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Poll - Treatment of MMD? (Read 17411 times)
JeepNerd
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Poll - Treatment of MMD?
Jun 27th, 2008 at 3:32pm
 
Ok, based on my other thread, and I AM listening, I wanted to see if there are others out there like us or if we are the only ones?

Ok, so here is my poll question (and if someone can create an official poll / better / feel free to have the mod kill this and go with yours!?)

So

Option A:  Has MMD, had stroke/symptoms, has had the surgery to bypass, has no current symptoms / stroke afterwards.

Option B:  Has MMD, had stroke/symptoms, had the surgery, had complications or other symptoms afterwards (and if you will tell us we would apprec it!)

Option C:  Has MMD, has had a stroke, based on MRI (with dye), has good blood flow and has been recommended to not go with surgery at this time.  Treating medically (if so, what are they on?)

Option D:  Has MMD, has not had stroke, treating medically.

Option E:  Has MMD, has not had stroke/symptoms, had surgury.  (Tell us if any issues after?)

I am hoping this is ok to ask for a raising of hands here, we know we have over 1000 folks on the site, maybe we can see what kinds of treatments are going on and how they are working in our own informal setting?

I want/need to see this info to see if we are the only ones getting told this, thanks in advance!

OH, if you could just give quick background on the person, age, sex, and anything else that MMD folks believe is applicable?
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JeepNerd
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Re: Poll - Treatment of MMD?
Reply #1 - Jun 27th, 2008 at 3:36pm
 
I will be my own first reply:

Emily, female, age 34, OPTION C

She had no previous symptoms, TIAs, etc.  Had stroke on 6/5.  Recovering well, and she is on Plavix.

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Kath41
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Re: Poll - Treatment of MMD?
Reply #2 - Jun 27th, 2008 at 6:48pm
 
I will be happy to help out with this poll...I am a female and I had my stroke when I was 41, hence the username, the stroke was in September of 2004 and I had my surgery in March of 2005 with Dr. Steinberg. I would be option 'A' thank the lord! I realize looking back that I was symptamatic (sp?) for quite some time before with TIA's but I did not realize what was going on, I thought I had a pinched nerve in my back!!  My eye doctor was the one that said I need to get an MRI because the storke affected my vision, my primary doctor said to me after the MRI "the radiologist mentioned moya moya, I will be like you and have to look it up on the internet because I don't know what that is.." Thank god for the radiologist!! I dont think an MRI should be the final diagnoses, a true diagnoses is done with an angiogram.  I was put on Plavix for awhile but Dr. Steinberg took me off of it before surgery and if I remember right I dont think Plavix helps the mm??  Aspirin is recommended because it helps keep the blood thin.  I am sorry this is so long but I have read your other threads and I am in complete agreement with the others, waiting can be VERY dangerous please contact a specialist for an opinion, I went to my neurologist with all the information from this web site and his reply to me was " ...it looks like you are on a good track, let me know how it comes out..." basically he left the foot work up to me because he wasn't sure what to do after the diagnoses of mm.  After the surgery some of us here still experience some headaches, trouble with our memory and speech usually when stressed or tired but I think that is from the strokes suffered before the surgery??  These are all tolerable because we can say at least we ae alive!!  Good luck on the poll, and again I apologize for being so long. 
Take Care,
Kathleen
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Shan
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Re: Poll - Treatment of MMD?
Reply #3 - Jun 27th, 2008 at 6:59pm
 
Hi,

I had an emergency double bypass and EDAS in March 2005.  Prior to surgery, I had many TIA's.  Since my surgery, I have had great results from numerous MRI/MRAs, CTs, angiograms (2), and EEG and Perfusion study tests.  Thank God!

Option A:  Has MMD, had stroke/symptoms, has had the surgery to bypass, has no current symptoms / stroke afterwards.


Hope this helps~

Take care,
Shan
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Shan
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Re: Poll - Treatment of MMD?
Reply #4 - Jun 27th, 2008 at 7:03pm
 
ooops!  forgot to add.. I was on Plavix prior to my surgery (recommended by my  neuro that didn't even diagnose me with MM) Embarrassed

since my surgery, i've been taking AGGRENOX and aspirin.  my neurologist also has me taking Zonegran for seizures; however, i have not had any seizures pre/post surgery.  (i'm having another EEG to see if it's okay to stop taking it).

i do get a feeling of pressure every now and then near/around the surgery area, but they last for a second or two.  i noticed that i can induce this feeling by yawning and turning my head to the left (opposite side of my surgery). 

take care,
shan
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Re: Poll - Treatment of MMD?
Reply #5 - Jun 27th, 2008 at 10:14pm
 
my daughter is 16 had surgery in April

Option A, was told by her neurologist we should wait and see if she had another stroke or seizures.  I saw this website and contacted Dr Steinberg, her recommended bypass.  I agreed and she is doing wonderful now, much much better.  Get the second opinion, you'll be glad you did.

Margaret
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moyamoi
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Re: Poll - Treatment of MMD?
Reply #6 - Jun 28th, 2008 at 5:30am
 
I am option A too - presented with stroke symptoms, got the diagnosis and surgery was the only option in my opinion. Had first bypass and then my neuro advised that it would be a good idea to get the other side done although I had no further problems. I did and they found that my other side was as bad if not worse than my original side. The MRI I originally had showed up several silent strokes that I was not aware I had, and all I ever had before my stroke was a little bit of tingling in my fingers and hand. I have fully recovered from the original stroke, but still get the occasional headache but not as often as before. I am now 7 years post op, and after the initial bypass I had trouble with remembering words and things, but that comes from having surgery on a very delicate part of your body. If you are even considering that you can get away with just having your wife's condition monitored medically without surgery, you actually need to have your head read! This is a dangerous disease and if you value her and want her around you would not consider putting her at risk by not acting now. I am sure that if the people on this site who have had surgery decided to wait and see instead, there would be a lot more people who had died of MM or were severely affected by the stroke that they did not see coming. That is my 2 cents
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Mar
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Re: Poll - Treatment of MMD?
Reply #7 - Jun 28th, 2008 at 10:04am
 
I personally think this poll is RIDICULOUS! It will prove absolutely NOTHING! Every MM case is different and unique to each person, due to each person’s individual factors involved, so technically, it doesn’t matter what others had, or what complications, or any of that!! One blood pressure could be higher than another’s, or one MM case may progress faster than another, etc. I could go on & on as to the difference’s each case could have. THE FACT IS surgery is the mainstay treatment for MMD to avoid stroke/hemorrhage or death PERIOD! So those doing nothing and taking the “wait and see” approach are taking the risk of stroke or death, END OF STORY, and those who had surgery have lessoned that risk dramatically! The latest research is, the long-term outlook for those that had successful surgery is excellent!  So, what’s the point of any poll?? I don't get it!?!

In fact, there is NOT even such a thing as an option C or D with a doctor that’s experienced with MMD. Again, the facts to date are, there is NO such thing as MEDICAL TREATMENT!! NOTHING will stop the MM vessels from developing or the disease from progressing!! Those options are those of an inexperienced doctor, PERIOD!

So again, what’s the point of the poll?? This guy just doesn’t get it. No poll or anymore advise is gonna help this poor woman get the treatment she deserves.

Smiley
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MrsDeej
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Re: Poll - Treatment of MMD?
Reply #8 - Jun 28th, 2008 at 11:49am
 
JeepNerd,

I have to agree with Mar on this, no poll will make the outcome any different.  We all have reached out to you in both threads regarding the route to take with your wife.

Take the information or leave it.  You have what you need, now it's up to you to make the call.  We can only talk until we are blue in the face for so long. 

Just my  Smiley
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Re: Poll - Treatment of MMD?
Reply #9 - Jun 28th, 2008 at 11:50am
 
I agree Mar.  This poll is Absolutely ridiculous!!!  Surgery is the only way to go.

Lisa
(Husband coming home today from surgery and is doing awesome. )
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Re: Poll - Treatment of MMD?
Reply #10 - Jun 28th, 2008 at 4:05pm
 
When I was first diagnosed my neurologist took a wait and see what happens approach, and we waited for four years before I decided to have surgery. Seemed to work out well for me.
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Re: Poll - Treatment of MMD?
Reply #11 - Jun 28th, 2008 at 6:48pm
 
I also agree with Mar. The circumstances for every person with with this disease are so unique. Basing such a critical decision on the information attained from a poll is ludicous.

Surgery isn't easy - it takes a lot of courage. It helps tremendously though when you have complete confidence in the neurosurgeon. You shouldn't give that trust to someone simply because they profess to be a moyamoya expert or because they happen to be geographicaly convenient. Do the research, find someone with experience and a high success rate. Then get the job done.

The quality of life is a whole lot better post-surgery.

Kim
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Re: Poll - Treatment of MMD?
Reply #12 - Jun 29th, 2008 at 4:49pm
 
JeepNerd wrote on Jun 29th, 2008 at 4:11pm:
As for Mar, nothing I can say can please you for that I am sorry.  I have been told by others on this site via PM that you are difficult along with several of the oldtimers and they have quit bothering to try and have a dialogue here because of that.

That is a real shame that you are running away MM patients...


OK, I'm gonna go ahead and stop this before it goes any further.  First of all, Mar is only of the BIGGEST contributors on this site, and has NEVER ran anyone off  because of her words.  I do believe an apology is in order for that.  Whatever is said to you in your PRIVATE PM's, needs to stay there.    

It's hard to hear "body language" when you read someone's words.  I personally have spoke with Mar about this and I know what she meant by what she said.  Now, she and her family have been through hell and back with this disease, and in all honesty, doesn't want you to go through what they have!!!  Mandy is a walking miracle, I think we can all agree to that.

I will say this again, what you choose to do with the information on this site is up to you and your family.  Take what you want and leave the rest.  But there will be no room for rude words or behavior.  We are all here for the same reasons, us or someone we know is affected by this progressive disease.

We can't always choose the situations that life brings us, but we can choose the attitdes we will use to face them.  

But, getting back to your TWO opinions, I would be interested to know what Dr. Steinberg, the leading expert in Moyamoya disease, had to say about her bloodflow?  


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« Last Edit: Jun 29th, 2008 at 4:51pm by MrsDeej »  

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Re: Poll - Treatment of MMD?
Reply #13 - Jun 29th, 2008 at 5:12pm
 
Removed post... and will keep all opinions to self

Feel free to delete all my posts...

I cannot win...all I was trying to do is get more information to help me understand why the doctor was recommending this direction for my wife.

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Re: Poll - Treatment of MMD?
Reply #14 - Jun 29th, 2008 at 7:41pm
 
JeepNerd wrote on Jun 29th, 2008 at 5:12pm:
all I was trying to do is get more information to help me understand why the doctor was recommending this direction for my wife.

Jeep,

I think herein lies the problem you've run into...

You haven't come across as trying to understand the direction your doctors are recommending, you've come across as trying to justify (to the board) the direction your doctors are recommending.

You've decided the best decision for your family is to "go along" with a recommendation made by a physician with little MMD experience, and most of the people on this board have done exactly the opposite when they were in the exact same position with themselves, or their loved ones.

They questioned their doctor's recommendations and did their own research.  They heard 95% blockage in an artery that supplies blood to the brain, but bloodflow is adequate and said NOT FOR MY SON/DAUGHTER/HUSBAND/WIFE IS'S NOT!! ...next!

People on this site are not... and do not claim to be physicians.  But I bet you most of them have experienced  more strokes, hemmorages, and even deaths from MMD by sharing on this board than many physicians will ever be a part of.

I sincerely wish you and your family all the best!

DJ
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Re: Poll - Treatment of MMD?
Reply #15 - Jun 29th, 2008 at 11:01pm
 
Hi all,
I haven’t posted in awhile but I felt this thread required one from me.  I have caught up on all the posts, and hope my 2 cents will add some value (though I heard the 2 cents really cost more these days LOL).  

JeepNerd,
I just read DJ's post and I do think you are trying to justify  your approach, not necessarily in your poll but in your other posts.  However, I read your a poll as an information gathering post.  I doubt you will find many who are of the C & D options, if there are any out there, especially on this board, but I’m sure you were well intentioned.  I think you should continue as you have been to read as much as you can (and not just on this board) about this disease and what you/your wife should do.  I know at this difficult time, it is hard to always think clearly (I was very lucky – I had a brother, a doctor, who did most of the thinking for me and a mother who did all the worrying for me).  Take a deep breath, and let your heart guide you.  

I consider myself pretty straightforward (as much as that is allowed on this board Smiley ), and thus, I do want to say in regards to Mar, that though she and I have sometimes had differing opinions in the past (about how things are said vs. what is said), she is very well intentioned.  She is very passionate about her views, and she is number one looker-out-er (if there is such a word) for everyone’s health on this board.  She has done her homework and posts the most informative information out there for newcomers (especially when some of us would like to but never have time to).  

The reality is there is no cure for MMD.  You can still die of a stroke, even after having had surgery.  BUT it is the most optimal TREATMENT out there.  You are correct, that full blown clinical studies haven’t been done on this.  But I don’t see this as possible, as who wants to be a guinea pig?  There is a study at a major university here in NYC – I was asked to be a part of it and the neurosurgeon there said I didn’t need surgery.  Long story short, I didn’t want to be a case study.  I had the surgeries elsewhere, and now I’m an anomaly in their case study.  Was it worth it?  I still have some symptoms but they’re milder and I also see improvement in other areas.  It was 100% worth it.  I don’t feel like a ticking time bomb and that mental peace was worth every “penny”.  It all comes down to risk.  How much of your wife’s life are you and she willing to risk?  

I hope this eases your mind.  This board should be a place of support – if you have more questions or concerns, please don’t hesitate to air them, whether privately or publicly with anyone.  I’m sure those who seem like they are being aggressive are not intending to be so except to explain the need for a very aggressive approach to help your wife.  That is what you came for, and that’s what we’re all here for.  

Best wishes,
Trina
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« Last Edit: Jun 29th, 2008 at 11:04pm by tiomasai »  
 
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Re: Poll - Treatment of MMD?
Reply #16 - Jun 30th, 2008 at 8:25am
 
DJ, Tio, thank you for your replies and yes you are absolutely right I do feel as if I have been trying to justify my doctors opinions.

I have been told over and over again that he has little experience with MMD and yet from the hospital and staff I understand he is the local expert, folks are referred in to him in this area and he completed his fellowship at Washington Univ where the NIH study/Moyamoya center is located.  Emily's case / blood study was reviewed by the Wash Univ Moyamoya team.

The bypass was mentioned and we will now know enough to ask when / and "why wait?"  If the answer/reason is just because Emmie was terrified of the surgery then we need to know that.

I would love to have all of the off-topic posts removed or split off into a new post, from the poll I really wanted to use this as a info gathering poll so I can walk into our appt with our NeuroSurgeon on 7/14 with as much information as possible.

For example, things I have learned since I have been on here...  so far we seem to be in the minority about treating this with medicine.  That has lead to an extended conversation over the weekend with my wife and her parents that "everyone" on here is telling us to have the surgery!!!

So you ARE making a difference, I am AM listening...but I also NEED to know the whole story, not just one side.

In other words, these are the questions asked by my wife yesterday, and my mother in law / father in law is simple.  

Does the bypass "fix" the disease / lead to no other symptoms?  [Everyone on here says MMD is progressive..so is the bypass a 10 year fix, 20, ?]  

What are the risks (I read in Moyamoi's PM/msg about dizziness and some other post surgery issues for example and Trina just mentioned she has some issues still) and what are the long term repurcussions?  YES, dizziness vs death, EASY decision but still good to know...

What are the risks of repeat stroke without the bypass

[I told them the opinion here was it was very high, our NeuroSurgeon mentioned 25% over next 12 months based on the current studies of Aspirin only treatment vs Aspirin+Cumidin.  Aspirin only actually had LESS strokes!]

So thanks again for the feedback, I am not sure how I am not communicating that we are reading and listening, but we are...

I still would really like to see this poll be successful, it would be a great resource.  Again, if one of the admins would split off this / off topic replies and put them elsewhere that would be great, thx!

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Emily
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Re: Poll - Treatment of MMD?
Reply #17 - Jun 30th, 2008 at 9:14am
 
Yo.

I am Emily also! (duh). Now aged 26 (how is that possible?) First diagnosed Oct 2005, aged 23. After having a month of several strokes and millions of TIA's I presented to hospital, stayed in for 2 weeks, on heparin drip, as I was thought to be quite high risk. Had first STA-MCA (left side) 1 month after diagnosis. Was wobbly for about a month and a half, had second STA-MCA (right side) 5 months after the first one. have had a few of very minor symptoms since then over the years. Have been on plavix and aspirin daily for years (had about 10 months off plavix but been back on for 9 months, might go off it again soon).

So yeah I am mostly A, bit of B.

Apart from taking my meds every night, I pretty much ignore the whole thing most of the time. Works for me mostly!
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Re: Poll - Treatment of MMD?
Reply #18 - Jun 30th, 2008 at 9:55am
 
JeepNerd -

I understand that this is highly confusing and frustrating and overwhelming, but I believe you are not really reading what people have been posting.  This is valuable and priceless information from people that have been there!  Have gone through it already either themselves or along side people they love.  This is pretty powerful information!

I strongly advise you to read the Q and A from Dr. Scott.  He is a pediatric neurosurgeon in Boston, a MM Specialist, and a very knowlegable man.  By the way, he loves getting emails so you can always email him further question.  Yes, this article is from a pediatric standpoint, but the basics are there.  It's a good starting point.
http://www.childrenshospital.org/clinicalservices/Site2156/mainpageS2156P9.html

You asked "Does the bypass "fix" the disease / lead to no other symptoms?"  but numerous people have already said there is no cure.  The "fix" is not guaranteed, but it can reduce the chance of further strokes.  I say can, because no one can predict the future, everyone's cases are different, and as DJ said, no one here is a doctor!

You asked "What are the risks ... and what are the long term repurcussions?"  Risks of what? 
   A.  Not having the surgery?  Well, you are risking stroke and death.  Need I say more?
   B.  Of having the surgery?  There is always a risk of stroke post brain surgery - and a good surgeon will tell you about this.  I had 2 strokes prior to, and one stroke after my second surgery.  Bottom line, each one got progressively worse....I felt like a ticking time bomb prior to my surgery. 
   C.  Long term repercussions?  I don't know - I feel much better post surgery!  Yes, I had to go through speech and occupational therapy...but I'm alive...and I've learned not to dwell on the small things that just don't matter in the grand scheme of things!  The only think I need to do is take one baby aspirin and make sure I'm drinking enough water...and get rest when I need it.  (My disclaimer, as always, every case is different, and I'm not a doctor)

I highly suggest you go back and re-read the posts and pay attention to what you have been given - informative information and adivice from the people who have survived it!  (Leave the polls and studies to the doctors!)

Just my Smiley

-Shari

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Re: Poll - Treatment of MMD?
Reply #19 - Jun 30th, 2008 at 10:43am
 
Post removed by DJ due to HIPAA concerns.


JeepNerd, people can post their own information if they want, but a "running total" with names and symptoms posted by a third party will not be allowed.

You are more than welcome to compile your own decision making matrix from responses, but let people speak for themselves.

DJ
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« Last Edit: Jun 30th, 2008 at 2:23pm by DJ »  

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Re: Poll - Treatment of MMD?
Reply #20 - Jun 30th, 2008 at 1:47pm
 
Just shaking my head at all of this right now. 

I'm not giving my data, because what does it matter really?!?!?! 

JeepNerd - all I can say is that you need to go back and re-read some of these responses -- especially Strantas' response, because I couldn't have said it any better than her.  Most importantly you should re-read this.

Quote:
You asked "What are the risks ... and what are the long term repurcussions?"  Risks of what?   
   A.  Not having the surgery?  Well, you are risking stroke and death.  Need I say more?


I know that if I was faced with those facts, then there is no question in my mind that surgery would be the way to go.  Without a doubt!  Anytime anyone has surgery whether it's something as simple as removing a cyst or something as serious as a brain bypass surgery there is always going to be some sort of risk.  But being alive today far outweighs those risks in my book.  I get to live my life now whether than worry everyday about whether this will be the day that I have a serious stroke or die.  And if it was a loved one faced with the same problem - I would be making sure they get that surgery.  Oh wait...I forgot, I do have a loved one that his this disease.  My brother has MMD too.  And you better believe that I made sure that he got the surgery.

So...this is all I've got to say about the matter.  I wanted to put in my  Smiley  I wish you wife much happiness and will be praying for her.

Michelle
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Re: Poll - Treatment of MMD?
Reply #21 - Jun 30th, 2008 at 2:08pm
 
JeepNerd wrote on Jun 30th, 2008 at 10:43am:
Thanks for the replies so far, this is creating a nice amount of data!!  Please review and update/let me know if I have misread the info presented here to date?


Mayhem      E

Mayhem      Treated with Medicine for 4 years, then surgery, no symptoms since (8 years)

Actually I'm A. No med treatment, and I've had numerous TIAs which has left me with bad short-term memory and minor physical impairment. I have also been diagnosed with heart disease a couple of years ago, and have had stents inserted in a few coronary arteries. I've been on Plavix and aspirin therapy. My doctors are convinced that clots are a bigger danger to me than hemorrhage.
My brother, who also has MMD, had the same surgery I had in 2001. His docs were concerned that he would have a hemorrhagic stroke or event, due to his history, and he had a major ischemic stroke in October, blowing out the left hemisphere totally, leaving him a vegetable. Surgery is no guarantee of future events, but it does reduce the risk.
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DJ
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Re: Poll - Treatment of MMD?
Reply #22 - Jun 30th, 2008 at 2:10pm
 
Ok JeepNerd, you're starting to "split hairs" and run this into the ground.  I've seen your request to split the off topic replies to your poll and I'm the one making the decision to not do that.

I feel that a poll of this nature will not justly serve the moyamoya.com community, and the newly diagnosed patients/families, in this particular format.  I feel there are entirely too many variables in each person's individual circumstances to accurately give a simple A, B, or C answer.

I believe trying to conduct such a poll in an online, support group format, without any sort of medical control or guidelines could serve as an injustice to new MMD sufferers and their families who find this site for the first time by providing them inaccurate or misleading information.  And, as the creator of moyamoya.com, not an option I’m willing to accept the risk of.

I have considered doing a poll along the lines of what you have suggested but decided to let people read the posts, do the research, and decide for themselves which path to take.  As always, I will post a link to the results of any medical surveys or studies that I’m made aware of to help in making those decisions.

I believe that 99.9% of the population is capable of making an informed decision on how they want to proceed with MMD given the current information on, and linked to, from moyamoya.com without demanding to know what percentage of people had a hangnail on their right index finger prior to surgery prior to making a decision.  It’s ridiculous.

There is a severe lack of medically supported information on MMD.  All we can tell you is what we have experienced… from personal struggles with MMD and from years of supporting/sharing with others on this site.  People are answering your questions in their replies to your posts.  Quit being so damn hard-headed and stop trying to twist everything around to so that it will fit into your agenda.

Sincerely,
DJ
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Re: Poll - Treatment of MMD?
Reply #23 - Jun 30th, 2008 at 2:29pm
 
JeepNerd,

I do think something is getting lost in your translation.  While I appreciate your need to organize your thoughts and present to your doctor "evidence" of who has had surgery (clearly your unscientific poll shows that there are not many, if any, that haven't had surgery), I think it probably doesn't make sense to mark people as "A" or "C".  I'm one of those (I don't remember what your options stand for) but as DJ says, everyone is different.  We are not a scientific population.  (Not to mention, I never really answered your question and your designated option is incorrect). 

It sounds like your wife is really down on surgery - of course she will be.  I wanted to avoid it too.  But in the end, all the evidence pointed otherwise.  By the way, I didn't get that information on this board.  Most of my research was outside of this board.  I came to this board after I made my decision.  It just turned out most of them supported my decision. 

I agree with DJ - let's not make this a calculation on which way to go for your wife.  Ask the right questions and go with your heart.  It is my opinion that it should be instinctive.  I was in a cloud of gray until one doctor said, how long do you want to wait before you have another stroke, which next time could kill you if not leave you permanently scarred?  That should give you your answer right there. 

Again, I do not think the posts here are meant to be obnoxious towards you.  I gathered from at least one of your posts that you are listening.  I just think some of your replies seem to indicate that you are not and that is frustrating some.  Just forget about the "poll" because I think that is becoming a central point of the discussion when really, it should be about your wife's health and what to do.  And you will learn that from hearing about people's experiences and not what option they are. 

Best regards,
Trina
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Re: Poll - Treatment of MMD?
Reply #24 - Jun 30th, 2008 at 2:47pm
 
I have read the replies and because of everything being said on here, started a conversation at home that we need to SERIOUSLY consider the bypass surgery based on what everyone here is saying...

"Everyone" on here is recommending surgery, correct?  Even I, apparently Criminal#1, have begun to think that sounds like the most logical option. 

What I was not aware of, before this poll, was just how many of you are still having some / slight / symptoms after the surgery.  Is that not good info to know in advance?  Kill my poll, but add that info in the information for new folks??

Now, I am going to back off and let the experts talk, emphasis is mine below, links to this info as well.

Colin P. Derdeyn, M.D.
"Moyamoya is not a disease; it is a narrowing of the carotid arteries that restricts blood flow and starves the brain of oxygen. In North America, the condition most often affects young women who are otherwise healthy."

[He links to the wikipedia article in the stmt above, wikipedia goes into great detail about progressive nature, etc.]

http://neuro.wustl.edu/patientcare/clinicalservices/moyamoyacenter.htm

"The treatment of patients with moyamoya is difficult because so little is known about the disease. Some people never have a stroke while others may have several.
There are surgical procedures that may improve blood flow to the brain.
 
These procedures may cause complications, however, and may not always achieve the desired result of improving brain blood flow.
 
Sometimes blood flow to the brain is normal despite the blockages because of connections from normal arteries that bypass the blockages. People with normal blood flow may not have anything to gain from surgery."


Ok, who is this guy?

Colin P. Derdeyn, M.D.
Current Position
Professor, Radiology
Division of Diagnostic Radiology
Neuroradiology Section
Associate Professor, Neurology and Neurological Surgery
Program Director, Endovascular Surgical Neuroradiology


Specialty Areas
Interventional Neuroradiology
Moyamoya Disease

Awards

Listed in Best Doctors in America, 2005, 2006, 2007 (Best Doctors, Inc)

Editorial Responsibilities:

Editorial Board:  American Journal of Neuroradiology
Stroke

Internet Stroke Center

Well is he a published expert in Moyamoya according to the Neurosurgeons?

Journal Articles

1.  Hallemeier CL, Rich KM, Grubb TL, Jr., Chicoine MR, Moran CJ, Cross DT III, Zipfel GJ, Dacey RG Jr, Derdeyn CP. Outcome in north american adults with Moyamoya phenomenon. Stroke 2006; 37:1490-1496.

2. Zipfel GJ, Fox DJ Jr, Rivet DJ. Moyamoya disease in adults: the role of cerebral revascularization. Skull Base. 2005 Feb;15(1):27-41.

3. Dunn GP, Refai D, Derdeyn CP, Zipfel GJ. Angiographic patterns of revascularization in North American Moyamoya. Accepted for presentation, Congress of Neurological Surgeons, October 2006.
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