Relaxing time in the Sierra Nevada foothills with my family.  Lots of good food and company.  We had a blessed Christmas together, and send out our best wishes to all of you.  Free time allows my mind to wander...and I'm thinking about blood flow and blood volume this week.  Perhaps its from watching the rainwater rush and wend its way down our mountain trails....here's what I've been thinking about.

For many women, pregnancy offers a time of blessed relief of MS symptoms.  This has lead to studies of hormones and MS, and a clinical trial of estrogen in MS patients.   But looking at pregnancy from the CCSVI/vascular paradigm, what else can we learn?  

When women are pregnant, their blood volume increases dramatically.  This sends blood pumping throughout the body.

Perhaps the most striking maternal phisiologic alteration occurring during pregnancy is the increase in the blood volume. The magnitude of the increases varies according to the size of woman, the number of pregnancies she has had, the number of infants she has delivered, and whether there is one or multiple fetuses.The increases in blood volume progress until term;the average increase in volume at term is 45-50%. The increase is needed for extra blood flow to the uterus, extra metabolic needs of fetus, and increased perfusion of others organs, especially kidneys. Extra volume also compensate for maternal blood loss during delivery. 

After delivery is the time during which many women report having exacerbations in their MS, or a return of MS symptoms.  Yes, hormone levels are fluctuating, but so are blood volume levels.  Pondering this fact has lead me to do more reading on blood volume, and I am finding some interesting things to consider.

Hypovolemia means low blood volume.  This condition can be very serious and happens due to blood loss from injury, but it can also be mild and happens in a body that is dehydrated or is inactive or not functioning well. This happens often to the elderly.   Low blood volume can cause orthostatic hypotension. This is when there isn't enough blood getting to the brain when a person changes position, from lying down to upright.  This can lead to dizziness, confusion and falls, and often happens in the elderly.  But it can happen in people with MS, too.  Orthostatic hypotension is well-documented in MS and has been a mystery for researchers.  It is thought to be due to autonomic dysfunction.

Thinking about blood volume in terms of CCSVI treatment and restenosis has been very interesting to me.   If angioplasty is returning good, open routes of flow, but the body is not able to compensate by providing adequate blood volume, then these opened vessels will not have the necessary pressure to remain opened.  And the areas of prior stenosis might re-collapse, just like an old garden hose with low flow.

I hope to bring this avenue of discussion to the doctors.  Perhaps aftercare needs to include additional hydration, salt intake, maybe even intravenous fluids--all to keep blood levels adequate.  Inactivity and remaining in the supine position increase hypovolemia--therefore,  movement, exercise and upright activities would encourage blood flow and blood volume.  Something to think about as we move forward with CCSVI research in 2011.

All this talk about dehydration is making me thirsty!  Time for some fresh, mountain water and a walk in the pine trees with Jeff and our dog, Angel.  

With wishes for good flow in the New Year!

Joan