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How Prevalent is Moyamoya Really? (Read 17086 times)
KTiller
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How Prevalent is Moyamoya Really?
Dec 11th, 2007 at 3:18pm
 
Does anyone know if the frequency of MMD in the U.S. has been updated recently? 1:2 million just doesn't seem right.

I'm very much a newcomer to this disease and to this board as I only became aware of moyamoya when I was diagnosed this summer (well, officially this fall).

North of Seattle, WA there are 3 women diagnosed with moyamoya disease this year alone who live within about a 10 miles radius of one another. I'm one of them. This is a sparsely populated, rural area. Most likely there are more who were diagnosed this year or in previous years. We just don't seem to fit the statistics.

We're all caucasian, 2 in our 50's, 1 in her 20's. Seattle has a large population of people with Nordic ancestry. I know that my heritage is Swedish, French, Swiss, and Dutch - not sure of the others. Are we an anomaly or are more cases of MMD being found as the medical community is becoming more aware of the disease and/or the MRI/MRA is being used more frequently as a diagnostic tool?

Given that stroke is the #3 cause of death in the U.S. and that the frequency of stroke is more common in women than men (just like the incidence of moyamoya), maybe some reasearch into the cause of those strokes should be undertaken - how often might it be attributed to MMD?

Within the U.S. is any body tracking the number of new cases diagnosed each year and other associated genetic and geographic data?

If it was found that MMD is not as rare in the U.S. as originally thought, maybe more of our U.S. dollars would be invested in MMD research.

Kim

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lotsofkids
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Re: How Prevalent is Moyamoya Really?
Reply #1 - Dec 11th, 2007 at 6:57pm
 
Many in the medical field believe it more prevalent than originally thought.

Now that advances in diagnostics are discovering the MM....the numbers are on the rise. It is still quite rare compared to other ailments and a lot is yet to be learned...but it is probably not as super rare as we would like to think....LOL

This year the University of Texas has isolated a genetic marker for MM....that is a very exciting breakthrough. Hopefully....much more will come about over these next few years!

Well....no matter the numbers.....WE ALREADY KNOW WE ARE EXTRA SPECIAL : )

hope you are doing well...did you have the surgery? My sister lives on Bainbridge Island....if I am ever in the area....we'll have tea....!!! (and chocolate cake)

hugs...Diane

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Hmmm....seems I'm kinda "special" LOL
 
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KTiller
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Re: How Prevalent is Moyamoya Really?
Reply #2 - Dec 11th, 2007 at 9:01pm
 
Hi Diane -
Yes, I had surgery with Dr. Steinberg - right side Oct 31st and left on Nov 7th. So, I'm about five weeks into the recovery process. I'm feeling really well, though when I reflect on the surgery (I try not to) I sometimes can't believe that it was ME that it happened to.  You're so right, we are special. Takes a tremendous amount of courage and faith to sustain yourself or especially a loved one though this process.

Sure hope this disease gets more and more media coverage, so that fewer people are given an ineffective treatment. I'm meeting with a reporter from our small local newspaper (though, it is online) tomorrow afternoon. She wants to write an article about moyamoya. At least we'll meet if she hasn't delivered her first child - she's about a week overdue.

I'd love to meet you when you come out this way and have tea and cake. My new philosophy - "Eat dessert first!"

Kim
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Mar
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Re: How Prevalent is Moyamoya Really?
Reply #3 - Dec 11th, 2007 at 9:46pm
 
I have no idea if MM cases in the U.S. have ever been updated, but I feel, even if the diagnosis of MMD is being reported or recorded, I still don’t think it would even be close to being accurate anyway. Many doctors are still not looking for it. Many in the medical community still don’t even know much about it, so they’re not ordering the proper tests to diagnose it properly.

Just one example posted here, was a child having 50-60 seizures a day, yet her doctors at a major children’s hospital never diagnosed MMD. For years this child never had so much as an MRI, just CT scans and EEG’s, which you know is not diagnostic testing for MMD. Then when the child was finally given an MRA, years later, the report said, “suspect congenital narrowing of terminal internal carotid arteries bilaterally”, these doctors at a major east coast children’s hospital said, “Low risk for a stroke and no further diagnostic studies recommended”. That is so disturbing!! With cases like that we see and hear about so often, there’s no way this disease is being accurately diagnosed to have accurate statistics, IMO. 
I admit that due to advances in imaging technology, we’re seeing it diagnosed more often than five years ago when I started here, but I still believe with all my heart that MM is not as rare as they think. I have to believe that just from this website alone. I would bet there are so many more out there with MMD and they have no idea and perhaps never will.

We have a long way to go.

Smiley

Mar
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Lore
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Re: How Prevalent is Moyamoya Really?
Reply #4 - Dec 11th, 2007 at 9:48pm
 
Hi Kim,

Welcome to the family.

My brother Kevin (Cubbie) had surgery on both sides in May 2005 at Stanford by Dr. Steinberg.  He had gone misdiagnosed for four years after two strokes.

We live in a rural area of Ohio and the closest city has about 30,000 people.  We are currently aware of 6 people in this area diagnosed with MMD in the past 3 years.  They range in age from 20 to 50 plus.  There are more women than men.  My brother is the only male in this area diagnosed with MMD that we are currently aware of.

I too believe the numbers don't reflect the actual current ratio.  I do believe MMD is still considered rare in comparison to other diseases but as technology and awareness continue, I believe we will see and hear more people diagnosed with MMD.

MMD was originally diagnosed in Asian decendents but today, it is found in all races.  Our ancestry is German, Dutch, English, and Scotish.  I'm unaware of any race not touched by MMD although there may be such a thing.  If so, I'm sure the researchers would be on top of that in a heartbeat.

It sounds like you are doing well since your surgeries.  It's quite the experience, no doubt about it.  Just eat lots of chocolate or at least as you mentioned, eat dessert first. LOL!

Let us know how you are progressing.

Hugs,

Lore
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Re: How Prevalent is Moyamoya Really?
Reply #5 - Dec 11th, 2007 at 11:55pm
 
hello again Kim....

you are bringing me back! I walked your shoes just a short while back....Aug 06 ....having both sides done at stanford too! There were so many feelings...it was surreal to be faced with something so unknown.

Not only is MM underdiagnosed....misdiagnosed and even worse.....

I had a glaringly "perfect" MRA performed at Cleveland Clinic...which was screaming MOYAMOYA ~18~ months before my actual diagnosis and the doctors sent me home!!!!! Saying I was just have migraines and fibromyalgia...go home and stretch! Turns out the radiologist didn't know how to read it....and said twice in her report, it needed repeating, mentioning there is a lack of flow at both the right and left coratids and she felt this was probably due to "motion artifact" (a poor quality film) and there was also lack of flow seen at the middle cerebral arteries, again....probably due to motion artifact.   It actually didn't even need repeating.... it just needed someone to know HOW to read it!!!None of the doctors treating me actually looked at it the films....and NO ONE told me it anything was ABNORMAL and should be repeated!!! In fact I was told all the tests came back and everything was quite normal. 

Fast forward ~18~months......by the Grace of God.....I had 2 small strokes brought about from a Pericarditis surgery...which then lead to my actual diagnosis at a separate hospital!
I only found out about this 6 months ago....and I was floored...it was only accidentally I stumble upon this and ordered copies of those MRA and MRI films....I then thought long and hard whether to pursue legal action and in the end, decided ...although I wanted to wring their necks! I have drafted a letter to the CEO of the hospital instead...which I will eventually finalize and send. I just want them to change/implement policy....so that this may never happen again. Hoping from here on in, any time a diagnostic needs to be repeated.....whether it is a pap smear or an MRA, the patient MUST be notified by certified mail....then the responsibility lies with them...(who better to mobilize for their own health)...not left to an incompetent system which failed grossly.

My 2cents......

sorry for such a long vent......Ok...now we can enjoy that CAKE!

Smiles....Diane : )
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Hmmm....seems I'm kinda "special" LOL
 
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Re: How Prevalent is Moyamoya Really?
Reply #6 - Dec 13th, 2007 at 2:32pm
 
Hey Lore, Diane and Mar,
Hearing your stories, reading through the earlier posts to this site and from my own experience it's clear that the wrong and delayed diagnosis of moyamoya happens far, far too often. It frightens and saddens me to think of the number of lives that have been and will be so needlessly lost or impaired because of it. This web site is a lifesaver, but you first have to at least hear the word moyamoya in reference to your case or you'll never know to do the internet search that will bring you here. Jill told me that Dr. Steinberg is currently averaging 2-3 revascularization surgeries for MMD every week so it seems the awareness is improving - but so much more is needed.

I found the link to the genetic study and called. I did the telephone interview and am waiting for the "spit kits" to arrive. They asked for a sample from my parents, and brother as well as from me - lots of early heart attack and stroke in my family history. Maybe when the results of this study are published MMD will receive more press.

I'm having a stay-at-home day today. Got frustrated in the shop yesterday. I'm finding that multi-tasking is a bit more difficult right now. Waiting on customers, answering the phone, placing orders, receiving, unpacking and stocking new shipments... too much. Today, I'm ONLY going to sort through a huge stack of bills (some medical), take the dog for a walk and EAT CAKE.
Best wishes to all,
Kim
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Re: How Prevalent is Moyamoya Really?
Reply #7 - Dec 14th, 2007 at 12:58am
 
Hi Kim,

Since last few days I am just thinking about the same question? Is it realy so rare....I think couple of weeks back I saw a posting in guest book from San Ramon California. We moved out from San Ramon,California to Portland Oregon in July 2007.... My daughter has been diagnosed with MM and had her surgery last year.She is 7 years old and doing well. The posting was about another 7 years old girl from San ramon.When we contacted them we realised we lived in the same community. Not even 5 minutes walking distance........
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Reply #8 - Dec 14th, 2007 at 7:15pm
 
Hi All
this post really makes me wander. Diane, my mom suffered all of her life with migraines and fibromyalgia and died 16 years ago of a massive stroke. No-one even thought about MM back then. Only when I presented with my problems and my husband demanding answers that we got people who knew what they were doing. Pity my father wasn't as proactive with my mom - I would still have her with me today if he had been.
Moira
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Lore
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Re: How Prevalent is Moyamoya Really?
Reply #9 - Dec 14th, 2007 at 10:04pm
 
Kim,

You mentioned multi-tasking and it sent a flag up for me.

Kevin can't multi-task and in fact, he couldn't begin to work in a shop with all the activity you mentioned.  For Kevin, that amount of activity is like a full-body overload and he simply can't process that much activity at once.  It is very much like a child that is having sensory overload.

I have had to escort Kevin out of a store because there were too many people and it was simply overwhelming and he couldn't deal with it.  It must be a hugh whirlwind for him.  He always wants to know how many people or how much activity is in the place we are about to enter whether that be a store or a restaurant.  I don't know that every MMD patient experiences this sensory overload but I do know that some MMD folks do so it must be somewhat common.  Kevin also has high anxiety.  Just thought I should mention it so you know that it isn't necessarily uncommon for MMD folks to experience sensory overload. I'm sure not every MMD individual experiences sensory overload to the extent Kevin does.

Just relax and enjoy dessert! LOL!

Hugs,

Lore
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Re: How Prevalent is Moyamoya Really?
Reply #10 - Dec 14th, 2007 at 10:39pm
 
Hi Lore,
I talked this over with my son today (he's my business partner). We decided that I'll stick with working on the books at home for the next couple of weeks. He says that he can handle the Christmas crowd on his own, but promised to call if he gets too swamped. David is a whirlwind in the shop, whereas I'm moving a bit slower these days. Things can be disorganized and he simply plows right through and gets his tasks done, whereas me, I've always been most productive in a neat and well organized workspace, only right now the clutter seems to bother me a little more - ok a lot more.
I only spent four hours in the shop today, but came home with a small stress headache tonight. This was a very slight one and didn't last once I got home, but I never used to get headaches. I'm not sure if all of this is part of the recovery from surgery or if it's due to the damage from the 3 very small strokes. Sure hope it gets better soon.
Kim
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Re: How Prevalent is Moyamoya Really?
Reply #11 - Jun 2nd, 2008 at 8:36pm
 
aloha kim,

i too believe there are many more unreported, misdiagnosed, etc. cases of MM. 

as rare as it is reported, another high school friend of mine was diagnosed with MM in a school of about 250.  so just think, that was 2 in 250.  what's the odds for that happening? 

after my surgery, i did a couple of interviews with our local news, and i immediately received phone calls and emails from other "locals" here in Hawaii who have MM too!

in fact, just last week, without saying i had MM, i shared with some friends at church that i had brain surgery--and one of them came up to me asked "do you know what MM is?"  her cousin was diagnosed last year!  i would say that i know of almost a dozen people diagnosed with MM here in the state of Hawaii.

i have noticed though, that word must be getting out because i've met a handful of dr.'s that seem to have "heard" of MM.  they may not know the specifics, but they've "heard" of it.  i do believe--there is still much more to do regarding MM awareness, and when this happens, i believe the numbers will increase.

just my  Smiley

take care,
shan
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Re: How Prevalent is Moyamoya Really?
Reply #12 - Jun 2nd, 2008 at 9:45pm
 
I have argued time and time again that MoyaMoya isn't rare, just misdiagnosed. My 19-year-old daughter was finally diagnosed three years ago. But it took several visits to doctors in Southern Illinois, Central Florida and Middle TN before we finally learned what was wrong.
Thank God for Vanderbilt, Dr. Mericle and his team. Heather had her first surgery January 2007 and her second in July 2007... she is now symptom free.

SadFrustrated with the lack of information doctors receive about MoyaMoya I've made it my mission to educate every health care professional I encounter. I also tell them to check out this website and get educated.

We live in a very small town yet there are four females living here with MoyaMoya. It just can't be that rare. Why aren't we hearing more about it in the news?

With the help of members from our local children's theatre I created t-shirts that say:
MoyaMoya Look it up!

p.s. I am originally from Seattle, just spent two weeks in the Lake City area... didn't realize how much I missed the smell of evergreeens. So nice to hear from another Northwest gal.

Kim





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Kimberly Frick-Welker&&Cookeville, TN&&Mom to Heather Frick&&patient of Dr. Mericle at Vanderbilt&&Nashville, TN&&
 
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Re: How Prevalent is Moyamoya Really?
Reply #13 - Jun 6th, 2008 at 11:42am
 
Hello~

Reading all your posts just sent zings of familiarity.

I had a brain CT scan in the early 80's and, what they were looking for wasn't found (great news) but they were astounded because I didn't have a left caroted artery. Was sent to the local surgeon who told me to just be careful, etc etc. At that time  there was very little known about mm. No thought to look for the 'tangled mass of veinns' that is mm.  So I set that (and my congenitally nearly blind left eye) on the back shelf -- not literally!. the major stroke in 1999 got my husband and the brain sergeons up here in rural Nortern Calif to investigatie and I was sent to UCSF and Stanford for tests.  Had my bypass in 1999. I'm rameling here abit sorry. MM just hasn't been realized for that long a time.

I was at  one of those driving classes one takes for speeding (urgggg they caught me!!!) and I asked the teacher if I could say a few words about how serious car acciednts can be in causing brain injury (I teach and attend TBI school because my brain glitches are very similar to TBI)... so after I did my 'drive safe prevent TBI' talk a 30ish Japanese lady came running up to me and said 'Did you say MOYAMOYA!!????  Her brother in Japan has it and so does she. She's the first mmer I've met ourt of the blue (not thru the board here). We both  just hugged and hugged in that parking lot. Strangers, but now 'sisters'.   Doctors here rumor that there may be a couple others here but I haven't met them.
So I think with more availability of the facts re: mm being dispersed/realized that more people will be found. 

Having a grouping like you do Kim in the Seattle area seems strange to me too...if it's so rare. I guess further stats will help. I am Finnish and Norwegan.

Hope I covered everything,

and YES I get tired and can only follow a single track of thought too. It expands but it's slow......

Linda
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Re: How Prevalent is Moyamoya Really?
Reply #14 - Jun 7th, 2008 at 2:01pm
 
Hi Kim, I have hear 7 case ofMM in Virginia, it may be more, this disease being miss dianosis, like myself, I have headache since I was kid, my mom said I was sick all the time, no body know why, I have learn that my memory fade away, my arms and/or legs is so weak and tired time to time, I have 5 ER within 3 years, 1 I thought that I have heart attack because my left arm is so numb and tired, ER doctor said I have anxinity(spell)attack, and send me home,the other 4 is they said it migrain headache and stress, even my family doctor said the samething, until Jan, 2006 I got dianosis,my left side total close and my right side is 3/4 close, doctors so suprise that I still walk and talk and alive, my neurosurgion said it slowly attack about 3 years ago, even though i have some brain damage but i'm happy that i alive, if i have been dianosis 3 years ago, i would have a healthy brain, I have 2 surgery on 2006, I still working on finding my memory  Smiley but I do much better, my brain used to be like a computer but now i feel so retarded Shocked, i still working on learn to live with it also, my speech is bad, my husband told me i mumble time to time, can't do multi stack any more, and the organize part is bad, and lots of little thing.
my dad is Italian, swedish and my mom is vietnamese, so I don't know where the disease come from, I would sue them both, what do you think(LOL).
I working on go to Washington to see Tammy, hopefully I will see you too.
Kieu
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Re: How Prevalent is Moyamoya Really?
Reply #15 - Jun 7th, 2008 at 5:29pm
 
Kieu~~~

I love your sense of humor---
Getting back to functioning takes a long time.
I had speech therapy, and lessons in how to live, how to think, how to relax and stretc......Every day is a lesson still and my surgery was  in 1999. Strokes are really tough.

Keep plugging away,

My husband Jack and I also hope to get Kims reunion.

Linda (LA)
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Re: How Prevalent is Moyamoya Really?
Reply #16 - Jun 12th, 2008 at 8:52pm
 
Hey Kieu!
Try to come visit Tammy during the weekend of August 16-17th. That way you can come to the moyamoya gathering in Langley, Washington. Tammy's planning to be there.
We're tied 7 to 7. I'm now aware of 7 MM folks here in the Seattle area - the number is increasing way too rapidly for a rare disease; and I only became aware of this disease within the last year.
I'd bet on the Swedish connection - my Mom is half Swedish, half French. Any time she makes a silly mistake (really not very often), we blame it on the Swedish genes - it's one of those senseless family jokes. But, there is a huge Swedish population here.

Hi Heather's Mom (Kim) -
I love the T-shirt idea! Do you mind if I borrow your slogan - I'd like to have some baseball caps printed up for the gathering here this summer.
A newspaper article about my struggle to get a MMD diagnosis was published in our small-town newpaper. It brings local folks into my shop nearly everyday who share their stories with me and I get a chance to tell them more about moyamoya. I met a woman this morning who was just diagnosed with her second cancer and told she had six months - go home. Because of the article she sought other opinions and now has appoinments with Seattle Cancer Alliance. I can't imagine being told death is imminent and not trying to beat it. Doctor's just don't know everything - I wish they did, but we need to help ourselves too. If we all do small things to get the word out about moyamoya, it will make a huge difference. Like you, my awareness of this disease is fairly recent. I hope my passion doesn't lessen as time passes.

Hiya Diane!
Did you get a response from your letter to the hospital's CEO?
I'm working on one to Harborview Medical Center - it's a difficult letter to write. I don't want to place blame, but I do want to promote a change in policy regarding the diagnosis and treatment of moymoya.
Do you think I should address the letter to anyone other than the CEO of the hospital? Maybe the CFO or the board of directors or the head of the Neurology department ...?
Kim
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Re: How Prevalent is Moyamoya Really?
Reply #17 - Jun 15th, 2008 at 7:31pm
 
Long time, no visit.  My sister has MM, diagnosed several years back in her early 40s. We're Caucasian.  And now I have a student at the school where I work (she's 7 and also Caucasian) who should be having surgery in July, God willing.  She's had two significant strokes and they're letting her brain recover before risking surgery.

I don't know two million people, but I know two with MM.  So their stats are OFF.
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Re: How Prevalent is Moyamoya Really?
Reply #18 - Jun 23rd, 2008 at 11:47am
 
300 million folks in the USA means there should be 150 cases of MM in the entire country.

This is excluding our Japenese population which is 3 of 100k.  There are 13 million Asians, could not break down further with wikipedia facts, but lets say 4 million.  That would be 160 folks in the US that are of Japenese heritage / MMD.

Adding those together and you would have 300 cases approx in the US.  I would suspect a few more on West cost than in rural / east just based on more folks with Japense heritage living there over the years.

That is approx 6 per state...  You can look at the number of folks registered on this site, maybe we represent the entire population otherwise the stats are off probably due to mis diagnosis. 

I feel lucky that we were in a hospital with a doc with MMD experience.  He sees 3-4 cases per year here in NC area.
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Re: How Prevalent is Moyamoya Really?
Reply #19 - Jun 23rd, 2008 at 4:04pm
 
Dr. Steinberg does on average 3-4 cases a week now.



Now something tells me the numbers are WAY off!!
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Re: How Prevalent is Moyamoya Really?
Reply #20 - Jun 23rd, 2008 at 8:54pm
 
Mrs. Deej may be right, but:
1. I know that while I was at Stanford for my surgeries, there were three by-pass cases (including myself), but only two of us had the moyamoya diagnosis. 

2. Most patients are having more than one surgery(are there for more than one week.)
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Re: How Prevalent is Moyamoya Really?
Reply #21 - Jun 23rd, 2008 at 10:53pm
 
If you don’t mind me commenting, I don’t think Steph necessarily said or meant Dr. Steinberg does 3-4 different MM surgeries every week (although his surgeries are numerous now for MMD, but I don’t know the exact amount) But I think she’s talking about Dr. Steinberg seeing/diagnosing at least 3-4 moyamoya cases a week now. He reads films and goes over different MM cases from people all over the country and it keeps increasing.

I believe her post was simply reflecting a point from the previous post (and thread for that matter) about the stats of MMD being waaaaaaaaaaay off.

In fact, the previous post stated his doctor was experienced with MMD seeing 3-4 cases per year, so it goes unspoken to the difference in experience in seeing 3-4 cases per year to Dr. Steinberg seeing that amount per week. Now that's experience and definately blows the stats to kingdom come.

Smiley
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Re: How Prevalent is Moyamoya Really?
Reply #22 - Jun 24th, 2008 at 4:58am
 
AMEN!
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Michelle
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MrsDeej
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Re: How Prevalent is Moyamoya Really?
Reply #23 - Jun 24th, 2008 at 9:05am
 
Yes, thank you Mar!!  That was exactly what I meant.  I apologize for the confusion with my words!!

Smiley


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Re: How Prevalent is Moyamoya Really?
Reply #24 - Jun 24th, 2008 at 10:25am
 
Hello MMers

I think if you look at the sites total members,which is 1148 at this time.That would blow away the stats.

I know they are not all MM surgery,but they are supporting,or looking for info for people who do have MM

Smiley

Kevin
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« Last Edit: Jun 24th, 2008 at 10:27am by cubbie »  

Kevin Allen- I was so much older than,I am younger than that now,The Byrds,My Back Pages
 
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