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Although the complexities of coronary bypass surgery are beyond the scope of this book, a few comments are in order. Briefly stated, this recent surgical advance is a procedure involving the removal of one or both of the major veins (saphenous vein) in the leg and its careful transplantation in the chest. After appropriate cardiac catheterization to determine the adequacy of the coronary circulation, the vein is placed between a hole made in the aorta as it leaves the heart and the more distant part of the coronary artery. With its 5-10% risk to life, the exorbitant cost ($30-50 thousand), and the lack of long-term statistics as to its effectiveness (at best 2 years), this operation should be regarded as a last resort.

Reconditioning programs are springing up around the country and offering a superior alternative to many bypass candidates. The combination of a low fat diet free of cholesterol and progressive exercise in a center with preventive capabilities will often minimize the necessity for cardiac drugs, while relieving chest pain and similar cardiac symptoms. Nevertheless, a few individuals with disease of all three coronary vessels or underlying impairment of the heart valves may need and profit from this operation. In such cases, it is my recommendation that a medical center experienced in heart surgery be selected with much prayer and care.

Following the bypass operation, cardiac rehabilitation should begin in a lifestyle conditioning center where both diet and lectures are calculated to prevent recurrence. As rapidly as possible this will recondition the patient for a return to normal living. Otherwise, the temporary relief obtained by a revascularization procedure may be short-lived as the new vessels plug themselves with cholesterol once again. One can easily see how every aspect of coronary heart disease from the cradle to the rocking chair will benefit from preventive measures.

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Formerly the most common operation in the United States, tonsillectomy has fortunately declined in popularity. It is now known that our tonsils play a useful role in the formation of antibodies to respiratory infections. The incidence of poliomyelitis and cancer have been less in those fortunate individuals who were able to keep their tonsils. Infections in these organs will usually respond to prompt administration of simple remedies. Some of these will be discussed in Chapter Fifteen.

Indications for surgical removal of the tonsils are primarily limited to chronic recurring infections where the deep pockets (crypts) prevent adequate self-cleansing, and debris and infected material reside there. Recurring ear infections sometimes require the related lymph tissues in the nasal pharynx, called adenoids, to be removed. Both of these operations should be highly selective.

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Tortuous dilation of surface veins in the lower extremities are also caused by our lifestyle. Prolonged standing and sitting allow an increase of venous pressure to develop in the lower extremities. Tight-fitting garments— such as girdles, belts and garters—will predispose to this degenerative condition. The increased venous pressure of late pregnancy often aggravates the situation. Elastic stockings are very helpful to prevent throbbing and progressive dilation of these large leg veins. Surgical treatment may be necessary, with the ligation and stripping of the veins, but this should be evaluated by an experienced surgeon competent to assess the indications—one who is inclined to avoid surgery whenever possible. Proper posture, daily exercise, deep breathing, and a diet that maintains good bowel action will all assist to keep the pressure low in the veins and thereby prevent unsightly legs, throbbing calves, or the ulcers that occasionally follow.

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Usually ulcers involve the stomach or small intestine (duodenum) and can heal without surgery. The only conditions warranting surgery are severe gastrointestinal hemorrhage, or perforation of the ulcer with the spillage of stomach contents into the abdominal cavity. Also, the prolonged scarring of chronic ulcer disease can produce obstruction in the region of the stomach outlet (pylorus) or duodenum. When this occurs and prolonged vomiting ensues, the only recourse is to surgically bypass the obstruction and again provide a basis for adequate nutrition.

A fourth indication listed in many textbooks is intractability, meaning that the ulcer just won’t heal and therefore surgery is necessary. In my opinion, this usually implies that the patient is “intractable.” Often a refusal to quit smoking, eliminate coffee or alcohol, or change behavior patterns to a more peaceful, low stress mode lies at the root of the nonhealing ulcer.

In my medical and surgical experience, the best results in most types of ulcers are seen when the minimal amount of surgery is performed. Usually this means a selective vagotomy, in which the small nerves that influence only the acid forming portion of the stomach are cut. When necessary, an operation to enlarge the pylorus or to bypass scarring is done. As all surgeons know, tampering with normal stomach physiology in this manner is not without hazard. Iron deficiency anemia, the dumping syndrome (in which the ingestion of simple carbohydrates results in immediate diarrhea), abdominal cramps, and various types of malabsorption can occur.

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The high fat diet of this ‘junk food” age has rapidly increased the incidence of stone formation in the gallbladder. Designed to be a reservoir of bile, the gallbladder has the capability of concentrating this liquid into a thick syrup. A diet rich in fats and cholesterol tends to overcharge the bile with bile salts and cholesterol, which readily crystallizes to form stones. Large single stones or many small stones may lie dormant for years, then produce a sudden crisis. In the area of the gallbladder, located just beneath the liver, pain develops, associated with vomiting, fever, or chills.

When a gallstone passes into the common bile duct, obstruction occurs, with jaundice, and even more excruciating pain. In such conditions surgery is mandatory to remove both the stones and diseased gallbladder. Nonsurgical treatment includes a low fat diet and strict avoidance of grease, oils, and other fatty foods. They may help the body to dissolve these stones. Contrast x-rays and ultrasound tests can easily be done to evaluate the gallbladder’s progress. Check first to see if the patient is allergic to the iodine of the gallbladder dye. For best prevention I recommend steadfast control of obesity, and a lifetime adherence to natural foods. This will prevent most gallstones.

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