Surgery is no longer necessary for many injuries, ailments, and conditions for which it used to be the only option. It is invasive and unpredictable, and recuperation is often slow and painful. Surgery does not guarantee healing and can leave patients vulnerable to serious infections. The bottom line is that the natural healing mechanisms of the body are responsible for repairing and mending any injury or condition. From shoulders to ankles, Dr. Lazar's patients have experienced firsthand the incredible healing power of the combination of modern medicine and the body's natural healing processes. More than one thousand of his patients have benefited from platelet-rich plasma therapy, where a patient's platelets are extracted from their blood and when necessary combined with stem cells from their abdominal fat or bone marrow, and re-injected into the injured site. The results of the platelet-rich plasma treatments speak for themselves: baseball pitchers are back on the mound a few weeks after being benched with shoulder injuries. Tennis players sidelined with tennis elbow are able to again hit shots without pain. Everyday people suffering from debilitating knee pain are now walking with ease. People everywhere, in all walks of life, are gaining full mobility and improved quality of life faster-without surgery.
Beyond the Knife
Alternatives to SurgeryBy Alan M. Lazar Maury M. Breecher iUniverse, Inc.
Copyright © 2011 Alan M. Lazar, MD, FACS with Maury M. Breecher, PhD, MPH
All right reserved.ISBN: 978-1-4620-1767-6Contents
Dedication.............................................................................................................................................vForeword...............................................................................................................................................viiAcknowledgements.......................................................................................................................................ixIntroduction...........................................................................................................................................1Chapter 1 — Why You Should Go Beyond the Knife to Avoid Surgery..................................................................................5Chapter 2 — Introducing Stem-Cell Therapies and Platelet Rich Plasma.............................................................................11Chapter 3 — State-of-the-Art Beyond the Knife Treatments Allow Faster Healing for Professional Athletes and Weekend Warriors.....................22Chapter 4 — PRP and Stem-Cell Therapies to Heal Arthritic Joints.................................................................................32Chapter 5 — Nonsurgical Treatments for Joints, Tendons, Ligaments, Shoulders, Elbows, and Knees..................................................38Chapter 6 — Complementary and Alternative Medicine Options to Surgery............................................................................48Chapter 7 — The Role of Supplements in Combating Inflammation and Preventing Surgery.............................................................59Chapter 8 — Other Beyond the Knife Therapies.....................................................................................................72Chapter 9 — Beyond the Knife Future Therapies: Nanotechnology, Nanomedicine, and Gene Therapy....................................................85Endnotes...............................................................................................................................................95Index..................................................................................................................................................115
Chapter One
Why You Should Go
Beyond the Knife to Avoid Surgery
Have you seen the following headlines?
"Hospital-Acquired Superbug Infections Soar ..."
"Lax Infection Control at Surgery Centers"
"Staph Infection Risk Rises with Brain, Chest Surgeries"
Aren't those headlines scary? Their common message is that surgery isa leading cause of staph infections. They occur after many types of surgeryespecially brain and chest surgery, and after orthopaedic and plastic surgery.Further evidence is highlighted by the Consumer's Union citing the U.S.Centers for Disease Control and Prevention (CDC) which says that morethan 290,000 surgical site infections occur in U.S. hospitals each year. Surgicalwounds become infected with staph or other germs, killing thousands of peopleeach year, according to the US Centers for Disease Control and Prevention(CDC). Not surprising since the CDC also estimates that 25 percent to 30percent of the American Population are carriers of staph infections.
The first headline above reports that not even our newborn babies aresafe because the MRSA "Super Bug" has increased "over 300 percent inU.S. newborn care units (NICUs) in the past ten years." MRSA stands formethicillin-resistant staphylococcus aureus. This antibiotic resistant infectionis notoriously hard to treat.
Studies have shown that MRSA exacts a heavy financial toll. Patientsinfected with MRSA after surgery spend an additional three weeks in thehospital and cost an additional $60,000 to care for. Furthermore, comparedwith patients who go home from surgery uninfected, patients with MRSAinfections are thirty-five times more likely to be readmitted to the hospitaland seven times more likely to die within three months.
According to one study, almost 32 percent of patients who developedMRSA pneumonia died in hospital during that admission. Vancomycin,the only drug effective against MRSA, is unlikely to boost survival sinceit is associated with more adverse effects such as renal toxicity but not withimproved survival.
Headlines such as those reveal a simple fact: surgery is dangerous. Itsometimes even results in death. Surgeries can also cause pain, scarring, anddisfiguration. For those reasons, surgery should never be decided on withoutknowledge of its risks and the effectiveness of any available Beyond the Knifealternatives.
Don't get me wrong. Surgery still has a vital role in medicine. There is nodoubt that in cases of malignancy, such as cancerous tumors and in cases ofsevere physical trauma, surgery can be a lifesaver.
However, doctors are now realizing that surgical site infections (SSIs) are areal risk associated with any surgical procedure. They, "represent a significantburden in terms of patient morbidity (illness) and mortality (death), andcost to health services around the world." An estimated 2.6 percent ofnearly thirty million surgical operations get SSIs every year, according to theInstitute for Healthcare Improvement. Each infection is estimated by theInstitute to increase a hospital stay by an average of seven days and add over$3,000 in charges.
SSIs refer to the sites of surgical incisions. The phrase, "surgical siteinfection," came into being in 1992, when the CDC revised its definitionof "wound infection" and created the definition "surgical site infection"to prevent confusion between the infection of a surgical incision and theinfection of a traumatic wound. Most SSIs are superficial, but even so, theycontribute greatly to morbidity and mortality, according to three creators ofa medical website dedicated to providing an overview of SSIs.
Other Risks of Surgery
All surgeries have a risk of death, but some types have higher risks than others.For instance, during open-heart surgeries, the heart is actually stopped foralmost an hour before being restarted. Obviously, that surgery has a higherrisk than surgeries in which the heart is not stopped.
Furthermore, when undergoing any surgery, an individual faces theadditional risk that internal organs may be damaged. For instance, a patienthaving an appendectomy (removal of their appendix) may incur an accidentalinjury to the intestine, which is attached to the appendix. That sort of injuryis usually detected during the surgery and fixed immediately. However, ifit is not, the intestine can become infected, and the infection can spreadthroughout the body. This can be life threatening.
Elderly people and those who are obese and/or have type II diabetes areat increased risk from surgery. Among those risks are SSIs, excessive bleeding,anesthesia complications, blood clots, and interior and exterior scarring.
– The Risks of Anesthesia during Surgery
Drugs used in general anesthesia are thought to cause injury to brain cells.Consequently, medical experts have speculated that the dangers of the use ofanesthetics include memory loss, an increased risk of Alzheimer's disease,and, in children, may even interfere with brain development.
Anesthesia involves exposing your body to controlled levels of toxicchemicals in order to cause you to enter an unconscious state. One of the mostcommon dangers of anesthesia is an allergic reaction to one of the chemicalsused to induce this unconsciousness. All anesthetics, even a local one, cancarry the risk of allergic reaction. In high doses, local anesthetics can causetoxic effects, since the chemicals are being absorbed through the skin andspread throughout the body by the bloodstream. Anesthesia, even local orregional anesthesia, can significantly affect your breathing, heartbeat, bloodpressure, and other vital bodily functions.
– Intubation Difficulties that May Occur During Anesthesia
Many of the problems associated with anesthesia are often caused by theprocess of intubation, the insertion of the breathing tube. Breathing tubesare necessary because a person deprived of oxygen for four to six minutes canexperience brain death. Longer periods without air lead to heart failure. Toprotect against that occurrence, the anesthesiologist inserts a breathing tube,called an endotracheal tube, into the windpipe. Just behind the windpipe'stracheal opening is the esophagus. If this tube is mistakenly inserted into theesophagus, oxygen will not be delivered to the lungs. After a few minutes, thepatient will turn blue and suffer cardiac arrest, unless the condition is rapidlyidentified and rectified.
Some patients have throat and airway abnormalities that may make theplacement of the airway tube hard or even impossible to accomplish. Repeatedattempts to intubate the patient can lead to airway trauma that could interferewith the patient's ability to breathe. If that occurs, another surgical operation,an emergency tracheotomy (a hole in the windpipe), has to be accomplishedquickly, or the patient will die.
Trained anesthesiologists have sophisticated equipment to preventmisplacement of the endotracheal tube. However, if that equipment is notpresent, say in a doctor's office where surgery is performed or if it is notworking, or the airway tube is being inserted by someone not as well trainedas an anesthesiologist, misplacement may occur and hypoxia (lack of oxygen)would result.
Other Problems Involving Anesthesia during Surgery
– Aspiration
Aspiration, the breathing of fluid into the lungs, can be a life-threateningproblem when intubated. That's why patients are told not to eat or drinkanything for several hours before surgery. Pregnant patients, very obesepatients, trauma victims, and patients with bowel obstructions are the mostat-risk groups for aspiration.
– Nerve Damage
Even local or regional anesthetics can, in rare cases, cause nerve damage,including persistent numbness, weakness, or pain. For most patients, thosesymptoms are temporary conditions, but some unlucky patients may experiencethese symptoms as permanent complications.
Ventilation Problems
Once the airway tube is in place, oxygen and other gas exchanges need to occurso that oxygen is delivered to the body and carbon dioxide is removed.
This is usually accomplished by the use of a device known as a ventilator.Although it is a normal procedure for an anesthesiologist to introduceparalyzing drugs to the patient to keep him or her immobile, deeplyanesthetized paralyzed patients are not able to breathe on their own. If theventilator malfunctions or anything else interferes with this normal exchangeof gases, the patient can rapidly be in severe danger from hypoxia.
Still More Life-ThreateningConditions Associated with Surgery
– Blood Circulation Problems during Surgery
Many anesthetic drugs can interfere with blood circulation. Anesthetics areall toxic in amounts slightly higher than those that produce unconsciousness,thus, their administration is a balancing act between unconsciousness anddeath. An overdose can stop the heart. However, a "normal" dose of variousanesthetics can also lead to heart stoppage if the patient has a low thresholdfor that type of drug.
– Blood Clots, Excessive Bleeding,and Infections from Transfusions after Major Surgery
After major surgery, many postoperative patients are given medications to thintheir blood and prevent the formation of clots. Clotting can become a criticalcomplication if the clots travel through the bloodstream and lodge in the lung,a condition known as pulmonary embolism, or the brain, causing a stroke.
One type of blood clot is particularly dangerous. It is known as deepvenous thrombosis (DVT). It can occur after any surgical operation, but ismore likely to occur following surgery on the knee, hip, or pelvis. A DVTcan cause the leg or legs to swell and become painful and warm to the touch.Like other clots, it could lodge in the lungs or brain.
– Excessive Bleeding
Another blood-related risk is excessive bleeding. This can be severe enough tonecessitate a transfusion. Although the nation's blood supply is very safe, HIV,hepatitis A and B, and other viruses can be transferred during transfusions.
– Paralysis Caused by Surgery
Although rare, one of the most severe complications that can occur duringsurgery is permanent paralysis. However, it can occur, particularly duringspinal or brain surgery.
– Numbness, Tingling and Pain after Surgery
Many surgical patients experience numbness, tingling, and pain after surgery.These sensations generally go away within a few days. However, a very smallpercentage of patients will experience those sensations for the rest of theirlives!
– Delayed Healing after Surgery
Certain patients take longer to heal than others. People with co-morbidities(other illnesses, such as diabetes, hypertension, or an immune disorder) mayhave a longer, more painful recovery period. People with diabetes whose bloodsugar levels are poorly controlled are likely to experience delayed healing aftersurgery. Consequently, people with diabetes must carefully consider the risksand rewards of any surgical procedure.
Conclusion
Surgery, when needed, can be life enhancing or even lifesaving. However,there are dangers to any surgery; no surgery is risk free. Surgery shouldbe avoided when it can be. Alternatives to surgery, if available, should beconsidered. Those alternatives are the subject of the remainder of this book.
Take-Home Points from Chapter 1
• Surgery can leave one vulnerable to many serious infections and
can neither guarantee nor even promote healing.
• Surgery should be avoided when it can be.
• Alternatives to surgery, when available, should be considered.
Chapter Two
Introducing Stem-Cell Therapies
and Platelet Rich Plasma
Do you recollect the toys called Transformers? They were neat because theycould transform from toy cars, trucks, tanks, and other pieces of equipmentinto giant good guys—fighters against evil. Did you know that there are cellswithin the adult human body that have the same transformative powers?Those cells are named stem cells. They are the pluripotent progenitors fromwhich all other cells—blood cells, skeletal cells, vascular smooth musclecells, muscle (skeletal and cardiac muscle), and adipocytes (fat tissue) cells—originate.
There are two types of stem cells: those that come from embryos andthose that come from your own body. I do not use cells taken from embryosbecause of all the ethical, legal, religious, and political controversies that swirlaround that type of stem cell. Instead, I use the second type, those known asadult stem cells (ASCs).
There are two types of ASCs:
1) Hematopoietic cells, from which all other blood-related cells arederived, and
2) Mesenchyme stem cells (MSCs), which are undifferentiated cells fromwhich all other cells are derived.
Hematopoietic cells have been used for many years in the treatment ofa variety of malignant and nonmalignant blood-related conditions, solidtumors, and autoimmune diseases. The beneficial roles MSCs play have onlyrecently been recognized.
The MSCs I use are harvested from the patient's own bone marrow oradipose tissues (fat cells).
ASCs from either source are little miracle workers because they arepluripotent. That means they have the capacity to give rise to the committedstem cells that make all other types of cells, platelets, or intermediary productsduring the body's own tissue repair process.
Our bodies are made up of billions and billions of cells, but by far, thevast majority of those cells are not stem cells because they have differentiated.That means that they have turned into specific types of cells. Skin cells, nervecells, and heart cells are just three examples.
ASCs, however, are undifferentiated, which means they still have theability to turn into any other type of cell. This has great ramifications forhealing.
The Use of ASCs in Regenerative Medicine
ASCs are ideal candidates for use in regenerative medicine, tissue engineering,and bone cell replacement therapies because of their amazing ability totransform into various types of cells. The even have the ability to heal injuredheart tissue, thus potentially eliminating the need for certain types of cardiacsurgery. This is huge. Heart disease remains the number one killer in theUnited States, according to the CDC. Every 25 seconds, an American willhave a coronary event (a heart attack).
Continues...
Excerpted from Beyond the Knifeby Alan M. Lazar Maury M. Breecher Copyright © 2011 by Alan M. Lazar, MD, FACS with Maury M. Breecher, PhD, MPH. Excerpted by permission.
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