1. Overview

As more people with CCSVI are being treated with angioplasty, increasing numbers are asking about both short and long-term aftercare.

While short-term aftercare typically focuses on monitoring the effects of any medications prescribed after treatment, and any unexpected physical changes/discomforts, there is no universally recommended longer-term aftercare. In fact, physicians often hesitate to recommend long-term aftercare because such programs have not been formally defined or tested.

However, many physicians are willing to work with patients to help develop reasonable longer-term aftercare that emphasizes both vascular and whole-body health. The goal of CCSVI Alliance's Aftercare page is to provide a menu of research-based aftercare activities from which a patient, together with their medical professional, may craft an individualized, common-sense plan that emphasizes both short-term medical monitoring and longer-term vascular and whole-body health.

2. Immediate Aftercare – Medical Monitoring

Following angioplasty, physicians typically focus on monitoring the patient's immediate physical health. Physicians generally believe there is a "risk window" for patients that is highest during the procedure and in the first few hours after treatment, but that quickly decreases over the next several weeks to a month or two. Thus, to many physicians, aftercare consists exclusively of critical medical monitoring during this risk period. Typical risk-based aftercare programs include:

• Monitoring for any/all post-procedure medications and related physical parameters (for example, ensuring the patient is taking their blood-thinner regimen and having their coagulation/clotting levels monitored according to a set timeline)
   
• Monitoring for, and potentially treating, any negative physical changes

Beyond these critical activities, many physicians don't recommend any long term post-procedure care other than generalities about smoking and excessive drinking (and other behaviors that are obviously bad for your health). However, patients often wish to understand various general risks to their vascular system, and steps they can take to achieve optimal vascular health following CCSVI treatment.

In fact, research suggests that patients can take a number of steps to maintain or strengthen their vascular health. Further, research has tied many of these steps to improved overall physical health, and in some cases, to reduced risks associated with MS. However, before considering a long-term vascular health program, patients must know that, at this time, no research has been conducted showing that any activity or program will prolong the effectiveness of CCSVI treatment or reduce the risk of restenosis.

3. Aftercare Begins Prior to Treatment (Knowing your Blood Coagulation factor; Planning your Aftercare)

While several studies have confirmed the general safety of CCSVI treatment^1,2, excessive blood clotting (or its opposite: excessive bleeding or bruising) is a legitimate risk for several weeks to a month or two after angioplasty. Thus, a good aftercare program begins with understanding and managing your blood clot risk prior to treatment.

Many factors may contribute to the risk of clotting or bleeding. These include:

• Characteristics of the vein(s) and obstructions being treated

• The type of treatment (for example whether stents or balloons or both are being used)

• The patient's natural propensity for clotting

Fortunately, your natural propensity for clotting (known as your "clotting factor," or "coagulation factor") can be tested prior to treatment. Knowing your clotting factor can be extremely helpful to your aftercare program because it allows your physician to better tailor your post-procedure medication(s), dosages, and timelines based on your individual clotting risks.

While the risk of clotting due to angioplasty is low, your personal coagulation factor may increase post-procedure clotting risks:

The risk of excessive clotting or bleeding ranges from relatively negligible to, in extreme cases, issues that could be life-threatening if not properly monitored and treated. If you have a coagulation disorder, its best to know it and plan for it prior to treatment.

To determine whether you have uncommonly high or low blood coagulation factors, you may request that your physician have your blood coagulation factor tested prior to treatment. One of several tests is commonly used:

• PT time and INR (Prothrombin Time and International Normalized Ratio)
• PTT (Partial Thromboplastin Time)
• D-dimer

An explanation of what these tests mean and how they work can be found here: PT & INR and D-dimer.

⇒ Patient Tip: Don't assume your doctor will automatically request a coagulation test prior to treatment. Ask him/her!

Beyond requesting a test for your blood coagulation factor, it's best to work with your physician on your aftercare plan prior to treatment. Some basics that you may want to ask your doctor:

• What is your physician's typical aftercare plan -- how many follow-ups, where, when, with whom, and for how long post-treatment will aftercare be needed?
  
  
• What medications does he/she typically prescribe post-procedure?
  
  
• How will the meds be monitored (how, where, and by whom)?
  
  
• What types of physical experiences are normal and may be expected after treatment?
  
  
• What types of physical changes are not normal and should be reported immediately, and how and to whom should they be reported (get names, phone numbers, etc.)?
  
  
• What should you do if you suddenly feel ill or faint?
  
  
• Will your physician work with you to create a longer-term post-treatment vascular health plan?

Note that because everyone's treatment is unique, your immediate aftercare program may also be unique.

4. Beyond Medical Monitoring: Longer-term Vascular Care

Longer-term aftercare may focus on augmenting the immediate post-treatment emphasis on medical and physical monitoring with longer-term strategies for optimizing your vascular and whole-body health.

Prior to treatment (if possible), patients seeking to optimize their vascular function may want to work with their physician(s) to craft a long-term aftercare program. Research suggests that the following items may be helpful to those looking to optimize their vascular and whole-body health:

• Physical activity. Generally, most physicians recommend little or no strenuous physical activity immediately following treatment. However, the many significant physical and emotional benefits of physical activity for MS patients^4,5,6,7,8,9 warrant a conversation with your doctor about when you may begin or resume some form of exercise routine. Specifically, exercise has been show to improve strength, cardiovascular and endothelial function, bladder and bowel function, fatigue, and improve emotional well-being in MS patients.

Beyond returning to your pre-procedure levels of physical activity (or beyond), many patients have found it helpful to work with specialized MS physical therapists after angioplasty. For example, some patients report renewed energy and/or renewed mobility after treatment. However, because patients may be reacquainting themselves with muscles they haven't used in some while, a physical therapist may be able to help avoid injury or overexertion. Further, a physical therapist can help you craft a new and more vigorous exercise routine commensurate with your physical abilities. Note, however, that you should always plan your exercise regimen in conjunction with your treating physician and, whenever possible, your neurologist.

That said, we understand that patients with advanced disability may not be able to engage in many types of physical activities. Below, we provide a list of exercises appropriate for those with mild to moderate disability. Following this list we provide options for those with more advanced disability.

Exercise for those with moderate to light disability:

Patients with moderate to light disability wishing to expand their exercise routine may consider the following:

• Stretching: a good method to reacquaint yourself with muscles you haven't used in a while

•  Biking, elliptical/stairmaster machines, which provide excellent cardiovascular benefits

•  Swimming, which combines both cardiovascular exercise and muscular toning

• Walking or jogging, which provide both strength and cardiovascular benefits

•  Yoga, which both strengthens muscles and focuses on breathing. Note, however, that some doctors recommend avoiding exercises that will keep the head in a lowered position for extended periods of time. This would include inverted poses in yoga, like headstands. However, yoga positions that maintain upright head and neck posture and do not require stretching or straining treated areas should be fine. As always, ensure that your treating physician reviews your yoga routine.

•  Weight lifting and weight bearing exercises, but only so long as they are reviewed by your physician and you are careful to breathe consistently during weight training. (Excessive straining or holding your breath and accidentally performing a Valsalva maneuver may be counter-productive. Scroll down in our glossary to see 'Valsalva.')