je dépose la premiere partie car mon anglais fragile a presque planté la résolution de l écran!
You have reserved a CCSVI investigation and treatment via PrivateScan at the St Jan General Hospital in
Bruges, an exclusive PrivateScan partner. This brochure provides a brief overview of what will happen
during the investigation and treatment days, and what additional tests you will undergo.
CCSVI - Chronic Cerebro-Spinal Venous Insufficiency - is a syndrome in which free drainage of oxygenpoor
blood containing waste products from the Central Nervous System (CNS) is hindered, due to
constrictions (stenoses) and/or dysfunctional valves in the neck (jugular) and chest cavity (azygos) veins.
This can cause reversed or sluggish blood-flow (reflux) in the blood vessels of the brain. Due to this reflux,
the natural protection against reversed flow, the Blood Brain Barrier, may be damaged, and then the
oxygen-poor blood containing waste products can flow back into the CNS. According to Dr Zamboni's
theory from 2008, this can cause an auto-immunological reaction in MS patients, which is responsible for
symptoms associated with multiple sclerosis (MS), such as chronic infections in the brain with permanent
brain damage and ever more serious MS symptoms.
PrivateScan diagnoses CCSVI using extremely advanced investigative methods, the latest generation of CT
scanner, if necessary supplemented with duplex ultrasound Doppler scanning. In this, PrivateScan makes
use of the protocols developed by Dr Zamboni and other authorities in the CCSVI field. Using a Ballooning
procedure the CCSVI can be relieved, so that infection processes in the brain may reduce, what are known
as exacerbations may be reduced or even abolished, and the typical symptoms associated with MS may
diminish or even disappear.
Your CCSVI investigation at St Jan General Hospital, Bruges
On your investigation day, you will be expected at the hospital in the morning at 08:00 am, fully
fasted, to take blood samples. You may directly report to secretariat General, Vascular and Pediatric
Surgery (Algemene, Vaat- en Kinderheelkunde). The secretariat is staffed from 08:00 hours. On
entering the St. Jan Hospital via the main entrance, go straight through the main hall to the end,
where you will see six lifts. Take a lift to the fifth floor, and once you arrive there, take a left as you
come out of the lift. Go through the door and then immediately right. After going through a door
again go along the corridor. You will find the secretariat office about half way down where you can
take a seat. Here you will be welcomed by a Privatescan attendant (available from 07:45 am) who
will assist you. The attendant can be reached via mobile phone +32 479 94 58 42. Later in the
morning, the CT investigation will take place, and following on the duplex ultrasound Doppler if
necessary, and then the consultation with the doctor. If you are diagnosed with CCSVI, you will be
treated the next day. If you are aged 50 or over, it is important to the treatment that you have an
ECG. This will be performed in the afternoon.
CT Venography
Using CT, a scan of the skull will be made, in which very accurate measurements of blood flow in the
vessels can be made. The investigation is targeted at the left and right jugular veins in the neck, and the
azygos vein in the chest. During the investigation, a contrast agent is administered so that these vessels
can be meticulously investigated for the presence of stenoses and pressure differences in the vicinity of the
said vessel constrictions.
Note: In connection with the contrast agent to be administered, it is important that there are no
problems with the function of your kidneys or thyroid gland. In case of doubt, you should contact
PrivateScan in advance. Given the fact that the contrast agent contains iodine, it is important that
you are not allergic to this either.
Information CCSVI investigation and treatment AZ Sint Jan_ENG_20110407 2
Duplex ultrasound Doppler
If it proves from the CT Venography that additional investigation is necessary, a duplex ultrasound Doppler
scan will be carried out immediately thereafter, according to the protocol developed by Dr Zamboni. By
means of 3D and 4D recordings, this can also be used to make measurements of vessel flows and pressure
differences in the vicinity of stenoses.
Your CCSVI treatment at St Jan General Hospital, Bruges
On your treatment day, you will once again be expected to report to the hospital in the morning, where you
will be registered at the admissions department.
For patients with no significant functional limitations, the intervention can occur during what is known as an
outpatient admission, with admission/ intervention/ discharge all on the same day. For patients with
functional limitations, what is known as a short-stay admission is indicated: admission on the day of the
intervention, and discharge on the following day. The choice between outpatient and short-stay is made in
advance (additional costs for short-stay treatment).
Short-stay means admission to a standard hospital ward, which is better suited to provide additional help.
Admission and treatment are spread out a little more, so you can report to the hospital at a later time and be
discharged at your leisure the next day.
The intervention takes place under general anaesthesia.
In order to ensure the intervention is performed safely, you will need to complete the questionnaire for the
anaesthetist in advance. We understand you have already had to fill out countless questionnaires, but we
still prefer to use the hospital’s standardised questionnaire, which is enclosed.
General anaesthesia and the intervention require a limited number of pre-intervention investigations.
Of course you have already had a CT investigation for the presence of stenoses, through which
CCSVI was diagnosed. The doctor treating you must be in possession of the written results as well
as the images from this CT investigation in order to consult them during your treatment.
Limited blood tests are required, partly for the anaesthesia, partly for the intervention itself. This is
necessary to determine your peripheral blood count, coagulation, kidney function, electrolytes and
blood glucose levels. If you have this information available from within the last year and you have
not been seriously ill, it is sufficient for you to take along a copy of the findings. If this is not the
case, blood will be collected at the hospital on your investigation day.
An electrocardiogram (ECG) is required for anyone aged 50 or over, or patients younger than 50
with a heart condition or a history of heart disease. A copy of a previous ECG is sufficient if it is less
than one year old and you have not been seriously ill since it was made. If an ECG is required, this
will also be performed at the hospital on your investigation day.
For your own safety, it is important that you be fasted prior to general anaesthesia. This means no eating,
drinking or smoking after the midnight prior to admission. You may not take any medication on the day of
admission either. In order to allow proper monitoring of a patient during anaesthesia, it is important not to be
wearing any make-up or nail polish. Remove any nail polish and do not use make-up.
If you use any blood thinners such as Marcoumar, Sintrom, Acenocoumarol, it is important these be
stopped 10 days in advance, if necessary supplemented with temporary replacement therapy. You
must contact your (family) doctor or thrombosis service about this in advance. In this case you
must always contact Privatescan, who will consult with the doctor treating you.
Information CCSVI investigation and treatment AZ Sint Jan_ENG_20110407 3
Outpatient admission:
An outpatient admission begins by 07:00 because you must first be registered administratively and because
the first treatment of the day is planned for 08:00. Outpatients are scheduled first, as they must be awake
enough to go home later that same day.
If you are scheduled for outpatient admission, you may report directly to the surgical outpatients’ reception.
On entering the St Jan Academic Hospital via the main entrance, go straight through the main hall to the
end, where you will see six lifts. Take a lift to the tenth floor, and once you arrive there, take a left as you
come out of the lift. As you go along the corridor, you will find surgical outpatients’ office about half way
down.
Report to the office, where you will be registered officially as a patient in the hospital. You will need to
present a passport or identity card. Your data will already be registered in the hospital’s administrative
system, but the hospital naturally needs to check that this information is correct and that they are treating
the right person.
After this, you will be allocated a room. You will be shown there, where you change and get into bed. The
hospital will provide you with a surgical smock for the intervention. You then take your place in bed.
Family or friends can accompany you. Please limit yourself to one or two adult visitors, otherwise the
department will become too crowded. These visitors are welcome to have a drink (coffee, water or soft
drink) on the ward. For a meal, they can go to the restaurant on the ground floor.
Short-stay admission:
A short-stay admission is a little more restful, as there is more time. The treatment is scheduled for later in
the day, because after the treatment you remain in the hospital for one night. The start time for hospital
admission will be confirmed to you in advance, but will usually be around 09:00.
For short-stay admissions, administrative registration takes place via the central admissions desk in the
main hall. On entering via the main entrance, you will find this on your right-hand side. Take a number and
have a seat in the waiting area.
An electronic board will tell you which counter to report to. At the counter, you will be registered officially as
a patient at the hospital. You will need to present a passport or identity card. Your data ought already to be
registered in the hospital’s administrative system, but the hospital naturally needs to check that this
information is correct and that they are treating the right person.
You will be assigned a room, at which point you report to the ward. You will be shown there, where you
change and get into bed. The hospital will provide you with a surgical smock for the intervention. You then
take your place in bed.
Family or friends may accompany you until you reach the ward. However, these visitors cannot stay with
you for the duration of your admission, unlike in outpatients’. They must keep to visiting hours, which are
actually very generous, from 14:00 to 20:00. There is a place to meet on the first floor in the central hall
outside of visiting hours. Please respect these visiting hours, so that nursing staff on the ward can care for
patients in peace and quiet.
Information CCSVI investigation and treatment AZ Sint Jan_ENG_20110407 4
Preparation for the intervention itself is of course the same for both outpatients and short-stay patients.
Once you have reached your room, you may need to wait a while. Waiting is difficult for everyone, but only
one patient can be treated at a time. So bring something with you to read or occupy yourself and to relax.
As soon as it is your turn, you will be picked up from your room, and taken to the operating theatre
reception area in your bed. No visitors are allowed to remain with the patient from this point on.
The waiting time is generally short at this point. The aim is to get patients to the operating theatre in time so
the schedule can be followed, but it is impossible to predict exactly when your intervention will take place.
You may need to exercise patience at this point as well.
From here, you will be taken to the operating theatre preparation area. You will be given an intravenous
catheter through which medication for the anaesthesia can be administered. Electrodes will be attached to
monitor your heart. A type of clip will be placed on your finger to monitor oxygen levels in your blood.
The intervention consists of introducing a needle into a vein in your left groin. This requires the groin area to
be shaved. This is usually done for you, but you may do it yourself at home if you wish.
The intervention begins with the introduction of a needle into your left groin.
During the first stage, a catheter is introduced to make an X-ray of the veins using contrast liquid. The
technical term for these images of the vessels is phlebography. It is the only investigation method that can
determine the presence of abnormalities in the veins with certainty. In fact, the investigations for CCSVI
using CT and possibly Doppler ultrasound are primarily orientating. Phlebography is of course invasive, as
a catheter must be introduced, which is why it is only performed if other investigations provide sufficient
indication for the presence of abnormalities. For this reason, the information from previous investigations
will have already been sent to the doctor treating you, with the phlebography being planned if there were
sufficient arguments to do so.
The phlebography shows the presence and precise location of the abnormalities. In this way, a guide wire
can be sent to the target area, over which a catheter with a balloon can be slid allowing the target area to
be treated. This treatment is called balloon dilatation or PTA (Percutaneous Transluminal Angioplasty). In
principle, no stents are used. The usefulness of placing a stent has not been proven; in fact, long-term data
suggests more disadvantages than advantages. In very rare cases, placement of a stent may be useful.
This consideration is left to the doctor treating you. It is usually done to solve unexpected problems or
complications. If one or more stents are necessary, this will be added to the total cost.
As soon as the stenoses have been treated, the catheter is removed and pressure is applied to the insertion
point. This is performed by hand first, and later with a pressure bandage. When you wake up, you will only
be left with the pressure bandage on the groin area.
You will initially stay in the recovery ward. Once you are awake enough, you will be taken back to your
room. You will need to maintain strict bed rest until you are given permission to get up. This is usually only
given after the doctor has checked on you. The pressure bandage must stay in place until the next day to
prevent bruising and bleeding. Thereafter you may remove it at home. It is therefore important to bring
loose-fitting clothing with you. Minor bruising is usually visible in the groin, but this disappears within a few
days.
Meal on the ward.
About two hours after you return to your room following your intervention, you will be given a glass of water,
apple juice or cola, if your condition permits it. If you wish, you may eat a light meal once you return home in
the evening. Of course, the hospital provides this for a short stay.
Information CCSVI investigation and treatment AZ Sint Jan_ENG_20110407 5
Discharge from the hospital.
Outpatients are discharged on the same day. The doctor will come by to check on the insertion site and
provide you with the necessary information about the abnormalities found and the treatment. You will be
given a discharge letter containing the operation report. As you have been under general anaesthesia, you
may not drive a vehicle on the same day.
Patients are discharged from the short-stay ward on the day following admission. The doctor will usually
come by on the evening of the treatment, but this may not happen until late. You may still be sleepy if your
treatment took place later in the day. In any case, the doctor will see you the following morning before you
are discharged. The pressure bandage will be removed, and the insertion site checked. The abnormalities
found and the treatment performed will be explained to you. You will be given a discharge letter containing
the operation report. Unlike an outpatient, you are at liberty to drive a vehicle yourself.
What about complications?
The risk of complications is low; see the enclosed “informed consent” form.
If letting you return home from the day hospital would be irresponsible for any reason, you will be given a
room to spend the night where you can be monitored more closely.
First days at home.
You will be given a prescription for Fraxiparin upon discharge. Normally, this is a prescription for a oncedaily
subcutaneous injection of Fraxiparin for the first 20 days after the intervention. Two packages of
ready-to-use syringes will be prescribed. After disinfecting the skin, you can inject yourself or ask someone
to help you.
Depending on your home medication, there may be some variations from patient to patient.
Do not exert yourself at all for the first 48 hours following the intervention. You should restrict your exertions
for the first week after the intervention. Thereafter, you may resume your normal activities. Do bear in mind
you will bruise more easily as long as you are using Fraxiparin.
Pay particular attention to the access site in the groin for the first 48 hours; look out especially for swelling
and bleeding. The company of a friend of family member is recommended for the first 48 hours. You may
also experience a bruised sensation in the groin, as well as in the neck if balloon dilations were performed
there. You may take paracetamol as a pain killer for this. Please contact us or, if desired, the doctor treating
you or the hospital if you think something is not right.
Follow-up appointments.
It is sensible after around 90 days to have a follow-up appointment, including a duplex ultrasound Doppler
of the neck veins if they were treated. For this, you can make an appointment in the hospital in Bruges via
PrivateScan, or via your GP where you live. The costs of such an appointment in Bruges will be invoiced via
PrivateScan.
Information CCSVI investigation and treatment AZ Sint Jan_ENG_20110407 6
DO NOT FORGET:
Take along a passport or identity card for registration
Completed questionnaire for anaesthetist (see enclosure)
“Informed consent” form, read though and possibly sign in advance (see enclosure)
If available, a copy of blood test results, less than one year old
If available, a copy of ECG results, less than one year old
Make sure you are fasted on admission (no eating, drinking or smoking from the midnight before
the intervention)
You must not take any medication on the day of admission, though it is a good idea to take along
your own medication in its original packaging. In case of doubt, this allows easy checking of what
you take, and if the doctor feels it is necessary, you can take the medication with his permission.
Remove any nail polish and do not use make-up
If you take blood thinners, remember you are likely to have to stop taking them 10 days in advance
(see p. 2, and if in doubt, please ask)
If desired, shave your groin area at home
Pack personal toiletries and if desired nightwear or pyjamas
Loose-fitting clothing (pressure bandage on the groin) for discharge
Something to read or some other distraction to help you relax
Any forms to be completed for your employer or health insurance company
WHAT NOT TO TAKE:
(Management is not liable for theft, as the hospital is a public building)
Money
Jewellery
Valuables[/size]
Dernière édition par dane83 le Ven 24 Juin 2011 - 23:41, édité 2 fois
gis Mar 21 Juin 2011 - 13:06
Il était prêt à refaire le voyage, mais son chirurgien le lui a formellement déconseillé!
)
