Transcript document

The Treatment of Infection
Without Antibiotics
AANP Annual Conference
August 2003
Jared L. Zeff, ND
Goal: to present a system of effective
treatment for antibiotic-resistant infections
Overview:
1.
2.
3.
4.
The scope of the problem
Contrasting approaches to treatment
Principles of a naturopathic approach
Case illustrations
Primary cause of death: 1900
Infectious pneumonia
1929: Sir Alexander Fleming discovers penicillin.
Penicillin is effective against Streptococcus
pneumoniae.
1930’s: Howard Florey and Ernst Chain extract and
purify penicillin.
1941: British policeman is first person treated with
penicillin, dies: insufficient quantity.
1943: Selman Waksman discovers streptomycin.
Streptomycin is effective against Mycobacterium
tuberculosis.
1940’s: penicillin available to armed forces.
1950’s: penicillin available to general public.
More antibiotics are developed.
The age of miracle medicine has arrived!
By the end of the 20th century we will see the
“virtual elimination of infectious disease as a
significant factor in societal life.”
Sir F. MacFarlane Burnett, MD, 1962
Australian Nobel laureate
“…it [is] time to close the book on infectious
diseases.”
U.S. Surgeon General William Stewart
1969
Causes of Death (2000)
1. Heart Disease
2. Cancer
3. Stroke
4. Chronic Lung Disease
5. Accidents
710,760
553,091
167,661
122,009
97,900
Causes of Death (2000)
6. Diabetes
7. Influenza and Pneumonia
8. Alzheimer’s disease
9. Kidney disease
10. Septicemia
69,301
65,313
49,558
37,251
31,224
National Center for Health Statistics, CDC, 2002
Causes of Death
2,000,000 nosocomial infections
annually which kill 90,000 each year.
William Jarvis, MD Director: CDC
March 11, 1998
Causes of Death
5. Accidents
*6. Nosocomial infections
7. Diabetes
97,900
90,000
67,301
Causes of Death
1. Heart Disease
2.
3.
4.
5.
710,760
Cancer
553,091
*Infection
150,000 – 200,000 (?)
Stroke
167,661
Chronic Lung Disease
122,009
Antibiotic Resistance
1945
14% of Staph. a. penicillin resistant
1950
59% of Staph. a. penicillin resistant
1995
95% of Staph. a. penicillin resistant
Antibiotic Resistance
1.
2.
3.
4.
Why
bacteria reproduce every 20 minutes:
rapid mutation potential
significant antibiotic exposure:
common and inappropriate use
environmental presence: animal husbandry
hospitals concentrate the worst pathogens
reduction in hospital hygiene (fewer staff)
Antibiotic Resistance
Streptococcus pneumoniae
(pneumococcus)
7,000,000 cases of otitis media
100,000 – 135,000 hospitalizations/pneumonia
50,000 cases of septicemia
3,000 cases of meningitis
“Between 10% and 40% of pneumococcus infections are drug
resistant”
CDC, July 2002
Antibiotic Resistance
200,000 nocosomial Staph. Aureus infections
annually;
80,000 are antibiotic resistant.
CDC Fact Book, 2002
Antibiotic Resistance
The newest problem:
“CAMRSA”
Community Acquired Multiple Resistant
Staphlococcus aureus
Antibiotic Resistance
The Problem
1. Antibiotic resistant infection is a significant
and growing cause of morbidity and mortality;
2. The medical profession is increasingly
concerned;
3. Vancomycin resistance has occurred: no new
antibiotics are available.
Standard Medical Assumptions
“Diagnosis and Treatment of Disease”
1. Diseases exist as discrete entities
2. Disease entities can be identified (diagnosis)
3. Disease entities can be eliminated through
treatment
4. Evidence-based application of drugs or surgery
constitutes appropriate and effective treatment
Standard Medical Assumptions
about infection
1. Infection is caused by pathogens
(bacteria, virus, parasite)
2. Pathogens overwhelm the immune system
a. excessive virulence
b. weakened immunity/host resistance
3. Antibiotics will reduce the pathogenic presence:
eliminating the infection, or
until the immune system can take over.
4. Antibiotics are the only effective treatment for
infection
A Naturopathic Perspective
“The Restoration of Health”
1. The universe is ordered, intelligent, wise, and benign
2. Health is the constant and natural state of being
3. Ill health is an adaptive response to disturbance in the
organism
4. Removal of disturbing factors will result in the potential
return of normal health
5. Intervention should involve the least force necessary to
stimulate the self-healing mechanisms
Disease as Process
Normal Health
Disturbing
Factors
Discharge
Process
Disturbance of
Function
Reaction
(fever, inflammation, etc.)
Chronic Reaction
Degeneration
Standard Medical Approach:
directed against the reaction
Normal Health
Pathogens
Discharge
Process
Disturbance of
Function
Reaction
*(fever, inflammation, etc.)
Chronic Reaction
Degeneration
Classical Naturopathic Approach:
reduce the disturbing factors, stimulate the vis
Normal Health
Disturbing
Factors
Discharge
Process
Disturbance of
Function
Reaction
(fever, inflammation, etc.)
Chronic Reaction
Degeneration
General Medical Concept
Infection is an interplay of several forces
Virulence of pathogen
Susceptibility factors
Host resistance factors
Immune competence
Standard Medical Approach
(reduce) Virulence of pathogen
Susceptibility factors
Host resistance factors
Immune competence
Naturopathic Model
Virulence of pathogen
(reduce) Susceptibility factors
(strengthen) Host resistance factors
(strengthen) Immune competence
Reducing susceptibility factors
Determinants of health
What disturbs health?
1. Spiritual life
self-assessment/relationship to the larger universe
basic sense of safety, etc
2. Diet and digestion - toxemia
3. Emotional stresses and traumas
4. Rest and exercise patterns
Reducing susceptibility factors
6.
7.
8
9.
Physical Stresses, Traumas, and Exposures
Physical Strengths and Weaknesses
Illnesses, Illness Sequelae, and Addictions
Medical Interventions:
surgeries
suppressions
drug effects
Naturopathic Model
Virulence of pathogen
(reduce) Susceptibility factors
(strengthen) Host resistance factors
(strengthen) Immune competence
Clinical Models
Standard Medical Model
1. Diagnose infection
2. Identify pathogen (culture)
3. Apply appropriate antibiotic
(4. Support vital functions)
i.e.: Attack pathogen (antibiotics)
With antibiotic failure: no viable treatment!
Clinical Models
Naturopathic Model
1.
2.
3.
4.
5.
Reduce causes (disturbing factors)
Create a healthy regimen
Stimulate self-healing mechanisms
Support affected systems
Correct structure
i.e.: reduce susceptibility factors, strengthen host
resistance, and strengthen immune competence
A case of Osteomyelitis
Female, Age 40
May 11, 1999: Mandibular advancement surgery
jaw surgically cut and held by plate.
September 1: plate removed; appeared healed
2 weeks later: xray shows infection/non-union
mouth wired shut, antibiotics
October: systemic infection: IV antibiotics in hospital
November: oral antibiotics, pain medications
A case of Osteomyelitis
January 4, 2000: chief complaints
1.
2.
3.
4.
5.
Antibiotic-resistant osteomyelitis
Constant pain
Anxiety regarding healing
Anxiety regarding weight loss
Non-union of bone
A case of Osteomyelitis
Some significant aspects of history
Many teeth problems
Difficulty with stomach and digestion
Neck and back tension
hands go numb
Excessive fatigue
Gonorrhea age 22, tx with antibiotics (suppression)
A case of Osteomyelitis
Current Diet:
liquid only: wired jaw: 8 months
blended soup, “boost” (caloric drink),
fruit juice, fruit smoothies
weight: 116, began at 141.
A case of Osteomyelitis
Psycho/spiritual factors
Sister died of measles encephalitis when patient
was 8
Father died of MI when patient was 13
A case of Osteomyelitis
Pulse:
digestive stress, acute disturbance, deficiency
BP: 110/70
Sugar: 67
Stomach reflex: 3+
Arroyo: 2+ (adrenal fatigue)
A case of Osteomyelitis
Assessment:
1.
2.
3.
4.
5.
6.
Severe digestive dysfunction
Adrenal fatigue
Osteomyelitis with non-union
Significant childhood traumas
Suppressed gonorrhea
Acute pain and anxiety
A case of Osteomyelitis
Acute Treatment
Address pain and anxiety:
1. Arnica 10M: single dose
2. Acupuncture: St 4,6, LI4, CV12, Liv 3, Gb 41
(note: patient reports immediate reduction in pain, more
calm and relaxed)
A Case of Osteomyelitis
Treatment Regimen
1. Dietary change to reduce maldigestive toxemia:
“FIT” (Carroll method): Fruit Intolerance
2. Daily Constitutional Hydrotherapy
3. Medorrhinum 200c: one dose
4. Gentiana/Scutellaria: gtt 15 tincture cc
5. “Reishi Bupleurum”: (Gaia) gtt 40, tid
6. Avena/Glycerrhiza: tincture gtt 40 tid
7. Calc. Phos. 3x: #5, tid
8. Daily exercise
(note: patient leaves office feeling better: reduced pain, more relaxed, sense of hope.)
A Case of Osteomyelitis
January 9: (Day 5)
“doing much better, reduced swelling and pain.”
reduced pain meds
continue regimen
add acupuncture treatment:
Liv 3, GB 41, St 36, 30, 25, 6, 4, Lu 2, LI 4, CV 12
January 11: (day 7)
“doing better: no more pain meds needed”
continue regimen
acupuncture as above
A Case of Osteomyelitis
January 16: (Day 12)
significant pain reduction
significant reduction in swelling
significant increase in jaw opening
d/c immune tonic
d/c avena/glycerrhiza
acupuncture: Lv 3, CV 12, LI 4
St 36, 30, 25, 6
A Case of Osteomyelitis
January 23: (Day 19)
much better
acupuncture as above
January 30: (Day 26)
antibiotics cut in half by MD
jaw opens more, feels better
energy level significantly better: 75%
February: vacation to Venice
A Case of Osteomyelitis
March 3: (2 months)
doing well physically; jaw has knit (!)
March 23:
doing quite well
*reports a bit of jaw pain and swelling after
dietary violation (ate some fruit)
May 3: doing well; reports jaw mal-alignment
mouth opens to 27 mm (needs 28 to remove wires)
needs neck manipulation: performed
A Case of Osteomyelitis
May 10:
continuing improvement:
date set to remove wiring
repeat manipulation
May 24:
feeling good
June 19:
MD reports well healed;
feeling generally better than before surgery
Principles of Treatment
(A Therapeutic Hierarchy)
1.
2.
3.
4.
5.
6.
7.
8.
Address acute symptoms
Reduce disturbing factors
Create a healthy regimen
Stimulate self-healing mechanisms
Support affected systems
Correct structure
Treat pathology
Suppress pathology
A Case of Osteomyelitis
Mechanisms of Treatment
1. Address acute symptoms: do not suppress!
a. Relieve pain
hydrotherapy, homeopathy, acupuncture,
manipulation
b. Relieve anxiety
homeopathy, botanicals, confidence of doctor
A Case of Osteomyelitis
Mechanisms of Treatment
2. Reduce causes
a. toxemia:
dietary changes: no fruit
digestion
hydrotherapy
botanical stomach tonic
b. “suppression”: medorrhinum 200c single dose
A Case of Osteomyelitis
Mechanisms of Treatment
3. Create a healthy regimen
a. appropriate dietary changes
b. appropriate rest and exercise
c. stress reduction
d. spiritual exercise
e. “air, water, sunshine”
A Case of Osteomyelitis
Mechanisms of Treatment
4. Stimulate self-healing mechanisms
a. constitutional hydrotherapy
daily treatment
b. homeopathy – as indicated
c. acupuncture – once or twice a week
A Case of Osteomyelitis
Mechanisms of Treatment
5. Support affected systems
a. digestion: hydrotherapy, stomach tonic
b. immune system: hydrotherapy, immune
tonic
c. nervous system: nerve tonic, homeopathics
d. adrenal system: adrenal tonic
e. bone system: calc phos. 3x
A Case of Osteomyelitis
Mechanisms of Treatment
6. Correct structural integrity
manipulation
non-force: ease neck stiffness
force - wait until bone healing can
support this
A Case of Osteomyelitis
Mechanisms of Treatment
7. Treat pathology
often not necessary
8. Suppress pathology:
done for eight month with no effect.
A Case of Osteomyelitis
Summary
1. Address acute complaints: (pain and fear)
immediate relief
promise of continued improvement (hope)
2. Gradual and obvious improvement noted from first
intervention (infection, non-union)
3. Case resolved:
75% improvement within four weeks
total resolution within five months
patient health fundamentally improved
General Principles
II. Stimulate and support immune function
Stimulate and Support
Immune Function
1. Hydrotherapy
a. constitutional hydrotherapy
b. specific hydrotherapy to affected parts
c. sine current to affected parts
Stimulate and Support
Immune Function
2. Homeopathy
a. etiologic remedy
miasm, suppression, injury,
emotional trauma, etc.
b. constitutional remedy
c. systemic remedies (drainage)
d. specific or acute remedies
Stimulate and Support
Immune Function
3. Botanicals
a. botanicals to support or repair damaged
or weakened systems
b. botanicals to stimulate immune function
c. botanicals with antibiotic properties*
Stimulate and Support
Immune Function
4. Acupuncture
5. Specific nutrients to support immune
function
6. UV light and other specific therapies
7. Prayer and spiritual medicine
Botanical Support
1. Antibiotic activity
Anti-bacterial
Anti-viral
Anti-parasitic
2. Immune tonic activity
Antibiotic Resistance
most common antibiotic resistant bacteria
Enterococcus
Myco. tub.
septicemia, surgical,
UTI
meningitis, otitis,
pneumonia, etc.
Tuberculosis
Neisseria gonorrhea
gonorrhea
Haemophilus infl.
Antibiotic Resistance
most common antibiotic resistant bacteria
Streptococcus pneu. Meningitis, pneumonia,
otitis
Klebsiella pneu.
Septicemia,pneumonia,
UTI, post-surg. Infection
E. coli.
Severe diarrhea
Salmonella
severe diarrhea
Antibiotic Resistance
most common antibiotic resistant bacteria
Plasmodium spp.
malaria
Pseudomonas aer.
septicemia, UTI,
pneumonia
diarrhea
Shigella dysen.
Staph. aur.
septicemia,pneumonia,
post-surgical infection
Botanical Support
Antibiotic Activity
Anti-Staphylococcus aureus
Allium sat.
Anthemis nob.
Arctium lappa
Arctostaphylos
Astragalus memb.
Botanical Support
Antibiotic Activity
Anti-Staphylococcus aureus
Eucalyptus glob.
Eupatorium perf.
Honey
Hydrastis can.
Hypericum perf.
Hyssopus off.
.
Botanical Support
Antibiotic Activity
Anti-Staphylococcus aureus
Lomatium
Peonia
Plantaigo
Salvia off.
Trifolium prae.
Usnea barb
Botanical Support
Antibiotic Activity
Anti-Streptococcus
Allium sat.
Honey
Hydrastis
Plantaigo
Lomatium
Salvia spp.
Botanical Support
Antibiotic Activity
Anti-Pseudomonas
Allium sat.
Hydrastis
Lomatium
Salvia
Usnea
Botanical Support
Antibiotic Activity
Anti E.coli
Allium sat.
Eupatorium perf.
Hydrastis
Hypericum
Lomatium
Botanical Support
Antibiotic Activity
Anti-E. coli
Peonia
Usnea
Uva Ursi
Botanical Support
Antibiotic Activity
Anti Myco. Tuberculosis
Allium sat.
Usnea barb.
Botanical Support
Antibiotic Activity
Hydrastis can.
Staph. aureus
Pseudomonas
Gonorrhea
Strep. spp.
Syphilis
Vibrio cholera
Botanical Support
Anti-viral Activity
Allium sativa
Glycerrhiza
Hypericum
Hyssopus
Tabebuia impet.
(“Taheebo”, “Pau’Darco”)
Melissa off
Camellia sinensis
Lentinus, Ganoderma
(“Shitake”, “Reishi”)
Botanical Support
Anti-parasitic Activity
Artemesia annua
Cinchona off.
Gentiana lutea
Inula helen.
Spigelia anth.
(etc.)
Botanical References
1. Plant Medicine in Practice, Mitchell, Wm. A.,ND,
Churchill Livingstone, 2003
2. Herbal Medicine From the Heart of the Earth,
Tilgner, Sharol, ND, Wise Acres Press, Inc., 1999
3. The Book of Herbal Wisdom, Wood, Matthew,
Matthew, North Atlantic Books, 1997
4. Herbal Antibiotics, Buhner, Stephen Harrod, Storey
Publications, Vt. 1998
Botanical Support
Immune tonification
Echinacea: large doses work best; Bastyr used 10-30
drop doses
Baptesia: 1-5 drops doses
Phytolacca: 1 – 10 drop doses
Lomatium: 1/10 – 2 drops doses
Ligusticum: 5 – 20 drop doses
Astragalus: 5 – 30 drops doses
Etc.
A Case of Chronic Prostatitis
Male, age 48
Prostatitis began 1992
7 episodes of kidney stones
8th “episode”: pain is different
dx: acute prostatitis
put on antibiotic regimen: no change
put on anti-inflammatories
A Case of Chronic Prostatitis
6 months later: no change
put on new antibiotics
5 subsequent antibiotic regimens: no change.
constant pain, intermittent spasms
better: Imiprimine (symptomatic)
fatigue and depression due to pain
needs to nap daily
A Case of Chronic Prostatitis
Chlamydia: ’96: tx with antibiotics
Gonorrhea age 22, tx with antibiotics
arthritis in back, ankles
medicated for hypertension
BP: 90/60
Stomach reflex: 3+
Pulse: weak, small
A Case of Chronic Prostatitis
Acute Treatment
1. Thuja 30 c: single dose
2. Acupuncture: Liv 3, Ki 3, St 30, Li 4, CV 1.
(note: patient leaves office without pain.)
A Case of Chronic Prostatitis
Treatment
1.
2.
3.
4.
discontinue anti-hypertensives
remove dietary intolerances (potato)
daily constitutional hydrotherapy
Medorrhinum 1M: single dose (note: instant relief
of neck and back tension, headache pain; eases
pelvic tension)
A Case of Chronic Prostatitis
Treatment
5. stomach tonic: Gentiana/Scutellaria
6. adrenal support: Glycerrhiza/Eluthrococcus
7. Immune tonic/antibiotic formula:
Hydrastis, Phytolacca, Baptesia, Urtica,
Taraxicum: A:, gtt. 60, t.i.d.
8. Thuja 30c: prn for prostate pain.
A Case of Chronic Prostatitis
Treatment Results
1. pain of prostate intermittent, low level, gradually
decreases: improves with thuja 30c
2. energy gradually returns over four months,
no more fatigue
A Case of Nosocomial Staph Infection
Female, 81
Hospitalized for surgery,
contracts Staph infection,
on antibiotics for 8 weeks without
improvement,
developing CHF symptoms
A Case of Nosocomial Staph Infection
Treatment
1.
2.
3.
4.
daily constitutional hydrotherapy
diet of soup
colonic hydrotherapy
Hydrastis tincture
A Case of Nosocomial Staph Infection
Treatment results
Mother urinates (!)
Mother improves daily.
CHF symptoms recede.
Infection is cleared in three weeks.
Mother currently working in garden.
A Case of Lymphedema
with infection
Female, age 49
Presents with very swollen,
painful legs, red feet,
inflammation beginning to spread up legs.
A Case of Lymphedema
with infection
Patient has multiple pathologies,
multiple surgeries to legs and feet as child
She is very afraid.
Oral antibiotics have not worked.
Multiple pain drugs including methadone
One med causing kidney inflammation
A Case of Lymphedema
with infection
Treatment
1.
2.
3.
4.
5.
6.
7.
8.
9.
Homeopathic Staphisagria 1M: significant child abuse
Constitutional hydrotherapy with sine to feet.
Acupuncture to legs and feet
Homeopathic Belladonna and Phytolacca
Botanical immune tonic
Botanical lymphagogues and diuretics
Diet based upon “FIT” (no milk products)
Discontinue offending medication
Stomach, kidney, and adrenal support: botanical
A Case of Lymphedema
with infection
Effects of Treatment
1. Immediate pain relief: walks without pain
2. Feels significantly less anxiety
A Case of Lymphedema
with infection
Effects of Treatment
1. Rapid reduction of redness over two weeks
2. Gradual reduction of swelling over one month
3. Significant reduction of pain medications
over one month
4. Total resolution of edema and leg pain after
two months
Treatment of Infection
Principles of Treatment
1. assess whole patient
a) spiritual
b) psycho-emotional
c) physical
current - all systems
historical – illnesses,
suppressions, interventions
Treatment of Infection
a.
b.
c.
d.
e.
f.
g.
“Therapeutic Hierarchy”
identify and remove causes, with special
attention to toxemia, determinants of health
create a healthy regimen
stimulate the self healing mechanisms
support weakened/damaged systems
correct structural integrity
address pathology if necessaray
suppress pathology to preserve life or function
Treatment of Infection
Principles applied
90 minute first visit:
A. chief complaint details
let the patient tell their story
get as much detail as you can
B. dietary history
1.
2.
3.
4.
daily dietary details
presence of common intolerant foods
reactions to foods
cravings and aversions
Dietary history
1. Adequacy: calories, nutrients
2. Balance: excesses
3. Reactivity:
Intolerance vs. allergy vs. sensitivity
4. Supplementary needs
C. Review of systems
1. Patient has filled out a comprehensive form
2. I inquire regarding all marked areas
3. I ask whether I’ve missed anything
Past medical history
1. Infancy
1-5, 5-10, 10-15, etc.
2. Suppressions, significant events, illnesses,
injuries, medications, surgeries
Social history
1.
2.
3.
4.
5.
How’s life?
Relationships
Childhood
Work and exposures
Spiritual life
Treatment of Infection
Physical examination
1. standard exam
2. functional exam
pulse, tongue, reflexes, etc.
Goal:
a. assessment of function
b. discovery or verification of pathology
Toxemia
Fundamental Concept:
maldigestive processes foster a dysbiotic
intestinal population which generate toxic
products through inappropriate degradation of
poorly digested foods. These toxins enter the
blood and become the basis for chronic
inflammatory processes, autoimmune processes,
etc. This process promotes infection.
Toxemia
For example: as early as 1879, Baumann
demonstrated that Tyrosine is metabolized by
gut bacterial to generate phenols and pcresol.
(Baumann, E. (1879). Ber. Dtsch. Chem. Ges. 12, 1450.)
Phenols and p-cresol are implicated in
tumor formation in mice. Certain phenols are
demonstrated convulsant agents in humans.
Toxemia
1924, Harke and Koessler demonstrated the generation
of histamine by gut bacterial action on dietary amino
acids. (Urbach, K.F. (1949). Proc. Soc. Exp. Biol.
(NY), 70, 146.)
Perry demonstrated the generation of the body burden
of tyramine is entirely by gut flora. (Perry, T. L., et.
al. (1966). Clin Chem. Acta 14, 116.
Both histamine and tyramine are implicated in
hypertension, suggesting that essential hypertension
may be the result of “toxemia”.
Suppression
Spiritual Aspect of Treating Infection
1. “Tell me about your spiritual life”.
2. Discuss the patient’s fears and concerns.
3. Discuss patients beliefs about healing
Review
I. Treat the person, not the infection
1. evaluate/improve the general state of health
2. evaluate/improve the diet and digestion, with special
attention to intestinal toxemia:
a. recommend appropriate dietary changes
b. improve digestive function
c. facilitate toxin elimination
3. evaluate and treat to normalize all major systems
and functions
4. Stimulate and support immune function
5. evaluate the psycho-spiritual patient: treat as indicated
“How to treat infection
without antibiotics”
Thank you!
Jared L. Zeff, ND
[email protected]
360-823-8121