CONTINUED... And this was accomplished without ozone! I had numerous diagnosis of a sensitive nature that have been completly eradicated with herbs plus RHP/EBOO. All in less than 5 months! So, fear not. These things are not so mysterious. These doctors are truly amazing and compassionate. The only requirements are obedience (you must take all the supplements and herbs directed) and patience (time). Blessings and improved health to each and every one of you.
Forgot to mention we arrived here with a myriad of food allergies which included not being able to take vitamins, homeopathies, and supplements any longer (of which I am an avid believer). Needless to say, we are both able to eat abundantly from the grain family which we were not able to at all prior to coming. This plus many veggies and spices I was not able to touch without having skin reactions, itchiness, major aches and pains in my joints and insomnia.Plus, we're back on track 90% with our vitamins and homeopathies. I must confess the insomnia is not gone. I also must confess that it is quite possible my own mentality contributes to it significantly. I will be delving into yoga, tai chi and other methods of meditation and personal calming upon our return home to the States. The other symptoms have quite disappeared. Only when I inadvertantly eat a definite no-no, for instance a whole coconut which I shouldn't do in the first place, do I notice symptoms. I presume this will continue to improve after continuing supplements and herbs the doctor is sending home with us. Ask me in 3 months if my asthma is gone which was exaserbated alarmingly a few weeks ago by a fire here, which was a blessing because I would have neglected to bring it up do to it's original mildness. But three months and three treatments later I am promised eradication for ever. So, remember to ask me in about 3 more months after I complete the recommended course of treatment at home. I have no reason to doubt complete success as all the doctors have done here has been amazingly thorough, competent and trustworthy, not to say on the nose. I have deep gratitude for their expertise and care.
I drove myself crazy for years try to self diagnose; candida, gluten intolerance, chronic fatigue, Morgellon's, lyme,....you name it. I thought I had them all at some point. So many of these have overlapping symptoms. A leap of faith, a good, healthy dose of trust and time with Dr. Ali and Peter here in Malaysia hits the spot, wherever and whatever your "spot" is. Here, not only is the body treated and transformed, but just by committing to this recovery process, your mind will learn to rethink and understand the uniqueness of your own body, and that of everyone else's, too. It is an eye opener, to say the least. I did not realize how restricted I was even in my alternative sense of medicine and healing which I have been pursing for 10 years due to my sons special needs! I'm grateful to everyone here for allowing me to become the new, improved me.
But the road to Malaysia is one where we reaped many benefits and I do not mind working, saving, selling, changing my lifestyle (down grading), pinching every penny to pay off what was exchanged. I now have health to be able to work to pay off what is owed. I made a choice. A very definite choice. It was a risk before I got here because I didn't know. But after having arrived, I knew I had found the right place. Peter is right when he describes the people as loving and caring, and working 7/24 if that is what a particular patient requires. These people are die hards. I am put to shame with some of the things I have complained about in the past. No, I have no regrets, not even the money. If I don't find it worth while to invest in my life, my health, my happiness, then I've got my priorities twisted. I wasted many years not wanting to go into debt. I wanted my things, until I became so ill I could not function to care for my son. That's when I got serious. Made some choices that didn't pan out, but this one did. I now consider wealth happiness, attitude and health, not money.
Yes, the media machine that poisons our minds. Deadly, to say the least. I will also say, without mentioning any names or giving away and secrets, that I have watched a woman who came here with stage 4 breast cancer, be transformed as well. She's an incredible testimony unfoding before our very eyes.
We came back the very end of June this year. Started our stay there on Feb. 4th or 6th. Can’t remember which. I am doing terrific. My son is doing very well despite some setbacks due to aspiration pneumonia and US medical incompetence in treating him upon our return. Through it all he has not lost any weight, nor come near the “failure to thrive” child he was before going. Specifics on what we went for, conditions, symptoms: severe, multiple food allergies, asthma, insomnia, fatigue, rashes, arthritis, severe herpes and other STDs, depression, severe PMS, lack of desire to live, toxic liver, unable to take any vitamins, supplements or homeopathies. My son’s issues: failure to thrive, severe bloating and reflux, insomnia, severe herpes that settled in his brain that would one day turn it to mush and take his life, near kidney failure, a myriad of food intolerances, not able to take supplements, vitamins or homeopathies. In addition to treating all of the above with remarkable results, I will mention that his vision (he is legally blind) and cognition( he has cerebral palsy) significantly improved over the course of the 5 mos. we were there. To be honest all I know is general stuff, not excipients. I let all those concerns go after I arrived and understood the wonderful hands and hearts we were in. That did not come naturally for me. I had to learn it while there. I had trust issues and expectations that were, how do I put it, a product of Western culture and not helpful in Malaysia. We had liver flushes, RHP/EBOO, micro bubble, IV pushes and drips, homemade powders containing individual specific supplements, vitamins and herbs, special massages, delicious foods prepared for us containing the strangest things, 24 hour nursing care when necessary, tonics of every kind, immune building concoctions, pick-up and delivery to the clinic every day (at the time of our stay the patient housing features were not yet available), personal tours when we were physically able and willing, help with grocery shopping if needed (as my son is handicapped). That’s what I can think of off the top of my head. That’s not to mention the absolute dedication and determination to root out every problem’s cause for each individual and to bring them back to a state of health they could never imagine. I had forgotten I could feel this good. Feel free to ask more….. Not only did I experience physical healing, I gained a positive mental perspective that will serve me well for the rest of my life. I forged friendships that will hopefully last a lifetime. My mind was opened to new ways of doing things, less expectation, more acceptance of what is or will be, a calmer more patient spirit ready to accept all the blessings life has to offer.
I wondered if I had lyme because lots of the symptoms overlap with what I was experiencing. Then again, lots of the symptoms overlapped with Morgellans, fibromyalgia, chronic fatigue, etc ….. So many look so similar. I made myself almost crazy thinking I had all this stuff. I just wrote down all my symptoms for Dr. Ali and Peter and they took it from there when we arrived. Lots of blood work was done, no lyme testing. I’m sure they have their reasons. I was not happy. I expected things to be done differently. I expected all my “worries” to be tested for. Not always the case. I wasn’t happy, but I soon learned that things didn’t necessarily need to go the way I had them planned out in my head. I could feel the toxic/viral burdens being lifted from my body, too, just as Ani is describing them in her postings. At some point during this process it became completely unnecessary for me to demand information about what was being done to my body. I could feel the healing. I had more energy, a more positive attitude. I was tired of chasing things I thought I needed when nothing really panned out. I surrendered myself to the care of the Drs. and nurses. That’s the best thing I could’ve done as my mental state, I’m sure, contributed to my health crisis. I decided I didn’t want to do that to myself any more. Eradication was confirmed with blood work for the herpes. Since I had no diagnosis for much else, that’s the only hard copy I have, except the definite results I now experience in my daily life by being able to eat so much more than before, breathe without wheezing, have more stamina, and so on . Yes, whole coconuts are a big no-no for me. Did I tell you I ate two whole ones and drank all the coconut water from both in one sitting? Maybe overdose! I can eat coconut in small amounts now several times a day. I can’t give you long term results because I’ve only been home for a little over a month. Ask again later if you want. If you’re worried about relapse, just stay the entire time Dr. asks of you and that shouldn’t even be an option. I know it’s critical to do everything they tell you to do and stay for the whole course of treatment which, of course, is different for each person. I had no dietary restrictions except to stay away from the coconuts after the “episode!” Yes, viruses are everywhere. I do DIV, rectal and vaginal and ear insufflation, drink ozone water, etc… periodically to keep these things at bay. I eat a pure diet of raw and steamed veggies, nuts, free range lamb and wild caught salmon with occasional whole grains. No store bought prepared foods nor restaurants except the few who offer sustainably raised ingredients and free range meats which limits my choice to 2 here locally and even then I go once a year because they can be beyond my means any more often than that. I prefer to invest in supplements, vitamins, and homeopathies. Yes, I feel the infections and viruses are gone. But we are exposed to viruses all the time in our world and are not immune to picking up new ones. Our immune systems are much improved but we can still get sick. This is why I do the DIV, etc… routinely still to keep on top of this. This is my decision. The expectations I referred to were a rigid set of standards and “rules” concocted by Western medical and pharmaceutical companies that I finally learned had absolutely no bearing or relavance in my situation. I also had an unopened mind to how a doctor might operate significantly differently than what I’ve experienced here in the US. I was a true product of Western civilization; instant gratification. I learned healing is a process. I experienced compassion on a level I never knew existed outside of family. My husband had numerous RHP/EBOO’s and some concoctions and was sent home with some homemade pills. His blood work is now negative for herpes. His was much more mild than mine and David’s. I had to have 8 weeks of drips, on one week, off another. I am herpes free, my blood work attests to that. Any more questions? Or if I didn’t explain something clearly please do not hesitate to ask for clarification. Or if I skipped over something or forgot to answer something, just bring it to my attention and I will gladly do my best to answer.
Continued... The past eleven days, after extensive (and outrageously inexpensive) testing to determine exactly where my body was yes, my entire body, not just an organ, a system, or a disease , my protocol has consisted of precise "system boosting" treatments. Immune, digestive,nervous and endocrine support has been a strong part of my bio-specific regime so far, and boy, do I feel it. Can you imagine what medicine would be like in the Western world if Ozone Hospital centers were available everywhere? I can. Conventional western medicine would be bankrupt or completely converted to true medicine. Modern conventional medicine would become the Edsel of medical history, and we would all have a good laugh after we grieved the loss of so many precious lives, so much happiness, and so much vibrant health. We would laugh away a history of suffering and pain. Yes, we would, and we would gratefully. How I wish that day were here already, for each and everyone of us. Each day I end my day thanking God/dess for the awesome staff at Ozone Hospital, without whose dedication, love and vision, I know so many more would suffer "incurable" conditions and dis/eases. Hippocrates said: "First Do No harm." Ozone Hospital says: "First Heal." As I look out the panoramic windows from my quiet bedroom (lovely housing is provided here as well) to the blue skies of this spectacular Malaysian day, listen to the doves coo, and the exotic Asian breeze caress the trees, I know soon my journey through breast cancer will be over. I am eternally grateful for this truth.
After more than 1500 days of the American medical community insisting the breast cancer in my body was either, “severe,” “serious,” “lethal” or “terminal,” recent comprehensive cancer markers tell a different story. After only a two weeks of treatment at the Malaysian Ozone Hospital, a number of cancer markers, (not only for breast cancer), are so low, so below any standard measure of cancer, one cannot help but wonder what cancer wonderland really is and why it entered my life five years ago.
Is it possible that had I been able to find the treatment modalities available here at Ozone Hospital five years ago, I would’ve saved hundreds of thousands of dollars, my Santa Fe home and many close, significant relationships? Highly probable. Is it possible that what my body told me time and again: less invasive, non-toxic and compassionate treatment was the only accurate treatment was accurate? Highly probable. Is it possible my initial and all following diagnoses were somehow incomplete or misleading? Highly probable. In fact, based on what the compassionate and authentic physicians believe here, I could’ve been cured long ago. Can you imagine how different my life, the experience of cancer or any illness would’ve been? All anyone had to do was scientifically review what was happening in my body, what my medical history had been, and then scientifically address with the best non-invasive healing modalities available, not only breast cancer, but underlying immune-depilating pathogens that had allowed dis/ease to take hold in my body as early as 1993. And the design a treatment protocol that easily, quickly and most efficiently cleansed my body by the most natural means possible. Imagine medicine delivering a standard of care that eradicated disease instead of only treating symptoms! Imagine that this compassionate care, bio-specific to your body, your condition and your disease, was also covered by insurance, or even better yet free because the majority of treatment components where derived from Gaia! The good news is that Ozone Hospital is a dramatic step in that direction. Ozone Hospital practiced true, scientific medicine and is delivering as bio-specific and natural healing as possible. I thank God/dess every moment of the day for my good fortune, and yet, I wonder still: why should true medicine be good fortune? True medicine and personal choice are our birthright.
As you know, in the last two years, regardless of life-affirming and beautiful protocols, stress had taken a devastating toll and I was able to only follow my protocols about 50%. Daily at Ozone Hospital I was gifted detoxifying and cleansing and cellular and tissue repair support chosen specifically for my body, my condition, and my healing. Modalities included everything from stem cell treatment to monumental doses of essential amino acids, vitamins and minerals – in whatever form worked best for my body. As you know from my earlier post, these early weeks were not always effortless. Now beyond those trying moments, I can say thank you: they were NECESSARY.
Over the past ten days I’ve graduated to the addition of medical ozone therapy in the form of EBOO and an alkaloid anti-cancerous compound called Ukrain, neither of which are available in the United States or many countries for reasons only the Red Queen (“Off with their breasts!”) can tell you. EBOO was chosen because it is the most effective medical ozone method to cleanse the blood. Frankly, my blood was too toxic and my pathogen load too high – both probably from damage done to my body from mini-chemo almost five years ago and from the massive stress of the past two years! We couldn’t kill cancer cells (tumor lysis releases toxins into the blood) with the substance chosen (which does show some indication of toxicity, but nothing MOH cannot address immediately) without first extensively cleaning my blood. Pristine blood supports your liver, kidneys, colon, lungs and other organs of toxin release. RHP ™ is the highest grade medical ozone treatment available in the world today. Only highly trained medical professionals can administer RHP/EBOO although its true beauty lay in its seeming simplicity. Many physicians who have been trained to administer RHP/EBOO however can study years to understand it’s intricate yet simple beauty.
Unlike other forms of ozone use, RHP/EBOO is a highly specialized technique of treating all of your blood with medical ozone. My blood (700 milliliters of blood only leaves the body at one time) is first drawn from a large caliber vein through the use of a medical pump. My blood then filters through a micro-filter which filters removes a whole plethora of unwanted nasties. My blood is then bathed in medical grade ozone at a concentration chosen specifically for my body, at a rate specifically chosen for my body. This newly refreshed and ozonated blood is re-perfused into my body. Painless, relaxing and ultimately massively detoxifying, the process can continue for up to three hours. Usually for me the treatment now takes about an hour. What is so beautiful and simple about this treatment is that you feel great while doing it because your body feels instantly the discharge of a colossal burden, and you feel even better after! You cannot imagine how unburdened my body feels each time we do an RHP/EBOO treatment. Think about this true wonderland treatment: during my treatment, repeated usually every seven days, filtered, purified and enriched blood is returned to my body, relieving and rebuilding my organs, and the rejuvenation process continues for up to six months!!! RHP/EBOO is a wondrous medical ozone modality which reverses, or eliminates, chronic and acute illness, in a non-stressful manner, at a surprisingly low cost.
Thank God/dess for Ozone Hospital and their compassionate commitment to each and every patient. On bad days, someone is always available to assist with food delivery or special anti-cancer food preparation, laundry, cleaning or simply to lend a kind and loving ear when your mind spins wildly out of control. On good days, with me, each and every staff member rejoices, because like me, they love to experience well-being, joy and health, principally in their clients! Think about the difference between Ozone Hospital’s approach (much like Hippocrates’and other true physicians) and modern conventional medicine? Yes, think about that mountain-high, ocean-wide difference. There is a reason I traveled across the world, literally and figuratively, to access true healing.
While I wonder for us all, I find myself deeply grateful I have found medicine of integrity, purpose and compassion. Five years I waited. And the horrors I encountered along the way. Ahh, relief, release and renewal are finally here. I would like to recount a short story of an experience I had the other day. Because I was detoxing so heavily, I was prescribed my first RHP/EBOO session. As I complete more sessions I will address the process more intensively, but for now, I will make this as simple as the rodeo metaphor. Basically, your blood is removed from your body, very slowly, then cleansed with a specific concentration of ozone deemed medically safe and appropriate, then generously filtered to remove “remaining junk” and then returned to your body, cleansed of anerobic and other pathogens, and bursting with oxygen. Sounds amazing and simple. Sounds non-invasive and non-toxic. It is all that and more, if you have plumb, juicy veins and healthy, vibrantly red and oxygen-rich blood. Many of us, when we’re dis/eased, don’t have either the best veins or the best blood, unfortunately.
As I lay there, meditating on peaceful, happy, plump and healthy veins and blood, I wondered again. Looking at the dark blood ever so slowly flow through the tubing extended from my arm, I thought of how many times before my blood had been a resplendent cherry red, radiantly filled with vital oxygen, and so nourishing to my tissues, my organs, and my very being. I wondered again – only a short time of being able to follow my program about 50%, if I was lucky, and my blood is again wrecked. I looked over to my other arm, the arm where the blood was returning, waiting for health. Slowly but suddenly I saw my blood start to return to my body, bright red, vibrant, filled again with oxygen, strong and happy. Yes, happy. My blood was happy to carry oxygen robustly again. I wondered again how could my blood have become so polluted? I live on the ocean. I eat only organic, living and super foods mostly. I strive to live a lovely life. As I looked toward Vicki as she continued to wrangle my reluctant vein, she was smiling. She knew how I was beginning to feel – like a trillion dollars. Maybe more. Together we smiled. My body had been unburdened of who knows what. Although I understand MOH does analyze “the remains” of RHP/EBOO if you request an analysis. AK - 2010
Wow, many thanks to you and Dr. Ali. That is very extensive bloodwork. More than even I do and I usually do a lot on each patient. Quite expensive as well I am sure. Dr.MS - 2010
My experiences in Malaysia
by David Parker DIP ION, DIP EAV
I had been exposed to ozone therapies over the last few years, mainly the use of
ozone in the purification of water, the Trans-dermal application through the use
of a steam cabinet and the intra rectal and intra vaginal use.
However, my knowledge of the Recirculatory Hyper fusion method was limited to a
few rumours of it being used in Cuba, with Fidel Castro being one famous
recipient.
I therefore went to Malaysia with a very open mind, not knowing what to expect.
I had met Peter through one of his many websites purporting the benefits of
Ozone therapy and it was through Peter that I met Tremayne.
Tremayne and I arranged to travel together and before we knew it we were
touching down at Kuala Lumpur airport and meeting Peter for the first time.
Touching down in a strange land can be rather daunting, but exciting at the same
time.
However, any anxieties I had were soon dissolved when we were introduced to the
Doctor. He had come in person, along with his chauffeur to meet and greet us at
the airport. I thought, wow, this is five star service!
My first impressions were evolving from anxiety to very impressed and it was at
that moment, I thought to myself, if I were a patient coming for treatment, then
I would feel very comfortable, assured and relaxed.
As we were approaching Chinese new year, I was wondering if accommodation would
be a problem, however, once again, this had also been taken care of and we were
swiftly ferried to our home for the next week, a charming non pretentious and
may I say very reasonably priced hotel, approximately a 45 minute drive from the
airport.
After settling in, we sat down to a sort of welcome meal and started
acclimatising to the environment, the people and the food, all of which were
most satisfactory.
The food is always fresh and the people very friendly and accommodating.
The weather is quite balmy, although not stifling.
Over supper, Peter gave us an outline of the events to come and over the next
few days we were chauffeured from our hotel to various hospital and clinic
facilities.
This gave us a feel for what a patient could expect and what procedures would
need to be carried out.
Before any treatment is commenced, a full set of laboratory and clinical tests
are performed in order to prepare both Doctor and patient alike.
By having all the baseline figures the Doctor’s can then tailor the treatment to
the individual and therefore achieve the optimum success in the shortest amount
of time.
Hearing the Doctor speak about the therapies offered gave me great confidence as
I could tell that this is a man with enormous experience, integrity and
professionalism.
The sort of man that has been there and done that, seen it all, over the years
and no longer displays the ego of younger doctors or feels the need to prove
himself or impress others. Personally, I like that!
In times where few words were spoken, one still felt a sense of safety and
serenity.
Having viewed a number of treatments, I felt it was time to put myself in the
position of a patient, so I arranged to have some of the commonly used tests,
namely, an ECG, Liver function test and a full blood count.
My experience with the doctor who performed the ECG was very satisfactory and
very informative; the explanation of what was being viewed on the screen was
both comprehensive and exquisitely explained in great detail.
As my tests proved very positive, it was even more encouraging, very comforting
to know that one has a good strong heart which ticks all the boxes when it comes
to health.
The Blood tests were equally straight forward and performed with such delicate
control. Frankly, I have never experienced someone so gentle with a needle as
the nurse who took my blood. I literally never felt a thing when the needle went
in, as the blood was drawn or when the needle was taken out and no pain was felt
after, Amazing!
As I listened to some of the testimonials of previous patients, I felt even more
convinced that this type of Ozone therapy has something very special to offer
the world. If only more people knew about it, hence my reason for sharing these
experiences with you.
I realised I was in a very privileged position to actually witness this therapy
being performed.
Given much time for reflection while making the 13 hour flight home to London, I
concluded that it had been a very worthwhile trip and I would definitely be
recommending the therapy to my patients back in London.
The one thing I would ensure would be the preparation of patients before
travelling.
The patients I would consider for this therapy would be cardiovascular
conditions, Diabetes, heavy metal poisoning, candida and parasitic infections
and dementia.
In combination with Nutritional and herbal therapy, which they do, this form of ozone therapy
is most effective.
For detoxification, I see it as the king of detox.
Breathe deep and love life
David Parker DIP ION, DIP EAV Feb 2007
Biological and Bio-Energetic Practitioner
Chief Complaint
Norma is a 54
year-old, former ICU nurse, referred from the Clinic for admission due to
symptoms of increasing dyspnea, peripheral edema and hypotension.
History
of Present Illness
She
is well known to the cardiologists from previous evaluations. Norma has a
history of hospitalizations that average an admission every 5 months, the latest
being at the beginning of June 2003. This hospitalization lasted
approximately 5 days with very little fluid removed using IV Lasix®, Natrecor®,
and a Primacor® drip.
Previous Medical History
On August 6,
2003, she presented at the Clinic in a similar manner to her admission in June.
Prior to this admission, Norma has been taking Lasix® 80 mg b.i.d., Aldactone®
25 mg q.d., K-Dur® 10 mEq b.i.d., Digitek® 0.125 mg q.d., Darvocet®, Zaroxolyn®,
Restoril® 30 mg q hs, Altace® 5 mg q.d., Coreg® 6.2 mg b.i.d., in addition to
attending the Infusion Clinic twice a week for Primacor® and the recently added,
Natrecor® infusions.
Norma has a history of hypertension, diabetes mellitus, coronary artery disease,
status-post coronary artery bypass grafting in April 1994 with repeat bypass
grafting due to graft occlusion in March 2002. She has a history of
ventricular arrhythmia and is status-post automatic implantable cardioverter
defibrillator (AICD) implant. She was upgraded to a biventricular pacer
with AICD in June 2003.
Case Details
Her worsening
condition required her admission to Hospital and her treatment plan was unknown
at the time of her admission. She was showing signs of becoming refractory
to most medications. In April of 2003, the hospital began evaluating the
use of our system for fluid removal. When Norma was admitted,
it was clear that she would be a strong candidate for use of the device. A
venous catheter was placed for blood withdrawal and an existing peripheral IV
catheter was used for infusion.
After spending 2 nights in the hospital and going through two (2) treatments,
Norma was discharged from the hospital. With no clinically significant
effects to her hemodynamics or blood chemistry, a total of 9.75 liters of fluid
was removed. Although this amount only represented a portion of her excess
fluid, Norma’s cardiologist believed that by removing this initial bulk of fluid
through this system, the kidneys would become more responsive to the medications
and diurese the remaining fluid. This theory was confirmed when Norma
called the hospital 3 days after the final treatment to report that she did in
fact void the remainder of the fluid. Norma is scheduled to resume her visits
to the Clinic where she will be evaluated for continued maintenance therapy or
for additional system treatments with our unit.
After her our unit treatments, Norma has been responding well to her oral
diuretics. In fact, her doses have been cut in half to what they were
prior to treatment. She is currently prescribed Lasix® 40 mg b.i.d.,
Aldactone® 12.5 mg q.d., K-Dur® 10 mEq b.i.d., Digitek® 0.125 mg q.d.,
Darvocet®, Zaroxolyn®, Restoril® 30 mg q hs, Altace® 5 mg q.d., Coreg® 6.2 mg
b.i.d.
Discussion
The nurses
reported that our system is quite simple to use. After seeing how
effectively the device operates, they are eager to use it to help more patients.
More than this, they are impressed by how stable the patient remains on the
device, the levels of monitoring it really requires, and the immediate
improvements to the patient’s fluid overloaded condition with a reduction of
symptoms. Norma would have to agree. As the treatments began, she
soon stated that her breathing had improved and she could now lean over, bend
her legs, and put her socks and slippers on. Upon admission, she was
unable to lift or bend her legs to get into the car without assistance.
Norma summed up her feelings in the following quote:
“As a former ICU nurse, I have taken care of patients in the same condition that
I am now. I never dreamed I would be the patient. After one
treatment, my abdomen went way down, I was able to bend my legs to sit in a
chair, and my breathing became so much better. The difference in how I
feel, in such a short period of time, is remarkable.”
- Norma, August 8, 2003
Marion, OH
in a
Patient That Suffered a Perioperative Myocardial Infarction with Depressed
Ejection Fraction and Pulmonary Edema
Introduction
In the postoperative period, fluid shifts in patients on cardiopulmonary bypass
are common. These can often be treated with vigorous diuresis, but when patients
have depressed myocardial function or acute injury, diuretic refracturiness may
occur as the response to loop diuretics and is related to cardiac output and
renal perfusion. This report describes the use of our system in a patient
that suffered a perioperative myocardial infarction with depressed ejection
fraction and pulmonary edema.
Case Report
A 71-year-old diabetic male presented with unstable angina pectoris and after
cardiac catheterization, was found to have left main coronary disease and an
associated high-grade anterior descending coronary lesion. The patient underwent
three-vessel bypass surgery the day following angiography with saphenous vein
graft to the LAD diagonal branch and the obtuse marginal branch, as well as an
internal mammary artery bypass to the LAD. At the time of surgery, when the
anterior descending artery was opened, thrombus was noted in the artery. The
patient was readily weaned from cardiopulmonary bypass; but required significant
inotropic support on the first postoperative night. Electrocardiography the
morning following surgery showed a new Q wave in V-2, 3 and 4 and troponins were
as high as 400. He was extubated the day following surgery. On the evening of
the second postoperative day, the patient developed marked tachypnea, decreasing
oxygen saturations, and respiratory fatigue. His pulmonary artery diastolic
pressure went from 20 to 33 mmHg and required re-intubation. On the fourth
postoperative day, the patient was hemodynamically stable and had decreasing
oxygen needs on the ventilator. He was awake and alert and responding well to
diuresis. On the fifth postoperative day, however, the patient had decreasing
urinary responses to diuretics. The PAD was 21 mmHg. The CVP was 16 torr. The
BUN had risen to 36 mg% and the creatinine to 1.7 mg% from a baseline 22 mg% and
1.4 mg%. He also had hypochloremic, hypokalemic, metabolic alkalosis related to
loop diuretic utilization. Alif -1 Eboo Safe was prescribed at a
fluid removal rate of 300 to 500 cc per hour for a period of up to eight (8)
hours. A total of 2 liters of free water was removed over 4.4 hours. The
patient’s oxygenation improved and he was extubated on the following day.
Comment
Over diuresis occurs commonly, manifested by arteriolar intravascular volume
contraction, increased systemic vascular resistance, and decreased renal
perfusion particularly in the case of myocardial damage in which the cardiac
output may be diminished or fixed. Intravascular volume as measured by the
central venous pressure will remain increased. Pulmonary edema will then be
refractory. Patients develop problems with electrolyte imbalance, induced
arrythmias, particularly atrial fibrillation and enhanced activity of the
neurohormonal axis. The use of our system, a form of veno-venous
filtration, reduces this fixed preload without impacting hemodynamics or
electrolyte concentrations. Pulmonary edema can readily resolve and patients can
be more easily removed from mechanical ventilatory support.
Case
history courtesy of:
Co-Director of Cardiac Surgery
Minnesota
In A
High-Risk, Peri-Operative Setting Following Complex Cardiac Surgery
Chief Complaint
The patient was an 80 year old male who presented with shortness of breath,
signs of right heart failure, and ascites.
History of Illness
He had a right heart catheterization and right ventricular biopsy to rule out
restrictive cardiomyopathy and infiltrative diseases of the heart. He had
equalization of pressures suggestive of pericardial constriction. The patient
had been on high dose diuretics and had multiple abdominal paracenteses for
drainage of ascitic fluid.
Peri-operative Details
He underwent a limited incision exploration of the pericardium because of the
presence of a loculated pericardial effusion on echocardiography. This was then
converted to a complete median sternotomy. There were dense pericardial
adhesions and a radical stripping of the pericardial was performed from phrenic
nerve to phrenic nerve. The posterior aspects of the myocardium were freed up to
the inferior pulmonary veins. He did well immediately post-operatively, but had
a low urine output despite a good cardiac output. Despite adequate blood
pressure and cardiac output, he developed oliguria and his creatinine started to
rise. He was extubated and was oxygenating well.
After the first 20 hours post-op, we ultrafiltered him with the system.
We were able to take between 50 and 120 mL of fluid off every hour for 36 hours
in the cardiac surgery ICU with a dramatic improvement in urinary output. His
creatinine fell to baseline and he was discharged to the ward on the 4th
post-operative day. He was then discharged home within a week after surgery.
Discussion
Peri-operative fluid overload is common in cardiac surgery patients. Many of
them have been on diuretics for months if not years prior to seeking medical
attention and surgical intervention. Post-operative renal failure carries a high
mortality in cardiac surgery patients.
This
patient illustrates the efficacy of ultrafiltration in actually promoting urine
output and allowing incipient renal failure to actually regress. The mechanism
of this might be debatable, but the presence of tissue edema and higher right
sided filling pressures predispose to end-organ dysfunction in our experience.
Our aggressive stance with our system in
this setting has helped rescue many a patient and their kidneys!
Case
history courtesy of:
Associate Professor of Surgery, Director of Research
Illinois
Managing Late Post-Operative Fluid Retention Following Cardiac Surgery Using our
system
Introduction
Following open heart surgery, particularly in patients with valvular heart
disease and those with pre-operative congestive heart failure, late volume
shifts may occur. Whether related to inadequate diuretic administration, dietary
indiscretion, or medication interaction; following discharge, patients may
present emergently with peripheral and/or pulmonary edema. The removal of free
water is required and diuretic therapy alone may not suffice.
Case History
A 62-year-old female with mitral and tricuspid insufficiency, who had an
enlarging left ventricular chamber and decreasing ejection fraction, was
referred for surgery. Post-cath, she developed contrast induced nephropathy
(Creatinine reaching 2.7 mg%). She was admitted with pulmonary hypertension and
fulminant congestive heart failure. Surgical repair was accomplished with a P-2
quadrangular mitral leaflet resection, placement of a #28 Taylor ring, a DeVega
tricuspid annuloplasty and closure of a patent foramen ovale.
In
the immediate postoperative period, the patient was treated with diuretics and
had mild bilateral pleural effusions. Her postoperative course was otherwise
uncomplicated, and she was discharged on diuretics (Bumex® 2mg PO bid) with her
weight declining. Seventy-two (72) hours following discharge, the patient
re-presented with an eight (8) pound weight gain, shortness of breath, decreased
urine output, hyponatremia (Na = 129), pleural effusions and peripheral edema.
A
PICC line was placed in the right antecubital fossa and the patient underwent
our systems form of filtration. Using our system, she underwent two
eight (8) hour runs removing over 7 kg of fluid bringing her to preoperative
weight. The medical regimen was adjusted and she was discharged without
peripheral edema or shortness of breath. She has required no further
hospitalizations.
Comment
This situation represents an example of using the peripheral UF unit to manage
late postoperative fluid retention. The patient had congestive heart failure and
edema preoperatively, and in the early postoperative period, and acute renal
insufficiency, which limited effective diuresis. In spite of being discharged on
an adequate medical regimen, there were significant fluid shifts following
discharge that resulted in pulmonary and peripheral edema. The response to
diuretics was inadequate on readmission, and fluid removal with our system
resolved the hyponatremia and edema, did not impact potassium levels, and
limited the aggressive use of diuretics resulting in a shortened hospital stay.
Case
history courtesy of:
Director of Cardiovascular Surgery
Minnesota
in
the Early Post-Operative Period in a Patient Receiving an LVAD as a Bridge to
Transplantation
Introduction
Patients with end-stage heart failure secondary to either ischemic or idiopathic
cardiomyopathy frequently demonstrate worsening renal function prior to
initiating mechanical circulatory support. Extended cardiopulmonary bypass times
and large post-operative transfusion requirements contribute to the development
of third space fluid retention often seen in this population. Additionally,
diuretic response can be extremely variable in the early post-operative period
in these patients. This report describes the use of our system in the early
post-operative period in a patient receiving an LVAD as a bridge to
transplantation.
Patient History
A 61 year old male with ischemic cardiomyopathy listed as status lb on our
transplant waiting list presented with decompensated congestive heart failure
despite chronic Milrinone infusion. The patient had insertion of a Swan-Ganz
catheter and augmentation of his inotropic support with the addition of
Dobutamine. Attempts to diurese the patient with loop diuretics initially were
effective with some decrease in the patient’s pulmonary artery wedge pressure.
However, after 72 hours he became refractory to diuretics and demonstrated
continued decompensation with reduced cardiac output and serum sodium levels as
well as a rising serum creatinine level.
At
this point, the decision was made to implant an LVAD as a bridge to
transplantation. The patient had a cardiopulmonary bypass time of 225 minutes.
Multiple rounds of platelets and fresh frozen plasma were transfused in the
early post-operative period to control bleeding and correct his coagulopathy. On
post-operative day number one, the patient was found to be 9 Kg over his
preoperative weight. Additionally, he was demonstrating moderate to severe right
ventricular dysfunction with central venous pressures running in the range of 20
to 24 mmHg. Diuresis was attempted for 24 hour using a continuous infusion of
loop diuretics without significant response.
On
postoperative day number two , our system was begun through a subclavian
vein central line. Initial volume removal goals were an average of 150 to 200 cc
of fluid removal every hour. Treatment lasted approximately 24 hours with nearly
6 liters of fluid removed. The patients’ central venous pressures decreased to
12 to 15 mmHg and inotropic support was able to be weaned. The patient tolerated
our system well with stable hemodynamics and LVAD flow rates in the range of 5
to 5.5 liters per minute.
This
patient was ultimately successfully transplanted and currently maintains normal
renal function.
Discussion
Decompensated congestive heart failure is typically characterized by a
constellation of findings including reduced cardiac output, volume overload,
decreased systemic perfusion, and worsening renal function. Reduced renal
perfusion leads to activation of the Renin-Angiotensin-Aldosterone System
(RAAS), which in turn causes salt and water retention, expansion of
intravascular volume and exacerbation of CHF.
While, diuretic therapy has been a mainstay in the treatment of end stage
congestive heart failure, many patients become resistant to diuretic therapy
with prolonged exposure. Additionally, loop diuretics have been shown to
decrease glomerular filtration rate in patients with heart failure making
adequate fluid removal in the face of decompensation difficult [1].
Patients requiring LVAD placement for bridge to transplantation are
characterized by continued hemodynamic deterioration and organ function despite
maximal medical therapy [2]. Given time, ventricular support can reverse the end
organ ischemic insult seen in these patients. However, in the early
post-operative period these patients still have profound RAAS activation in
addition to elevated levels of neurohormones that in combination can make
diuretic responsiveness unpredictable [3].
We
have found that our system to be a safe and effective technique for
volume reduction in the early post-operative period in these patients. This
technique is well tolerated hemodynamically, and does not appear to affect the
performance of the LVAD in regards to cardiac output or stroke volume.
Case history courtesy of:
Cardiothoracic and Transplant surgeon
Texas
for
Fluid Volume Overload in Congestive Heart Failure with Renal Insufficiency
Chief
Complaint
The patient was a 73 year old male with atrial fibrillation, coronary artery
disease with previous inferior MI, preserved left ventricular systolic function,
mild pulmonary hypertension, and renal insufficiency who presented to the
hospital with complaints of shortness of breath and fatigue while performing
activities of daily living.
History
of Present Illness
The patient was volume overloaded and had failed outpatient attempts to
adequately diurese using oral and IV diuretics, and a short course of
nesiritide. At the time of admission, his serum creatinine was 3.1 mg/dl and his
BNP level was 1200. His hospitalization was complicated by a new diagnosis of
multiple myeloma, and as part of an evaluation for renal dysfunction, a renal
ultrasound demonstrated severe right sided and mild left sided hydronephrosis.
The patient underwent bilateral ureteral stenting with subsequent significant
bleeding from his urinary tract resulting in a hematocrit of 23. Because of
increasing resistance to diuretics and worsening heart failure symptoms, a
cardiology consult was obtained on hospital day 13.
Case
Details
At the time of consultation, his physical examination
was remarkable for a chronically ill appearing man who looked older than his
stated age. His blood pressure was 100/58, pulse 118 and irregular. Jugular
venous pulsations were seen 3 cm above the clavicle with the patient at 90
degrees. Bilateral coarse crackles were heard throughout the lungs. The abdomen
was firm and distended. Anasarca was present with 4+ edema from the feet to the
lumbosacral area. Pertinent objective data at time of consult included a chest
x-ray that showed cardiomegaly, pulmonary vascular congestion and bilateral
pleural effusions.
Despite controlling the patient’s heart rate and several days of achieving net
negative diuresis with high dose continuous intravenous infusion of lasix and
nesiritide, there was little change in the patient’s edema and chest x-ray.
Therefore, peripheral veno-venous our system filtration was performed. A
16 gauge, 35 cm peripheral catheter was placed in the basilic vein under
fluoroscopic guidance for blood withdrawal and an 18 gauge standard peripheral
IV catheter was placed in the opposite arm for blood return. The nursing staff
from a telemetry unit, primed the blood circuit, administered a 1600 unit
heparin bolus and followed-up with an infusion of heparin at 120 units/hour
administered through the access port (pre-filter) of the system’s withdrawal
line. filtration therapy removed 4 liters of plasma water over an 8 hour period.
Identical treatments were administered on days 17 and 18, removing a total of 12
liters over 3 treatments. Additionally, this controlled and stable fluid removal
allowed the patient to receive a blood transfusion without worsening congestion.
On
day 18, the patient’s exam was much improved. His lungs were clearer, his edema
was markedly improved and his jugular venous pulsations were not seen above the
clavicle with the patient at 90 degrees. The serum creatinine was 2.4 mg/dl. His
symptoms were much improved. The patient was transitioned to oral diuretics and
discharged to home on hospital day 21.
Discussion
Fluid overload can be challenging to treat in
patients showing resistance to conventional diuretics and/or a poor response to
natriuretic peptides to stimulate urine output. In this case, filtration
provided a rapid, predictable and safe removal of 12 liters of plasma water
while maintaining hemodynamic stability and serum electrolytes. This therapy
also allowed the patient to receive the benefits of blood transfusion. Because
of concerns about the patient’s bleeding from his urinary tract, the usual
systemic anticoagulation was successfully avoided by heparinizing the circuit
pre-filter.
Case history courtesy of:
Assistant Professor of Medicine/Cardiology
Oregon
MEDICAL SPECIALIST CLINIC
MEDICAL
SPECIALIST CENTRE
Dear
reader,
First, I must express my gratitude to ------- and his fellow doctors at
------------- Specialist Centre, for giving me opportunities to participate in
the management of their patients.
OUR treatment is a relatively new modality of therapy to me, although it has
been used rather successfully in many parts of the world, for a good number of
years. Since I started co-managed patients with ----, I started reviewing some
literature about the role of extracorporeal blood oxygenation and ozonation,
fondly called RHP/EBOO Researchers have experimented with RHP/EBOO ailments ranging from
ischemic heart disease to peripheral vascular disease and even viral hepatitis.
Clinicians have since applied this form of complimentary medicine to
multifarious disorders.
-------- has referred patients of various diseases to me for opinion and
assessment, particularly those with cardiac dysfunction. There were instances
whereby patients were previously advised surgery, as in coronary by-pass by
other doctors, subsequent referred to me by ------ for assessment of LV
function, in preparations for RHP/EBOO. I normally inform ------ to proceed with
RHP/EBOO if the LV ejection fraction > 45%.
Many of these cases have amazingly managed to avert surgery. Although their
symptoms improved appreciably. The exact mechanism has yet to be elucidated, but
it probably has something to do with plaque stability and endothelial function.
In conclusions, RHP/EBOO is a new and up coming way to treat many vascular -
based pathology. Although the evidence for it is not yet monumental, but many
ongoing studies will substantiate its role in clinical medicine.
Thank You,
BSc MD,
MRCP (UK)
Consultant
Physician (Cardiology)