Lewis S. Coleman, MD DABA
Fellow, American Institute of Stress
I am a board-certified anesthesiologist. I can be reached via my email address: firstname.lastname@example.org.
My adventure with stress theory began in medical school, when I attended the lectures of Dr. Johannes Rhodin at New York Medical College. Dr. Rhodin was a renowned expert on stress theory and electron microscopy. His lectures provided a solid foundation in stress theory, capillary gate theory, and unified tissue repair theory. They summarized the shortcomings of prevailing medical theory, and left me convinced that a capillary gate mechanism must surely exist, for it provides the only logical explanation of hemodynamic physiology. They also inspired me with the dream of a revolutionary Universal Theory of Medicine. However, Dr. Rhodin noted that although stress theory had been the most important idea in medicine for some 30 years, it was even then being abandoned because nobody had found even a clue to the existence of any mechanism that could explain how it worked. Without such a mechanism, stress theory could not be tested and verified. I thought at the time that stress theory had little relevance to my career, because it had no practical application. In retrospect, I could never have discovered the Mammalian Stress Mechanism without the help of Dr. Rhodin’s lectures. They enabled me to understand the meaning of the research reports that I reviewed. Sadly, Dr. Rhodin died in 2004, only six years before I published the first crude description of the Mammalian Stress Mechanism. If only he had lived a few more years, he could have known that he had successfully inspired the next generation. I regret that I did not avail myself of the opportunity to know him better when I had the chance.
Dr. Johannes Rhodin (1922-2004)
After medical school, I largely forgot about stress theory while I engaged in the fray of private practice. In 2001 I attended the annual skiing/anesthesia conference hosted by Dr. Ted Stanley at the University of Utah. By that time I had discovered and developed my technique of opioid-based general anesthesia combined with permissive hypercarbia, which was and remains at odds with prevailing anesthesia beliefs. Dr. Stanley is an expert on the use of opioids in anesthesia, and I sought his advice as to how I might somehow engage in clinical anesthesia research to test and verify the ability of my technique to reduce surgical morbidity and mortality, and demonstrate its safety and clinical practicality.
What happened at the conference was totally unexpected. I discovered fresh information about coagulation Factor VIII. I had always been fascinated by Factor VIII because of its association with hemophilia and the Russian Revolution. I found this new material so intriguing that I temporarily forgot about my opioid anesthesia technique while I sought to learn more about Factor VIII via PubMed using Internet search techniques. In the beginning, I had no idea that Factor VIII bore any relation to stress theory, anesthesia theory, my opioid anesthesia technique, or anything else I cared about. The more I learned, the more interested I became, until I found myself enmeshed in an extensive review of published literature that lasted some six years and consumed almost all my spare time. In the process I became friends with Dr. Stanley, who generously provided helpful advice and encouragement.
My focus on Factor VIII was fortuitous, because its unique characteristics enabled it to function as a “Rosetta Stone” that gradually revealed the secrets of the Mammalian Stress Mechanism. The Internet, which didn't exist when I was a student, provided invaluable access to research information. This, plus my memory of Dr. Rhodin’s stress theory lectures, enabled me to identify and comprehend the importance of the fresh research information that had appeared during the 30 years since stress theory was abandoned. First I explained how insoluble fibrin, the final product of the coagulation cascade, induces clot formation. Next I described the capillary gate mechanism, followed by the tissue repair mechanism and an explanation of the surgical stress syndrome. Finally, I realized that all these seemingly independent phenomena were explained by a single, cohesive physiologic mechanism that explains all the various manifestations of physiology, pathology and allostasis. I call it the “Mammalian Stress Mechanism” because it simultaneously explains both tissue repair and hemodynamic physiology, whereas the old stress theorists expected that it would only explain one or the other. At first I recalled so little of stress theory that I did not realize that I had identified the long-sought "companion mechanism" of DNA that not only explains embryological development, but also provides the foundation for the revolutionary Universal Theory of Medicine predicted by Hans Selye in 1954. I am now convinced that stress theory, like the proverbial Phoenix, is now poised for resurrection. This promises an exciting new era of directed medical research and pharmaceutical development.
Ironically, when all the dust settled, I realized that the SRM explains why my opioid-based method of general anesthesia produces such excellent clinical outcomes: it controls stress better than conventional anesthesia techniques that rely primarily on inhalation agents supplemented by muscle relaxants. I had discovered what I believe will eventually be recognized as the next importance advance in anesthesia technique even before I had identified the theory that explains it. I believe that the ability of the opioid technique to reduce surgical morbidity and mortality will become obvious once anesthesiologists realize that the traditional habit of mechanical hyperventilation during anesthesia is dangerous,while permissive hypercarbia, which is currently viewed with suspicion and fear, is a safe and beneficial strategy. Permissive hypercarbia eliminates the "opioid hypersensitivity" syndrome that causes unexpected respiratory depression in the aftermath of surgery, and it enables the safe and clinically practical administration of opioids in doses necessary to control nociception during and after surgery, and thereby reduce morbidity and mortality. Thus my present professional objective is to promote awareness of the benefits of permissive hypercarbia and the dangers of mechanical hyperventilation during anesthesia.
Some will wonder why I have not pursued the idea of performing clinical research to test and prove my ideas. The answer is: I have. The problem is my age, plus recent changes in the law that place all clinical research under the control of pharmaceutical companies. Nowadays researchers must obtain permission from the manufacturer for every drug that is used in clinical research, and the "system" allows virtually no opportunity for an older physician to engage in clinical research. Such is the nature of things in an aging and dying civilization.
PUBLICATIONS OF DR. COLEMAN:
“Bupivacaine and Ventricular Fibrillation”Response Anesth Analg. 2004 Oct;99(4):1269
“Insoluble fibrin may reduce turbulence and bind blood components into clots” Med Hypotheses. 2005;65(4):820-1
“An Improved Explanation of Atherosclerosis” PloS Med 2(4): e98 08 June 2005
“Atherosclerosis May Be Caused By Inadequate Levels of Turbulence and Mixing” World J Surg. 2006 Apr;30(4):638-9
“Should Soda Lime Be Abolished?” Anesth Analg. 2006 Apr;102(4):1290-1
“A Capillary Hemostasis Mechanism Regulated by von Willebrand’s Factor May Function as a “Capillary Gate” and may explain Angiodysplasia, Angioneurotic Edema, and Variations in Peripheral Vascular Resistance” Med Hypotheses. 2006;66(4):773-5
“Is von Willebrand’s Factor a Hormone that Regulates a Coagulation Mechanism?” World J Surg. 2006 Mar;30(3):479-81
“A Testable Hypothesis That May Explain the Morbidity and Mortality Caused by Surgical Stress” Anesth Analg. 2006 Dec;103(6):1589; author reply 1589-90.
A Hypothesis: Factor VII Governs Clot Formation, Tissue Repair and Apoptosis Med Hypoth 2007;69(4):903-7. Epub 2007 Mar 23
“A Stress Repair Mechanism that Maintains Vertebrate Structure During Stress” Cardiovascular and Hematological Disorders-Drug Targets, 2010, 111-137
"Intraoperative Hyperventilation May Contribute to PostOp Opioid Hypersensitivity" Anesthesia Patient Safety Foundation Newsletter Winter 2010
"A call for standards on perioperative CO2 Regulation Can J Anaesth. 2011 May;58(5):473-5.
United States Utility Patent No. 7/678,761: METHOD OF PROVIDING ANESTHESIA
References and additional professional information available upon request.
Some of my favorite quotes:
“Hitch your wagon to a star; keep your seat, and there you are.”—Ralph Waldo Emerson
“Most people say that it is the intellect which makes a great scientist. They are wrong. It is character. “---Albert Einstein
“Success comes after a lifetime of dedicated toil, soon followed by death.” ---Will Durant
“It must be considered that there is nothing more difficult to carry out nor more doubtful of success nor more dangerous to handle than to initiate a new order of things; for the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order; this lukewarmness arising partly from the incredulity of mankind who does not truly believe in anything until they actually have experience of it.”--Niccolo Machiavelli
“Every violation of truth is not only a sort of suicide in the liar, but is a stab at the health of human society.”---Ralph Waldo Emerson
Extreme positions are not succeeded by moderate ones, but by contrary extreme positions. --Friedrich Nietszsche
All things are subject to interpretation whichever interpretation prevails at a given time is a function of power and not truth. --Friedrich Nietszsche
“There are three kinds of intelligence: one kind understands things for itself, the other appreciates what others can understand, the third understands neither for itself nor through others. The first kind is excellent, the second good, and the third kind useless.”--Niccolo Machiavell