–i was amazed, and the chiro actually left to room, and re-entered a few minutes later, still shaking her hands vigorously–said she had never experienced such a release of negative energy–the usual beats the proadjuster called for were about 10–this was 138 vibrations called for! But after using this method for a few months, found I really needed the neck manually adjusted, and this chiro did not do that.

    When I do find a good cervical chiro, will let you know, so you will have it for any other enquiries.
    Again, thanks for your informative site, and for responding.

    • Drs Flanagan says:

      Thanks Shye, Some people are good with their hands and some aren’t. The same goes for using instruments. Craniopathy is also good but it is very difficult to find a craniopathic chiro. I have never heard of a Proadjuster but anything that release negative enegy from the body belongs in the realm of black magic and voodo. Good luck find a good chiro. It’s not easy. MFDC

      • Shye says:

        Hi Dr Flanagan-
        Her is a site that explains the Pro-Adjustor method.
        I might end up going back for this, until can find someone who will work on the Atlas. If you see a problem with this method, please let me know.
        I do know i felt better with it–it just did not seem to adjust enough on the Atlas and C1, although it did help lessen the pain.

      • Drs Flanagan says:

        Shye, I checked it out and I apologize. It has nothing to do, however, with releasing negative energy. It has to do with oscillating the spine. I’ll have to reread the info again as to how it oscillates the spine. I used two different types of intersegmental traction which mechanically articulates and oscialltes the spine. I also used a powerful G5 massage unit that had five speeds and many attachments to oscillate the spine, do deep tissue massage, and for cross friction rub to break up tissue fibrosis, and for numbing pain. Oscillating the spine is good for general loosening and relaxation but you are right, you will need to find someone to get your upper cervical spine adjusted because the ProAdjuster won’t do it. Thanks for the equipment info update. MFDC

  17. Drs Flanagan says:

    Spiros, I would like to know how you doing at this point. First, how does your neck feel? Second, how does your brain feel? Does it still feel poisoned? MFDC

    • Dear Dr Flanagan,

      My neck feels better but not perfect. I must say that there are no changes i am aware of MS wise, for better or worse. It has been 12 days since the adjustment Dr Koontz did to my Atlas and honestly, i wouldn’t expect instant relief.
      I think much more time is needed to be certain that i can be helped. Don’t get me wrong though: i have not even a single doubt that those subluxations lead me to my present condition. Sure, maybe there were contributing factors but in my case…that trauma is the triggering mechanism. Correct me if i am wrong but i am just not sure that by trying to put these bones back in place my nerves will restore their previous health condition.
      I am a realist Dr Flanagan. As i assure you most MS patients are. I don’t expect miracles. But a sign will do just fine as well. Like tinnitus vanishing or maybe my legs stop feeling kind of weak. Something to keep me going. I ll go with chiropractic adjustments because i am convinced that this is the only thing that may help me.
      As for my brain, there were improvements after “liberation” and that’s all there is to it so far. Maybe in my case it’s like you say: by opening these blockages there is better drainage that took of some burden by the real problem which is somewhere in the vertebral network or even inside the spine.
      I must say something though which is kind of interesting: apart from my neck i used to have a weird pain in my skull, about 4cms above my right ear and 1 cm to the back. I also had pains right above the atlas (bilateral). This is not a joke, it was most noticeable and one of the main reasons i ve always been thinking my neck as the core of my present problems. These “pains” feel like healing if i may use this word. I really want to take this as a sign but i ll give it more time just to make sure.
      What do you think Doctor? How long would it take for someone to be classified as a responder or non?

      So, i am very happy to see that you continue to help MS patients in every way possible. You have probably realized by now that we are thirsty for knowledge and even more thirsty for viable treatment options.
      Having said that, i should tell you that i am currently working on getting Dr Koontz on board and by that i mean posting and sharing his knowledge and expertise online. Given the fact that this may turn out being a full time job, i warned him and today we will discuss it in more detail. As i have already told you, he is very kind and caring so he should know a thing or two before getting his hands dirty.
      You will have to trust me when i tell you that there is an ongoing war nowadays concerning MS treatments. Now more than ever. It is not easy for anyone to fight with the status quo and one has to be brave in order to do it.

      After my first visit to Dr Koontz, i initiated a thread in TiMS (www.thisisms.com) concerning upper chiropractic adjustments.


      I have this link in my blog and of course there are links to your blog everywhere i could put my hands on for obvious reasons.

      Being pretty active (internet wise) since i was diagnosed, i knew that MS patients would look into upper cervical spine health in more detail and i assure you that many are now keeping a closer eye about developments in this field.
      I really believe because I SAW and my hope is for others to SEE also. Blocked veins, misaligned vertebrae, whatever may be wrong. All it takes for something to see the sun of the light is to be logical and be supported. The world wide web is contributing greatly to this and secrets belong to the past.

      I should notice that there are a few well respected (and i should add AWESOME) scientists currently helping patients by answering questions. On top of that some of them (Dr Sclafani for example) take it even further, working their way between the lines of fire and traveling all over the world because they believe that we deserve a break.

      You are most welcome to join the thread i started. I am trying my best to share everything i can with my fellow patients but i am only an MS patient myself, not to mention that my English is not good enough. Don’t get me wrong. God knows we appreciate what you are doing. Doctors like you is EXACTLY what is needed not only in the MS field but in general. Maybe in a couple of hundred years, when humanity realizes that money is not what life is all about, maybe then, all doctors will be like you, Dr Sclafani, Zamboni etc etc.
      Collaboration is essential and patients can only help to one extend.
      For the time being, when one suffers from MS treatment options are never enough. And the internet (TiMS in our case) is the best place in my humble opinion for scientists to share their views with patients mainly because of it’s easy to navigate structure.
      Whatever you decide, you have all of us on your side simply because you care.

      I wish that this battle was only for me to fight. But there are millions of young people suffering from MS and in the future there will be many more. Maybe we can somehow help, in any way each of us can. The way Multiple Sclerosis was widely being treated is idiotic to say the least. And I have my body after strong chemo to prove it. This MUST change.

      Best regards,


  18. moom935 says:

    Do you have a doctor you can recommend in the metro Detroit Michigan area?

  19. Thought I would share this thought I had. Chiari puts medical words to my condition of Ms. Explains to me why when ever my heart rate is above resting (not to do with my heart) It is difficult to function.
    Nobody talks to me about my link of foods. As long as I stick to a strict main diet I can maintain with no other problems. If I go off my main nutritional path then my functioning falls – my numbness returns in my right hand etc. I am sure I would be much worse if I did not take heed. Do I notice this because it was my quest to rid myself of hip pain – so my diet was strict before M.s (which would return if I resumed complexed eating habits). Now hip pain free 95% but have extensive Ms of the upper cervical region – But still standing!:)

    From what I have been crafted through – am I a import link here??

    My page, http://www.facebook.com/#!/group.php?gid=189358978299&ref=ts

  20. Michael says:

    Dear doc,
    My mom,65 has been diagnosed as having ventricular dialtion in brain and was admitted to hosppital to see if she could be suitable for lumbar pucture and shunt. However due to a backlog of patients they decided she was not that acute????
    Can an alternative approach might help?
    Thanks and God Bless.

    • Drs Flanagan says:

      Hello Michael, It would be better if I knew a little bit more about her particular case, such as her signs and symptoms. For example does she have problems with cognition, gait or continence. That said, the ventricles are most likely dilated due to poor cerebrospinal fluid (CSF) flow. Venous angioplasty and stents may be an alternative to CSF shunts in the future but not yet. Before considering more invasive and riskier surgical procedures, however, it is well worth getting her upper cervical spine evaluated and corrected first as it can help to restore CSF flow and possibly avoid further intervention.

  21. Michael says:

    Thanks for the reply Doc.
    Yes she is having gait and memory problems and frequent urination.
    She’s poorly controlled diabetic on insulin and has ischemic heart disease as well as both eyes macular problem for which she suffers poor vision. Unfortunately some times (in fact its happened at leat on 6 occasions) she’s fallen off the bed when she is about to get up from the bed.
    Also can a chiropractic help in correcting her upper cervical spine?
    We live in Hong Kong and I do not know if you know anyone in this part of the world or can I visit just some chiropractic form the yellow pages.
    I really appreciate your comments from the bottom of my heart and thank you for sharing this info with the rest of us.
    Thanks andGod Bless

    • Drs Flanagan says:

      Hi Michael, Your mother has arterial circulatory problems in that she has ischemic heart disease and diabetes. She also has macular degeneration and poor vision which are likewise suspicious indicators of poor circulation. The worst cases of Alzheimer’s also seem to be associated with glaucoma, a topic I cover in the fourth chapter in my book “The Downside of Upright Posture.”

      While upper cervical correctcan can’t change the damage to your mother’s circulatory system it can help improve blood and CSF flow. It can also help to reduce pressure on the brainstem. It may therefore help to improve her gait and balance and incontinence and slow down the degeneration.

      I don’t know anything about this doctor or how much experience he has but there is a Dr. Peter Hong in Hong Kong. He uses Atlas Orthogonal which is a well recognized method of upper cervical that uses special stylus rather than the hands to make corrections. His website url is: http://www.drhong.com.uk. His phone number is 852-2136-0196.

      If you decide to try care, you will have to give it several months at least to fairly evaluate her progress. Keep me posted.

  22. Michael says:

    Thanks Doc,
    I will get in touch with Dr Hong and keep you posted.
    BTW I forgot to add she also has been having stiff and cracky joints esp. knees which I believe may be due to arthritis.
    Thanks andGod Bless

  23. ion nica says:

    very,very UTILITY !

  24. rebecawatson says:

    I was diagnosed with Multiple Sclerosis back in 1983. I can hardly walk now and it seems my condition worsens every day. When I first heard about the Liberation procedure and its results from a friend, I thought United States would be the first to conduct the trials. I could never imagine the corruption involved. I ended up applying for this simple procedure in Poland and waiting.. The other options were to get it done in India. After researching the internet extensively, I came across http://www.ccsviclinic.ca/ . They are screening for CCSVI in Fargo, ND and have very affordable packages for the Liberation procedure in India. I called (404)461-9560 and spoke to their nurse administrator Lisa whose priceless support made me realize that we are not alone in the fight against MS. They are screening within the US and Canada, their medical travel package includes flight arrangements and help with the visas, world class accommodation and meals within their hospitals, the liberation procedure, a stent if needed, medications necessary, a site-seeing tour, Pre-and post-procedure supervision, Full medical file including copies of charts, screens, CDs of Venograms, blood work, EKGs, etc. Post Procedure Screenings, follow-up and consultation with surgeons for the next 6 months and so many other provisions Lisa told me about, I can’t recall however you might be able to find out more on their site.. http://ccsviclinic.ca/?page_id=564 . They are providing all of this at just $13000 as compared to the other companies that charge something like $20000 just for the procedure. You may also contact Lisa by emailing her at apply@ccsviclinic.ca or calling her on (404)461-9560. I am getting liberated mid-October and I am so very thankful to everyone at CCSVI Clinic for making this happen!

  25. Zdenka Maslakova says:

    Dobry den. Prosim o odpoved lekara, ktory sa zaobera teoriou CCSVI, ci vyrastky na krcnej chrbtici mozu sposobit SM. Dakujem za odpoved

  26. tIM says:

    I was diagnosed with possible Parkinson’s last fall after I noticed a tremor in my right foot off and on the past year or so, pending an MRI review. Upon getting the MRI a tumor was noticed in the floor of the 4th ventricle of my brain blocking about 2/3 of the ventricle outflow. The doc and surgeon don’t believe that this is causing my tremor due to the location of the tumor. After reading about NPH and CCSVI I’m wondering if this tumor might in fact be causing sluggish flow of CSF fluid, leaving iron or other residue, or even causing hypoxia which eventually has damaged my substantia nigra. Is this possible? If so, wouldn’t it seem logical to remove this tumor to allow the CSF to flow normally?

    • Hello Tim,
      The tumor definitely causes sluggish CSF flow. Furthermore, if it is blocking two thirds of the CSF flow then it can cause it to backup in the central aqueduct up to the midbrain area which contains the substantia nigra. It can also cause a drop in CSF volume in the cisterna magna at the base of the brain which the fourth ventricle empties into. Surgery and shunts may be an option down the road. Before contemplating more invasive risky procedures, however, I would try specific upper cervical chiropractor care for a few months to see if you can maximize CSF flow and get rid of the tremors more conservatively. It won’t get rid of the tumor but it can reduce resistance to outflow from the fourth ventricle by improving CSF flow in the subarachnoid space where it passes through the foramen magnum and upper cervical spine.

  27. WAYNE FENTON says:

    The key difference between Zamboni’s theory and mine is that Zamboni believes the problem is primarily caused by stenosis of veins in jugular routes. In contrast to Zamboni, I believe the problem primarily occurs in the vertebral veins as they pass through the upper cervical spine and base of the skull. Moreover, it is my opinion that mechanical strains of the upper cervical spine and base of the skull are far more likely to cause CCSVI due to deformation and compression of vertebral venous outlets rather than venous stenosis in jugular routes.

    Dr. Flanigan , This paragraph in your column caught my interest , in December of 2010 i had a ultrasound at the Toronto Centre for Medical Imaging it stated two criteria out of five needed for CCSVI, the two where no.1 intermittent retrograde flow in the j3 segment of the right internal jugular vein and no. 2 was no detectable flow in the vertebral veins , in either the supine or upright position , on may 18 i was at the Rhode Island Vascular Institute in Providence Rhode Island and angioplasty and a venogram was done it showed my rijv was partially blocked and my azygous vein was clear the angioplasty cleared my jugular vein but i still experience the same symptoms , the vertebral veins were not touched and no cause for blockage was looked for or found , i have to have a follow up ultrasound done in august at the Barrie Vascular Imaging in Barrie ,Ontario , Canada . They told me they will only do the ultra sound on the jugulars would it be wise to have the flow in my vertebral veins checked if possible , and if still no flow to have the possibility of the veins being compressed by a vertebrae as there may be damage due to neck trauma from the past .
    I had an x-ray done in august of 2010 of my cervical spine but the choiropractor never mentioned anything but he wasnt looking for it either being associated with CCSVI. My situation is Secondary Progressive Multiple Sclerosis .
    Your referance to the vertebral veins and the cervical spine connection causing CCSVI has been the first indication i have found .

    • Hello Wayne,
      I don’t know how accurate the ultrasound scans are when it comes to the vertebral veins. For one, the vertebral venous plexus is extensive with rich collateral circulation. Another problem is that it surrounds the cord and is less accessible on the front and sides of spinal canal. It is also inside the bones that form the spinal canal. Add these factors together and it makes it difficult to get accurate information. I have seen cases with stenosis of the spine from the upper cervicals to mid thoracics that reported normal flow in the vertebral veins. That’s impossible. Stenosis of the spinal canal impinges the thecal sac surrounding the cord which contains the vertebral venous plexus. Spondylosis (degeneration) of the cervical spine can lead to stenosis of the spinal canal. Upper cervical misalignments can also cause functional stenosis.

  28. oliver says:

    Dear Dr Flanigan,
    I read with great interest your blog. I started to get interested in UCC by looking at the website of Dr Erin Elster , member of IUCCA. She proposes alternative chiropratic therapy to treat quite a few diseases , just like the Doctors certified with NUCCA. But my attention was turned specifically towards her case study on Tourette syndrome children. After researching on the subject, my wife and I came to the conclusion that most of the causes and explanations for the Tourette syndrome (TS) are still very much unknown and unproven and the research and applications that she came up with make the most sense. Indeed , considering Tourette as a structural-reflex disorder due to some kind of structural deformity brings a whole new definition to the symptoms and a new way of treating it. Especially that none of our respective families had cases of Tourette or Tic disorders.

    Our daughter , 7 years old, has just been diagnosed with a complex tic disorder. These symptoms started about 2 months ago now, and translate into many different tics (motor and vocal,not necessarily all at the same time). By adding up all the pieces of the jigsaw that we had in front of us, we also remembered that she had a couple of head trauma in the last summers (early June 2009 and 2010.. June doesn’t seem to be her most opportune month!) Last year (June 2010) she fell flat on her face , breaking her two frontal (milk) teeth in the process. These teeth are yet to grow again and at this stage. But we started thinking that, a consequence of this trauma could have been an internal derangement of the upper cervical spine, or perhaps some sort of misalignment of her mandible to the skull base. Two American orthodontists (Dr Brendan Stack and Dr Anthony Simms) have made serious in-roads into TS and other Motor tic disorders and the link of these conditions with internal derangments of the TMJ. All of this is of course hypothesis, since at no point any scan/ imagery was taken. The only imagery done was an X-ray of the upper/lower jaw (at the time of the accident) to make sure that no fracture was present.

    Do you have any thoughts on the application of Upper cervical care therapy as a treatment of TS ? Now we re very curious to explore that line of thought and put it in practice by consulting a certified chiro, but our other problem is that we re based in Athens, Greece. I saw in some of your previous exchanges with Spiros that Dr Koontz was mentioned. Would you stil recommend him? I would really like to consult with a chiropractor equipped with the latest diagnosis equipment as in Paraspinal Digital Infrared Imaging, Paraspinal EMG Scanning, and Precision Laser-Aligned X-ray because I would think that this new equipment can isolate and diagnose the efficacy of the UCC treatment before even starting it. It can tell us : yes there is some obvious structural problem with her spine, or misalignement , and therefore THIS could be part of her problems, or helping reducing the intensity.Also I would feel more comfortable by working with a chiro using the old Palmer school touch method. On that basis would you still recommend Dr Koontz or would you have alternative chiropractor based in the “vincinity” of Greece? (I think I remember you mentioning some italian Dr in your blog. AlthoughI I am not familiar with what to expect with the sort of treatment and care needed , but if it would require frequent follow-up , I suppose it could be difficult to work with someone based far away from home. Thank you very much for your work , and I look forward to your feedback and suggestions. Sincerely, Oliver

    • Hello Oliver,
      Tics, tremors and muscles spasms are due to overexcitation which can be due to several causes such as emotions, toxins and faulty neurotransmitters. Mechanical irritation of muscles and nerves such as from spinal problems, can also cause tics, tremors and spasms. The cause of Tourette’s for the most part is unknown. Misalignments of the upper cervical problem may play a role in Tourettes and other syndromes. Among other things, upper cervical subluxations can have a profound affect on blood and CSF flow in the brain. They can also cause malposition of the brain inside the cranial vault such as cerebellar tonsilar ectopia (CTE).

      I would strongly suggest you contact Dr. Koontz and schedule and appointment for your daughter. Unfortunately, the doctor can’t take precision x-rays in Greece and has to send patients to a lab. Nonetheless, Dr. Koontz is a good upper cervical doctor and probably the only one in Greece. He uses a good method called the Kale Brainstem Method, which is similar to the original Palmer method. He also used thermography to monitor patients progress and he knows how to work with the Greek Health System to get the best upper cervical x-rays he can. He even personally escorted Spiros to the x-ray facility to make sure the x-rays were the best possible under the circumstances. You have nothing to lose getting your daughter’s neck checked and corrected considering the type of injuries she has had. She could have easily misaligned her upper cervical spine when she broke her teeth.

      If you want to learn more about tics, tremors and spasms, go to my other website and read about Parkinson’s. You can also get a copy of my book there. It’s called, “The Downside of Upright Posture.” The sections in the book on CSF flow, normal pressure hydrocephalus, glaucoma and Parkinson’s will help you better understand the role of the upper cervical spine in tics, tremors and spasms. Please keep me posted about your daughter.

  29. oliver says:

    Thank you Doctor.
    We will probably be contacting Dr Koontz in the very near future. However I surely would feel more at ease by having a Precision Laser-Aligned X-ray done on my daughter so as to maximize the details of the UC Subluxation (if it exists). Perhaps Dr Koontz will be able to advise on where to conduct such an X-ray outside of Greece (if this facility is still not available in greece).
    Thank you again for your advice. We’ll keep you posted.

  30. Nicole says:

    CCSVI is being considered for children with autism. A thermogram screening indicates if there may be a problem with blood flow in the neck to the brain. Then if recommended a doppler sonogram will be suggested. I don’t understand the difference between every other sonogram and the one suggests for CCSVI diagnosis.

    • Hi Nicole,
      Dr. Zamboni proposed strict protcols for using sonograms in the diagnosis of CCSVI to improve interexaminer reliability and reduce variables. That said, I am very skeptical of a connection between autism and CCSVI. In this regard, venoplasty is far too invasive to use on such a young person for such an ambiguous link in my opinion.

  31. It’s truly a nice and helpful piece of info. I am happy that you shared this helpful information with us. Please keep us up to date. Thank you for sharing.

  32. Swati Gosavi says:

    Hello uprightdoctor,
    Your article is very informative. Thanks a lot !!
    I am from India (Pune ). I am female ,38,SPMS.Walking problem since 3 years. Walker is needed. I got dx. in 2001 with optic neuritis to right eye. I heard that CCSVI is not helpful if your illness is this much old. Do you know any good center here in Pune which follows Dr. Zambonis protocol ?


    • Hello Swati,
      I suggest you contact the CCSVI Alliance for clinic that follow Dr. Zamboni’s protocol. It would also be a good idea to get an upright MRI and check the dimensions of the posterior fossa and possible Chiari malformation called cerebellar tonsillar ectopia, as well as basic x-rays of your spine. Malformations and misalignment of the upper cervical spine, head tilts, and abnormal curvatures of the lower spine called scoliosis can affect the base of the skull and consequently the contents of the cranial vault, especially the optic nerve.

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