LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

surgery

Surgery Advocated as Primary Treatment for Many Cases of GERD – (10-18-01)

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Surgery Advocated as Primary Treatment for Many Cases of GERD

I consider this topic, and this article, especially disturbing. To Western medicine, there are only two options to reflux disease: acid blockers or surgery. My gosh!! Have we forgotten that food allergy is known to play a strong role in lower esophageal tone? Cow’s milk allergy and GERD are well accepted bedfellows in infants–why do we forget this concept when the patient becomes an adult? How about avoiding the nightshade vegetables, caffeine and alcohol long before any pharmaceutical intervention?? Remember–it is not the acid causing the problem, it’s acid getting where it’s not supposed to be…

87th Clinical Congress of the American College of Surgeons Surgery is the only way to cure gastroesophageal reflux disease (GERD) and should be the preferred treatment for Barrett esophagus, according to Dr. Jeffrey H. Peters of the University of California, Los Angeles. Dr. Peters made the case for Nissen fundoplication during a debate on surgical versus medical management of GERD at the 87th Clinical Congress of the American College of Surgeons. In an interview with Reuters Health, Dr. Peters challenged a recent report in The Journal of the American Medical Association, in which Dr. Stuart Jon Spechler and others concluded that antireflux surgery does not obviate the need for medications in most GERD patients. According to Dr. Peters, Dr. Spechler’s group reported that 40% of GERD patients treated with surgery died within 10 to 13 years, and most of the surviving patients required proton pump inhibitors. Dr. Peters challenged the accuracy of those data and said that most of the surgery patients who were put on medical therapy following surgery had no indication for treatment. “If you look carefully at these patients, you will find that only 10% had acid indications that required proton pump inhibition,” he said. Dr. Peters added that surgery should be offered to patients with pH-positive, non-erosive GERD and said surgery is the “preferred treatment for patients with endoscopic esophagitis — but it should be the primary treatment for Barrett’s esophagus.” He said, too, that successful GERD surgery is often more dependent on “repair of the hiatal hernia rather than lower sphincter repair.” Dr. Joel Richter, head of gastroenterology at the Cleveland Clinic Foundation, represented the medical side of the debate and disagreed with Dr. Peters’ claim that surgery can cure GERD. “In some patients you may get a good result for 5 or 10 years, but these patients are going to once again become symptomatic. I think it is more accurate to call surgery a functional repair.” He added that “abdominal stressors don’t go away just because you perform surgery.” But Dr. Peters responded, “In a sense abdominal stressors do go away, because after a good repair, these patients can’t vomit.” Dr. Richter pointed out that surgery is “very dependent on good surgeons performing good operations on the right patients.” Before a standing-room-only crowd of surgeons, Dr. Peters’ remarks received long ovations, while Dr. Richter’s remarks were greeted with polite applause.

Use of Herbal Medications Before Surgery – (11-29-01)

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Use of Herbal Medications Before Surgery

This is a wonderful series of editorial letters commenting on a recent article regarding adverse affects of herbal medications and surgery. I have always said that herbs are held to a higher standard and that many of the “warnings” about combining certain herbs and prescription drugs are based on isolated case studies. Read each of the letters–the authors use well referenced material to dispute the original article.

Read entire article here

Do You Need Surgery for a Torn Cartilage in Knee?

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Your MRI shows that you have a tear in the medial meniscus of your knee and you have resigned yourself to the fact that surgery is the only fix.

The belief has always been that the posterior horn (the back half) of the medial meniscus (the shock absorbing pad on the inside part of your knee) does not have a very good blood supply. For this reason, any tears that occur are not going to heal on their own. This means surgery is your only option.

I’ve never been one to believe in dogma.

From an anecdotal standpoint, I have had more than my share of patients with documented medial meniscus tears that do perfectly fine without surgery. I still remember one of my early ones. This particular patient was on track for surgery, but just did not have the time off of work needed for the surgery and recovery. So he waited. In the meantime, we treated his knee, thinking that anything we could do to restore balance to the knee prior to surgery would be a good thing. Turns out, he did really well and never had the surgery. Later, he even forgot which knee it was that used to bother him.

Over the years, I have seen patients with meniscal tears do very well. Typically, the patient that responds best is closer to an ideal weight and more active. Patients who don’t fit this mold don’t do as well and seem to be more likely to end up in surgery.

Of course, my personal experiences do have some backing in the medical literature. For example:

In case all this isn’t enough to sway your decision away from surgery, pay attention to this particular study.

In it, researchers looked at the outcome of patients with medial meniscus tears who had surgery and compared these outcomes to those who didn’t have surgery and instead did rehab for his or her torn cartilage. They were evaluated using the WOMAC scoring (0-100, with higher numbers equating to more severe symptoms). Here’s what they found:

  • At 6 months the surgical WOMAC score was 20.9 points.
  • At 6 months, the rehab group score was 18.5 (yes–better, if ony slightly).
  • At 6 months, 30% of those in the rehab group ended up having surgery.
  • On the flip side, 6% of the surgical group had not undergone surgery.
  • At 12 months the situation did not change from the 6 month scores.
  • Adverse events did not differ in the groups.

Overall, there was no difference in long term outcomes between the surgical and non-surgical groups. Although 30% of the non-surgical patients ended up with surgery, this seems to match up with what we see in our office–some patients (overweight, sedentary) just don’t seem to do as well.

Either way, it seems clear that, if you discover that you have a torn medial meniscus and you are told you have to have surgery, it’s a very good chance that this just is not true.

CAN FLAXSEED SUPPLEMENTATION REDUCE PROSTATE CANCER? – (08-17-09)

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Flaxseed Supplementation (Not Dietary Fat Restriction) Reduces Prostate Cancer Proliferation Rates in Men Presurgery

Here we go again. Hate to sound like a broken record, but in this study of men with prostate cancer to be removed with surgery, they started them on intakes of flaxseed 30 days before any procedures and found that his helped to reduce the activity of the cancer cells–a strong indication that this could lower risk and improve treatment outcomes.

Read entire article here

SURGERY? THIS MAY SAVE YOUR LIFE

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While having surgery is always a last option, there is a time and place for most surgical procedures.  If someone has tried everything and surgery is the only option remaining, we need to consider what can be done to improve the outcome.

With this particular recommendation, however, the audience is far more extensive then just surgical patients and likely extends to anyone owning a human physiology.

You see, one of the most powerful tools for avoiding chronic disease and increasing longevity is calorie restriction without nutrient restriction.  This is the ONLY approach in the medical literature that has been shown to extend lifespan consistently in mammals.  This means that your 1200 calories / day comes from broccoli, not a Big Mac Value Meal.

Most of the research suggests that the reason this approach is effective is because it increases both the number and the efficiency of our mitochondria. (If you’re scratching your head trying to remember what that dust covered snippet in the back of your brain from high school biology is–the mitochondria are the powerhouse of the cell–they produce energy for the cell)  The better our mitochondrial health and our cells’ ability to produce energy is, the healthier we are.  In other words, death begins with poor mitochondrial function.

This may be why we’ve seen insulin-dependent diabetics off their insulin in one week with a very low calorie diet.  This is powerful stuff.  There are some who think that calorie restriction may be a very powerful adjunct to chemotherapy because normal cells will respond to the calorie restriction by protecting themselves, but the cancerous cells won’t, leaving them more susecptible to the chemo.  Pretty cool, huh?  (And also why “Boost” is arguably the absolute most toxic thing you could give to a cancer patient….)

So, what does this have to do with surgery?

This particular study looks at hypocaloric parenteral nutrition and it’s effect on surgical outcomes.  Parenteral nutrition is nutrition that is put directly into the body via IV (as opposed to enteral nutrition, which is pumped directly into the stomach via a PEG tube).  Granted, if someone is on parenteral nutrition already, there are some serious health problems.  So what did the researchers find?

  • Complications related to infections dropped 40% (in larger trials, this number plummeted to 79%)
  • Length of hospitalization was 2.49 days less, 95%CI −3.88 to −1.11, P = 0.0004; I2 = 48%)

This is powerful stuff.  But do you notice that we didn’t GIVE anything.  Not a drug.  Not a vegetable.  Not an herb.  All that was done was a lowering of the calories in.

As mentioned, this review looked at patients undergoing surgery.  Can we make a jump and hypothesize that calorie restriction without nutrient restriction may lower rates of infections and improve health in non-surgical patients?  I think, based on the overwhelming evidence, that the answer is a clear yes.

SPINAL ARTHRITIS – DO I NEED SURGERY?

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Pretty much every day I address this question from patients.  They come in after having an X-ray or MRI done after a few weeks of untreated back pain and may even have their orthopedic surgeon appointment set up.  The problem remains that there is very little correlation between what we see on imaging and pain levels of a patient.

As a matter of fact, this is probably one of the bigger educational challenges I have in my practice because society has brainwashed into thinking that all the answers lie in the MRI or X-ray and they are infallible.  I can’t tell you how many times I have had patients come in with knee pain due to “arthritis.”  However, after 2 or 3 visits they are greatly improved.  We obviously did nothing to magically get rid of the arthritis, but the arthritis was not the pain generator for this patient.

This particular article reinforces this same concept for back pain, with a specific focus on those over 60 years of age.  The researchers found a very high level of arthritis of the spine (75.8%), but only a small portion (28.8%) had back pain.  And again, referring back to the knee example above, how many of these patients with back pain would still have symptoms after a solid course of chiropractic care coupled with soft tissue treatment?

The bottom line is that arthritis is something we see on X-rays or on MRI, but it is merely the canvas on which your symptoms may be painted.  Only rarely is surgery in these cases a good idea with a good outcome.  Without a doubt, your best first option for any type of pain is a Mesa chiropractor.  And this is NOT my bias, but rather, strongly supported by claims data from insurance companies and clinical studies.

http://ard.bmj.com/content/68/9/1401.abstract