Notes from the Field: November, 2019
Nature Cure Clinical Pearls
Jared L. Zeff, ND, VNMI, LAc
The following is a not an article prepared for a medical journal. Not every statement of fact is cited or referenced. This is a commentary on the medicine, a running set of observations about practice in the field. It’s not meant to be a peer-reviewed presentation; rather, these are notes and thoughts from a practicing naturopathic physician, a primary care doc in general practice.
Penicillin & Antibiotic Resistance
Penicillin was the first great antibiotic and was one of the primary reasons that conventional medicine achieved the great primacy of position that it achieved in the mid-20th century.
In 1929, Sir Alexander Fleming discovers penicillin. The drug is effective against Streptococcus pneumoniae and is the first reliable pharmaceutical treatment against this killer bug. In the 1930s, Howard Florey and Ernst Chain extract and purify penicillin. In 1941, a British policeman is the first person treated with penicillin, but he dies due to an insufficient quantity of the drug. However, for the first time in history, as a result of this new drug, wound infections on the battlefield (WWII) could be effectively treated without amputation. In 1943, Selman Waksman discovers streptomycin – the first effective pharmaceutical treatment for Mycobacterium tuberculosis, the chronic disease killer of the time. Pneumonia and TB, major causes of death, could now be effectively treated chemically. The first great miracles of modern medicine began to manifest, and the physician (MD) went from being the least respected to the most respected professional within 2 decades. I was hospitalized with pneumonia in 1950 at 3 years of age. My earliest memory is being laid into an oxygen tent, having a teddy bear handed down to me, and the lid closing over me. I was given this new drug, penicillin, and rapidly recovered. This was seen as a miracle.
In 1962, Sir MacFarlane Burnet, MD, wrote that by the end of the 20th century, because of antibiotics, we will see the “virtual elimination of infectious disease as a significant factor in societal life.” In 1969, US Surgeon General William Stewert, MD, wrote similarly, that “…it [is] time to close the book on infectious diseases.” But a new problem was developing. In 1945, 14% of Staphloccus aureus infections were penicillin resistant. By 1950, that number was 59%. By 1995, 95% of Staphylococcus aureus infections were penicillin resistant. In March 2000, the CDC reported that nosocomial infections affect 2 million people annually in the United States, and kill as many as 90 000 people.1 In 2001, the CDC reported, “[Up] to 30 percent of S. pneumoniae found in some areas of the United States are no longer susceptible to penicillin, and multidrug resistance is common. Approximately 11 percent of S. pneumoniae are resistant to “third generation” cephalosporin antibiotics, and resistance to the newest fluoroquinolone antimicrobials has already been reported.2 And then MRSA developed.
A Difficult Case
In December of 2007, a 76-year-old diabetic woman was brought to me in a wheelchair. Her right leg was twice the diameter of her left leg and was red and painful. She could not walk. She was scheduled to have her leg amputated and, in a desperate attempt to save her leg, her family was bringing her to a naturopathic physician. The problem began in late 2006 when an abscess was discovered in her right knee, she was put on antibiotics, and referred to a surgeon. Two (unsuccessful) surgeries were used to debride the knee, but a larger abscess developed and the infection persisted. She now had a diagnosis of MRSA osteomyelitis and had been on antibiotic therapy for the past year, including a number of IV antibiotics. She was also diagnosed with hypertension, diabetes, and congestive heart failure, and was currently on metoprolol, metformin, morphine, and oxycodone, pending the amputation. This was a difficult case.
CT showed fragmented bone in the knee, and the marrow edema was consistent with osteomyelitis. My examination revealed a blood pressure of 178/78 mm Hg and a regular heart rhythm. Her kidneys were tender to percussion. Her blood glucose was 82 mg/dL, though they reported it ranged between 80 and 250 mg/dL. I measured the circumference of the leg at several points. She had 2 abscessed ulcers in the popliteal area of the right knee, with no drainage. The leg was red and swollen, and she was unable to lift or move the leg without significant pain. She could not stand on the leg. While I was examining her, I gave her a dose of homeopathic Belladonna 200C. Within about 2 minutes she reported that the pain had reduced. I was reluctant to take this case, but told her that I would treat her if she did exactly what I told her to do and that we continued to see improvement. Otherwise, I told her, it would be in her best interest to have the amputation.
How does one approach such a case? I am a traditional naturopath, a “vitalist.” I have been in practice 40 years. My primary mentor was Harold Dick, ND, of Spokane, WA. I practice, more or less, as he taught me. What he taught me first was that I must get the diet right and correct the digestion, to reduce the toxemia that must be driving this infection. The paradigm is fairly simple:
- Determine what is disturbing the body economy, advise or assist in the removal of the disturbing factors, primarily dietary
- Stimulate the self-healing processes
- Support the affected systems
- Respond to changes as they develop
Treatment & Follow-ups
Given the intensity and gravity of this case, I began treatment with a heavier protocol than I would usually use. I gave her homeopathic Belladonna to take several times daily at first, for pain and inflammation, along with homeopathic gun powder (an old remedy for infection) at the 6C potency, every 3-4 hours, and the homeopathic nosode of Staph aureus at 9X (which is what I had at the time), to be taken 3 times daily. I started her on daily constitutional hydrotherapy in my office, with sine-wave electrotherapy to the spinal centers of digestion, and tetanizing current through the affected leg after the hydrotherapy. I gave her a botanical combination of Sambucus, Olea, Allium, Origanum, Larix, and Rosmarinus. I also utilized old Dr Otis Carroll’s dietary evaluation, advising her to totally eliminate milk and its products from her diet and to separate fruit from white sugar products. The purpose of the dietary changes is to eliminate digestive challenges that in her case would not digest well and would generate increased intestinal toxins that were entering her blood and weakening her. Of all this advice, the dietary recommendations were the most important. Her most staple daily food was yogurt.
The following day we saw that her leg was a bit less swollen by measurement, and the pain was reduced, but she reported that she was still hardly sleeping because of the pain. I treated her in my clinic each day, and, day by day, we saw incremental improvement. After 1 week, I changed the botanical to a mixture of Echinacea, Glycyrrhiza, Astragalus, Hypericum, Hyssop, Hydrastis, Phytolacca, and Baptisia. I added the cell salt Calc phos 3X to stimulate healing of the bone. I reduced the frequency of the homeopathic medicines. She reported that she was now able to sleep through the night.
Each day, the redness and swelling decreased, the pain was reduced, and finally, after 14 days, the abscess began to drain pus. By this time she was not taking morphine, telling me she did not need it. We continued the daily hydrotherapy 5 days each week in the clinic, and she continued to demonstrate daily improvement. By now she told me she could put a little weight on the leg without pain. We continued to see slow improvement over 6 weeks. At week 7, she developed a bladder infection. I treated her with a botanical combination: Uva ursi, Equisetum, Juniperus, and Althea. It was better the next day.
After 2 months, she wanted to stop coming into the clinic for daily treatment. I told her to continue the hydrotherapy at home, without the sine wave. She would return in 1 week for an evaluation. But after a week without the clinical treatment, she began to worsen, so I insisted that she continue to come into the office for daily treatments. As soon as she resumed this, she began to improve again.
After 4 months the redness had cleared by 95%, and the swelling by 90%. Her blood pressure was now 160/80 mm Hg without medication. She was now off all medication except for metformin. By month 5 she could walk a few steps and could make it to the bathroom on her own. The leg swelling and erythema had resolved. At the end of the fifth month she could walk from the car into church. I discharge her as “cured.”
I have checked in with her occasionally since that time. I heard from her a month ago, after 12 years. She is still mildly diabetic, but her leg is functioning normally. The MRSA osteomyelitis resolved with dietary change, hydrotherapy, homeopathy, and botanical medicine. Within this case is a template for treating antibiotic-resistant infections.
The first problem to address, in general, is toxemia. What is toxemia? As early as 1879, Baumann demonstrated that tyrosine is metabolized by gut bacteria into phenol and p-cresol, both of which are proinflammatory and were found to induce tumors in mice.3 In 1924, Harke and Koessler demonstrated the generation of histamine by gut bacterial action on dietary amino acids.4 Such reports have occurred in the medical literature since the 1800s. In 1974, Drasar and Hill published the book Human Intestinal Flora, in which they demonstrated multiple pathways by which gut bacteria degrade dietary elements and bile residues into toxic metabolites, their absorption into the blood, and their implications for chronic disease and cancer.5
Toxemia is a phenomenon in which mal-digestive processes foster dysbiotic intestinal flora populations that in turn generate toxic products through their degradation of poorly digested food elements and bile residues. These toxins enter the blood and become the basis for chronic inflammatory processes, autoimmune responses, etc. This process also promotes infection. This was discussed by Hippocrates in the first “treatise” of Hippocrates, “On Ancient Medicine,” in The Genuine Works of Hippocrates, translated by Francis Adams in 1939.6 Herodotus, the Greek historian, referred to this as common knowledge among the ancient Egyptians.7 Toxemia has been a cornerstone concept in traditional naturopathic practice from its inception. It was referred to as “auto-intoxication” in conventional medical texts until the concept disappeared from conventional literature in the mid-1940s. A primary purpose of the dietary changes and hydrotherapy, developed by Otis Carroll, ND, in the 1920s, was to reduce toxemia.
Several years ago, I was called to the home of a patient who was suffering from a severe cellulitis. There was a red patch and growing streaks up his leg that were painful and disconcerting. I made the house call because he was unable to drive. I gave him alternating Belladonna (30C) and Phytolacca (30C), one or the other every 10 minutes. I drew a line with a pen around the extent of the redness. We watched the redness recede over the course of 30 minutes. He noted also that the pain was easing. I had him continue to take the medicines, in alternation, every 30 minutes. He reported that by that evening the redness was almost all gone and that it was totally cleared by the next day. I have found this combination extremely effective in similar infections. I have used the 6th, the 30th, but usually the 200th, potencies to do this.
There are several proprietary homeopathic drainage combinations in common use. I have tried some of these and have found them particularly effective.
Simple infections, like acute bladder infections, ear infections, and sore throats (even Strep), I generally treat with a homeopathic medicine, such as Cantharis, Pulsatilla, Mercurius, or Belladonna (or whichever fits the case best), or a botanical combination. And I might use both herbals and homeopathics together. The correct homeopathic will usually give instant relief. The botanicals have immune tonic and antibiotic properties. If the infection is recurrent or persistent, I will need to identify and remove the dietary elements that are generating the toxemia, which is underlying the susceptibility to infection. I will add hydrotherapy if the remedies are not sufficient or not available. And there are specific treatments, like throat wraps, drawing salves, poultices, etc, that may be applicable in particular cases.
Infections are not difficult to treat with these measures. They generally respond rapidly and completely. One of the advantages of these approaches is that they do not require prescriptions. Neither are they in any way dangerous; there are no side effects, with the very rare possibility of an allergic reaction. We have available to us simple means to treat even difficult infections if we understand the underlying concepts of naturopathic medicine and the order of therapeutic intervention, which is especially important with the growing problem of antibiotic resistance.
Jared Zeff, ND, VNMI, LAc
- Centers for Disease Control and Prevention. Monitoring Hospital-Acquired Infections to Promote Patient Safety — United States, 1990-1999. MMWR. 2000;49(8):149-153. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4908a1.htm. Accessed December 28, 2019.
- Centers for Disease Control and Prevention. A Public Health Action Plan to Combat Antimicrobial Resistance. 2001. Available at: https://www.cdc.gov/drugresistance/pdf/aractionplan-archived.pdf. Accessed December 28, 2019.
- Baumann E. Ueber die Bildung von Hydroparacumarsaure aus Tyrosin. Ber Dtsch Chem Ges. 1879;12:1450-1454.
- Urbach KF. Nature and probable origin of conjugated histamine excreted after ingestion of histamine. Proc Soc Exp Biol Med. 1949;70(1):146-152.
- Drasar BS, Hill MJ. Human Intestinal Flora. Cambridge, MA: Academic Press; 1974.
- Adams F, trans. On Ancient Medicine. In: The Genuine Works of Hippocrates. Baltimore, MD: Williams and Wilkins; 1939.
- Garrison FH. An Introduction to the History of Medicine. 4th Edition. Philadelphia, PA: W.B. Saunders Company; 1960: 57.
Jared L. Zeff, ND, VNMI, LAc, is a licensed doctor of naturopathic medicine and a licensed acupuncturist. In addition to functioning as Medical Director at the Salmon Creek Naturopathic Clinic in Vancouver, WA, Dr Zeff teaches on the faculty at National University of Natural Medicine in Portland, OR, where he was also Dean from 1988 to 1993, and holds a professorship in Naturopathic Medicine. Dr Zeff is a graduate of the University of California, NCNM, and the Emperor’s College of Traditional Oriental Medicine. He, along with Pamela Snider, is the author of the AANP’s Definition of Naturopathic Medicine, and the Therapeutic Order concept.