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Friday, November 19, 2010 12:30 AM | Lynne Volg link

Many of us had heard reports of an Ontario man dying after being treated in Costa Rica, but we did not have any of the details. Here is the story from CBC. Unfortunately, they made no mention of the fact he was denied treatment for complications in Ontario, resulting in him traveling back to Costa Rica, where he died.

Ont. man dies after MS vein opening

Last Updated: Thursday, November 18, 2010 | 5:51 PM ET

Mahir Mostic with his mother, Azra, and son Kareem, who is now seven, in a photo taken in Bosnia. Mahir Mostic with his mother, Azra, and son Kareem, who is now seven, in a photo taken in Bosnia.
(Courtesy Mostic family)
An Ontario man
with multiple sclerosis died of complications after a controversial
treatment in Costa Rica to open up his neck veins, CBC News has learned.

Mahir Mostic, 35, of St. Catharines died on Oct. 19, one day after doctors in the Central American country tried to dissolve a blood-clot complication.

"We didn’t find exactly what happened with Mahir, but I mean it was very terrible story for us," vascular surgeon Dr. Marcial Fallas of Clinica Biblica in San Jose said Thursday.

"He was a person that was looking [for] some way to improve his life. He found that for a short period of time his life improved."

After Mostic paid $30,000 to go to Costa Rica for treatment in late June, he was operated on three times to have a mesh stent inserted to prop open a vein in his neck. Dr. Marcial Fallas treated Canadian Mahir Mostic in Costa Rica.Dr.
Marcial Fallas treated Canadian Mahir Mostic in Costa Rica.
(Passport Medical)

When he returned to St. Catharines after receiving the stent, he was "full of hope. He was so happy, like a little boy," a neighbour recalled.

But his MS symptoms started getting worse and a blood clot formed around the stent in the vein, Fallas said. An ultrasound showed that the vein was 80 per cent blocked.

Mostic flew back to Costa Rica for treatment, but died in hospital there after doctors tried to dissolve the clot using powerful medication that Fallas thinks triggered internal bleeding.

Fallas said his clinic normally doesn't use stents because they are considered risky. But he said Mostic was willing to take the risk.

Unable to walk

Mostic had been diagnosed with a fast-moving type of multiple sclerosis three years ago. When he first sought the vein-opening procedure, he hadn't walked for 18 months.

Angioplasty, inflating small balloons to open up arteries, is commonly done for heart patients but is not an approved procedure for unblocking neck veins in MS patients in Canada.

A blood clot in the vein might be more dangerous to fix than to leave alone, said Dr. Barry Rubin, the head of vascular surgery at Toronto's University Health Network.

"Since veins have a remarkable ability to grow in other locations if one of the veins is blocked, generally it's extremely safe to just put the patient on blood thinners to try and prevent the clot from extending
or breaking off into the lungs, and just waiting," said Rubin, who is
also a professor of surgery at the University of Toronto.

"You don't have to go in and dissolve the clot once it's formed, if it's in a vein."

Rubin said Mostic isn't the first case of a serious complication in an MS patient who has sought treatment outside Canada. Last week, he treated a woman who had the vein procedure in Mexico.

"We found extensive clotting in the left arm reaching into the chest veins, and some of the clots had broken off and travelled to her lungs, which is called a pulmonary embolus, which is life threatening,
potentially life-threatening complication."

Italian doctor Dr. Paulo Zamboni is a leading proponent of treating multiple sclerosis with angioplasty. The therapy is based on an unproven theory, known as chronic cerebrospinal venous insufficiency (CCSVI),
that blocked veins in the neck or spine contribute to MS.

In April, Zamboni warned patients attending the American Academy of Neurology's annual meeting in Toronto against using stents — small mesh coils — because of the high risk of the stents moving and lack of
knowledge about their long-term effects.

He has urged clinical trials involving angioplasty for MS patients.

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