Orthostatic Flow Syndrome (Presentation Only Version) by SJ Smith, MD Clinician's Roundtable 04/25

Presentation only version, no discussion or Q&A. Dr. Smith discusses how fixable venous disorders underlie some cases of POTS, #MECFS, #longcovid, FMS, migraine, brain fog, IBS, ADHD, & IC.

0:00:00 Welcome by Isabel-Ramirez Burnett
1:13 Elly introduces Peter C. Rowe, MD, of JH ME/CFS & Similar Disorders Program
1:54 Dr. Rowe introduces Steven J. Smith, MD
4:15 Presentation - Part I: Introduction to Orthostatic Flow Syndrome
6:52 PCS Long Term Results
11:00 The Enigma of Pelvic Pain
14:31 How do I diagnose vein problems?
18:12 Are Bad Veins hard to detect? We use MRV, CTA, Ultrasound
19.54 Veins / Iliac, Ovarian, Renal
21:58 Watch Movies of MRA/V
25:06 Let’s Try to Fix It
25:29 Case: IC/POTS 40yo woman: Fix veins near bladder, 12 years of IC gone, POTS gone!
27:22 Case: 35 yo woman: Pelvic Pain, Chest Pain, POTS gone!
29:00 Veins & the named syndromes - the same 39 million?
30:50 Occam
32:01 Taylor, in 1949, reviewed world literature for what he called Pelvic Congestion Syndrome
35:41 PCS Facebook Survey
37:11 Dr. Rowe’s 1998 paper was rejected.
38:56 Presentation - Part 2: More Data, including veins and anxiety
39:29 POTS pts vs Kidney Donors
41:44 Ranking Symptoms of PCS PATIENTS
44:06 49% of Vein Pain Pts have O.I.! 13% after procedure
45:59 IC: Interstital Cystitis
46:20 Beighton Test - 56% of Vein Pain Pts had Hypermobility
47:42 ER Survey / Anxiety
49:55 Non-anxious Anxiety
50:24 Hip Pain
51:12 Iliac Pain & EDS/HSD
51:58 Migraines
53:10 Brain Fog
54:10 IVs fill up the tank temporarily - IR doctors fix the tank.
56:26 Severe POTS compared to Pelvic Pain Patients
58:02 PEM - ME/CFS Improves
59:11 POTS Improves
1:00:03 IBS/GERD Improves
1:01:01 Best Overall Scientific Presentation, CIRSE, Lisbon 2024
1:03:29 More ME/CFS & PEM
1:05:05 More Migraine Improvement
1:06:20 Gavrilov & Peptides (CGRP & Substance P)
1:08:21 Fibromyalgia, CGRP, & Substance P
1:09:19 Histamine
1:09:34 Neimark / IC Urodynamics
1:11:50 Chronic Fight or Flight
1:12:59 Flow Chart of Vascular Cause of Orthostatic Intolerance


#MayThurner #Nutcracker #pelviccongestion #stent #venouscompression #venousinsufficiency

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Dr. Smith is an expert in pelvic congestion syndromes (PCS) and intervention with minimally invasive embolization and stenting.

Dr. Smith, a retired interventional radiologist now focuses on research. He makes the case for poor blood flow being a core clinical issue. His studies show patient improvement across 5 centers, at 3-, 6-, and 12-month follow-ups, and across numerous symptoms.

A few relevant studies published in Phlebology: The Journal of Venous Disease:

Nonpelvic comorbid symptoms of 45 patients with pain of pelvic venous origin, before and after treatment 8/24; SJ Smith, BH Smith , M Sichlau, B Chen , D Knight, PC Rowe
https://pubmed.ncbi.nlm.nih.gov/39126...

"Improvement in chronic pelvic pain, orthostatic intolerance and interstitial cystitis symptoms after treatment of pelvic vein insufficiency" 4/24; SJ Smith, BH Smith , M Sichlau, B Chen , D Knight, PC Rowe
https://pubmed.ncbi.nlm.nih.gov/38050...

"An online survey of pelvic congestion support group members regarding comorbid symptoms and syndromes" 7/22; SJ Smith , M Sichlau, L E Sewall, BH Smith, B Chen, N Khurana , PC Rowe
https://pubmed.ncbi.nlm.nih.gov/35831...

"Imaging findings of pelvic venous insufficiency in patients with postural orthostatic tachycardia syndrome" 8/20; Martha-Gracia Knuttinen , K Zurcher, N Khurana , I Patel , A Foxx-Orenstein, L Harris, A Lawrence 3 , F Aguilar, M Sichlau , BH Smith , SJ Smith
https://pubmed.ncbi.nlm.nih.gov/32757...