From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.alternative,sci.med,sci.cryonics,sci.life-extension
Subject: Re: Defense of Scientific Realism (was: Cancer & Nutrition)
Date: 13 May 1998 23:57:24 GMT

In <355935FA.86D@enterprise.net> John Scudamore <whale@enterprise.net>
writes:

>Science is great in the right hands, but medical science is a bit of a
>joke.  You medicos want us to think you are great scientists and your
>medicine is "science in action".  Well, it might be, and bypass is
>certainly clever but just about useless for 98% of the poor punters
>who submit to it.


   The above is your usual mouthing off, but where is your evidence?
Cite the studies.

   Bypass is lifesaving in people with certain types of severe vascular
disease and poor heart function.  For a larger fraction of people it's
a viable alternative to drugs for relief of anginal pain (such people
would probably be better served by using the Ornish/Pritikin AMA C
stringent diet, however).

   Alternative types claim better treatnments, like chelation, but
these are all no more than really great stories, at this point.  Like
the Loch Ness Monster.   I enjoy hearing them, but I wouldn't want to
bet my life on them.

                                      Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Question: Alzheimer's and surgery
Date: 19 May 1999 21:20:45 GMT

In <374175C4.2BB7A142@alliedsignal.com> Ron McCormick
<Ron.McCormick@alliedsignal.com> writes:

>My father is in the early stages of Alzheimer's and has recently been
>informed that he needs multiple bypass surgery. My question is: Will
>major surgery of this type have any effect on his Alzheimer's? My mother
>was told by a friend that it will likely speed up the memory loss, etc.
>Is there any proof of this?
>
>Thanks for any responses,
>
>-Ron



  Heart lung bypass pump surgery (which is done for most coronary
bypass these days) causes tiny clots to go the brain during aortic
cross-clamping, and in times past this was a source of decreased mental
ability in some fraction of people having heart-lung pump bypass. As
time has gone on, however, bypass techniques have improved (arterial
filters, faster procedures, membrane oxygenators, etc), and the
"post-pump sydrome" is large now subclinical (doesn't show up in IQ
tests).  Though careful monitoring (stuff like SB100 levels in blood
from infarcted brain) does suggest that a certain amount of damage
continues to be done.  I would expect that someone with early
Alzheimers' who has less reserve, would be more sensitive to this, but
I know of no studies of it.  Basically, you should avoid bypass if
there are any medical options which are at all viable.  Your dad really
know needs bypass by strict mortality criteria if he has disease of his
left main coronary, or disease in 3 vessels and poor heart function.
Or, if he has chronic anginal pain that can't be controlled with
medication.

   There are a very few centers doing non pump coronary bypass, where
they essentially clamp the heart down so it doesn't move so much as it
beats, and the coronary bypass can be done while the heart is still
beating, so that no pump is needed.  If you can find one of the few
centers that do this, it's a better option if you must have bypass.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.pharmacy
Subject: Re: "Sundowning"
Date: 27 Mar 1999 13:56:28 GMT

In <clw-2503991715180001@i48-22-36.pdx.du.teleport.com>
clw@teleport.com writes:

>In article <7de62e$fnb@bgtnsc03.worldnet.att.net>, "Rainman"
>
>> I just wanted to see if there was some "common knowledge" out there
>> that I was missing out on. This only happens a couple of times per year
>> (we do about 6-7 heart cases weekly) and it really takes it's toll on
>> the family. Sometimes they've seen it before- "Grandpa did this when he
>> had his last bypass operation"... more often everybody is stumped.
>
>A little input from an old cardiac anesthesiologist. No one with any
>experience should be "stumped."
>
>Anti-cholinergics are given relativly rarely, and their central action
>can eaisly be reversed by physostigmine. I have not seen this as a
>problem for over 20 years. The high dose narcotic anesthetic management
>should keep a patient unconscious for about 4-6 hours if managed
>correctly. (I use sufentanil, midazolam, and a long acting muscle
>relaxant).
>
>The more common causes are: prolonged bypass time with cereberal
>dysfunction due to microbubbles or detritus from breakdown of formed
>elements of the blood due to pump trauma, arterial air embolization
>during graft placement on the aorta or decannulation at the end of
>bypass, post-operative narcotic medication, episodes of low perfusion
>pressure combined with carotid arterial occlusive disease, metabolic
>problems with acid base disturbances, low cardiac output (even
>transiently) during the post operative period, failure to manage
>co-morbid diseases (ie, diabetes, endocrine, COPD, renal or hepatic
>insufficiency etc).
>
>There are more, but I am tired of typing.



   Yeah, the more you know about bypass, the less you want to be
bypassed, that's for sure.

   However, a review of the literature I did recently suggests that the
post pump syndrome is decreasing in both frequency and severity.  We're
doing better.  We're using hollow fiber oxygenators, instead of those
damn bubble oxygenators (except where your HMO got a great deal on the
bubble type, and has lots in stock <g>).  And 40 micron arterial
filters are now standard, instead of oddities.  And so on.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.pharmacy
Subject: Re: "Sundowning"
Date: 28 Mar 1999 06:08:35 GMT

In <clw-2703991144490001@i48-35-22.pdx.du.teleport.com>
clw@teleport.com writes:

>In article <7dio2c$sqb@sjx-ixn10.ix.netcom.com>,
>sbharris@ix.netcom.com(Steven B. Harris) wrote:
>
>
>> Yeah, the more you know about bypass, the less you want to be bypassed,
>> that's for sure.
>>
>> However, a review of the literature I did recently suggests that the
>> post pump syndrome is decreasing in both frequency and severity. We're
>> doing better. We're using hollow fiber oxygenators, instead of those
>> damn bubble oxygenators (except where your HMO got a great deal on the
>> bubble type, and has lots in stock <g>). And 40 micron arterial filters
>> are now standard, instead of oddities. And so on.
>
>Yep, but "post pump syndrome" was a garbage can diagnosis for anything
>having to do with the lungs, brain, kidneys, liver or gut.
>
>The "secret" is short pump runs. Even with the centrifugal pumps and new
>oxygenators after about 4 hours you can hear a lot of pings and rumbles
>on a carotid doppler.


   You hear those pings in the carotid doppler when you take off the
arterial clamp.  Doesn't matter how short the pump run was.  Or even
how old the patient is (though of course the older they are, the worse
it is).  Lots of emboli no matter what.  The levels of brain glial
protein SB100 go up, indicating micro-infarcts, after any bypass.
Luckily, most people these days don't notice the loss.