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VICUS.COM (28 Sept. 2000) -- A 62-year-old woman was admitted to
the hospital for elective cardiovascular surgery. As part of the
presurgical workup, the surgeon asked if she was taking any medicines.
She replied that she was not. The surgeon then asked if she was taking
any herbal supplements or vitamins, to which she listed 12 herbal
remedies that were part of her daily self-medication routine.
Concerned that one or more of these herbals might increase her risk
of bleeding during the operation, the surgeon ordered laboratory tests
to determine her bleeding time. The results showed that, in fact, her
bleeding times were prolonged. As a result, surgery was postponed for
two weeks, and the patient was advised to discontinue all herbal
medicines during this time.
Upon returning to the hospital, her bleeding times were normal and
the surgery was performed without complications. She was discharged
and started to take the herbal medicines again. Four weeks later, she
went to the emergency room complaining of repeated blood loss from her
nose.
Probing to uncover
herbal medicine use
According to the American Botanical Council, almost one-third of
all American adults (almost 60 million people) use herbal products.
And there is evidence that when people are diagnosed with a specific
disease, their interest, as well as their intake of herbal medicines
and nutraceuticals, increases.
In fact, people all over the world are increasingly concerned about
the harm inflicted by modern, technological medicine, especially
pharmaceuticals, and the high cost of these treatments. Many patients
are finding that herbs can have actions similar to those of herb-derived
drugs, without drug side effects (Pelletier, 2000).
Unfortunately, using a
questionnaire or asking general questions does not reliably uncover
the use of these medications. A 1999 survey conducted at the Scott
& White Memorial Hospital in Temple, Texas, found that among 979
presurgical patients, 170 (17.4%) reported taking such products.
Although this is a significant number of patients, it is well below
the national average.
When conducting a
presurgical medication interview, it is important to recognize that
patients often consider herbal remedies to be natural, and therefore,
free from side effects or drug interactions. Just as people often
limit the word "medicine" to mean prescription drugs, rather
than over-the-counter drugs, patients may not recognize that an herbal
remedy is also a "medicine."
The key is for the
surgeon, anesthesiologist, nurse or other health-care practitioner to
probe and modify questions in a way that will help patients understand
exactly the information being sought.
Remedies
of special interest in surgical patients
See the
accompanying
table.
At the time of this
study, Charles McLeskey, M.D., was professor and chairman of the
Department of Anesthesiology at the Scott & White Hospital and
Clinic. He said he believes that among herbal medications, three areas
are of special concern to surgeons and anesthesiologists: herbals that
may predispose the patient to anticoagulation abnormalities,
cardiovascular complications and sedative effects during and following
surgery.
Surprisingly, although
herbal remedies are generally regarded as safe, many have potential
for or evidence of actions or interactions of concern to patients
undergoing surgery. The table
(Red
flags in drug-herb interaction) lists some of the more
commonly used herbal remedies that may be associated with three areas
of concern for patients undergoing surgery: coagulation abnormalities,
cardiovascular complications and sedative effects.
John
Russo Jr., PharmD, is senior vice president of medical
communications at Vicus.com. He is a pharmacist and medical writer
with more than 20 years of experience in medical education.
This article
was updated on 28 Sept. 2000.
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