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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