Herbal remedies surgery risk?

[Gillian (in UK)]

Question for David C (if you and your wife are still around) and anyone else with special knowledge or interested.

Should people going for surgery take the following report seriously?


Tuesday, 10 July, 2001, 23:52 GMT 00:52 UK
Herbal remedies 'pose surgery risk'

Herbal medicines can have many side effects

Patients are being warned that herbal medications can
increase the risk of serious complications during surgery.
The preparations can speed up or slow down the heart rate,
inhibit blood clotting, alter the immune system and change
the effects and duration of anaesthesia.

Physicians need to specifically ask patients about herbal
medication use

Professor Jonathan Moss
And scientists have found some preparations have an impact
if taken up to a week before a patient goes under the knife.

Among the popular herbs studied were echinacea, gingko
biloba, garlic, St John's wort and valerian - all
widely-available in tablet form.

The researchers, from the University of Chicago, have
published guidelines on when patients should stop taking
herbal medicines in the influential Journal of the American
Medical Association.

They hope that their work will encourage doctors to discuss
the potential dangers with patients.

Researcher Dr Chun-Su Yuan said: "While most of these
substances appear to be safe for healthy people, for
surgical patients they can affect sedation, pain control,
bleeding, heart function, metabolism, immunity and recovery
in ways that we are just beginning to understand."

Popular medications

Studies suggest that as many as one third of pre-surgical
patients take herbal medications.

However, many of those patients fail to disclose herbal use
during pre-operative assessment, even when prompted.

Further, doctors often are unsure what to do with the
information.

Professor Jonathan Moss, who also worked on the research,
said: "Physicians need to specifically ask patients about
herbal medication use.

"Many patients think of herbal medications not as
supplements but as drugs.

"Other patients may not want to admit to their use to
physicians.

"But in order to optimise patient safety and pain control
during and after surgery, we need to know what herbal as
well as over-the-counter or prescription drugs each patient
takes."

Current guidance

The American Society of Anesthesiologists has recognised the
potential for adverse reactions and suggests that patients
stop taking all herbal medications two weeks before surgery.

This advice may be difficult to implement, however, since
most preoperative evaluations occur only a few days prior to
surgery.

So the Chicago researchers began to search for more targeted
recommendations.

They focused on the eight most common herbs - echinacea,
ephedra, garlic, gingko biloba, ginseng, kava, St. John's
wort, and valerian - which account for 50% of all
single-herb preparations sold.

They warn that the ingredients of herbal medications vary
enormously from maker to maker, that potency and purity are
inconsistent, and that product labels are not always
accurate.

But they believe the guidelines are useful as many doctors
remain unaware of the potential risk.

More than 5,000 suspected herb-related adverse reactions
were reported to the World Health Organisation before 1996,
said the researchers.

Between 1993 and 1998 a total of 2,621 adverse reactions,
including 101 deaths, were reported to the United States
Food and Drug Administration.

Echinacea

Relevant effects: Boosts immunity.

Concern during surgery: Allergic reactions, impairs
immune suppressive drugs, could impair wound healing.

Recommendations: Discontinue as far in advance as
possible.


Ephedra
Relevant effects: Increases heart rate & blood pressure.

Concern during surgery: Risk of heart attack, stroke,
interaction with other drugs, kidney stones.

Recommendations: Discontinue at least 24 hours before
surgery.


Garlic
Relevant effects: Prevents clotting.

Concern during surgery: Risk of bleeding.

Recommendations: Discontinue at least 7 days before
surgery.


Ginko
Relevant effects: Prevents clotting.

Concern during surgery: Risk of bleeding.

Recommendations: Discontinue at least 36 hours before
surgery.


Ginseng

Relevant effects: Lowers blood glucose, inhibits
clotting.

Concern during surgery: Increases risk of bleeding.
Interferes with anti-clotting drug.

Recommendations: Discontinue at least 7 days before
surgery.


Kava

Relevant effects: Sedates, decreases anxiety.

Concern during surgery: May increase sedative effects of
anesthesia.

Recommendations: Discontinue at least 24 hours before
surgery.


St. John's wort

Relevant effects: Acts like anti-depressants such as
Prozac.

Concern during surgery: Alters metabolisms of other
drugs.

Recommendations: Discontinue at least 5 days before
surgery.


Valerian

Relevant effects: Sedates.

Concern during surgery: Long-term use could increase the
amount of anesthesia needed.

Recommendations: Taper dose weeks before surgery.

 

[Nancy]

Good thread Gillian-

I think that anyone with serious chronic health problems should take this info. very seriously. You never know when you will have an emergency requiring surgical intervention or other medical procedures. Why take chances with unknown ingredients. It's hard enough to manage prescribed drugs. Unregulated products pose very difficult issues. Those on Coumadin should be especially careful.

As you all know, Joe has been on Coumadin for 24 years. Long, long ago his doctors told him to not even take vitamins. He takes no herbs or over-the-counter stuff unless it's passed on by his doctor. I make sure he gets a well balanced diet. His INR stays in pretty good control.

Many of our present day drugs derive from extracts of plants and other home remedies. However, they're all refined and heavily controlled, so there are no surprises. When a doctor prescribes a certain dosage, he can be sure what the reaction will be. There have been many, many studies done on over-the-counter health food supplements and there is wide variance n the amount of the active ingredients. They just aren't well controlled even when the bottles have the supposed same ingredients.

 

[hensylee]

I heard the same news report on TV and believe it is valid. All meds, including herbs, should be reported to drs, especially when surgery is involved. And you are correct in saying drs don't know what to ask or do with the info. I asked my dr about red yeast rice and he told me he was not familiar with these types of products. Red rice yeast is what cholesterol lowering drugs (at least the one I am on) is made from, but who knows the dosage you get in the herb caps compared with the prescription. Don't know of any way to compare.

The herb sellers are so convincing as sales people they make you believe that the medical prof is just taking your money and while there is certainly something good to be said of herb medicine, and I know people who swear by them, I tend to check it out and then opt for my dr's rxes.

 

[srwieland]

I agree this is a serious concern and always tell my doctors what herbal supplements I take. I also discontinued taking my supplements two weeks before my surgery and didn't resume them until one month after.

However, working in hospital administration and with clinical trials of new medicines and having studied medical history in a medical ethics Ph.D. program at Georgetown University, I have learned how the pharmaceutical companies operate and it is not always in our interest, although they of course have developed many wonderful medicines for our benefit.

Sometimes, the establishment pharmaceutical cartel has a vested interest in opposing alternative remedies not because of true concern for our welfare but in order to keep the market cornered (read 'monopolized') in order to make enormous profits. I do hope that herbal alternatives become regulated in a way that we can rely upon their quality and safety and trust what they claim to help with. On the other hand, economics favors remedies that have more 'value added' by dint of having undergone more processing. But, I question whether more processing always means better medicine; indeed, I think sometimes simpler, and more natural and organic, proves best.

Fortunately, more and more doctors and researchers are no longer just following the dictates of the pharmaceutical cartel and are seriously testing and trying to better undrestand alternative herbal remedies and how to ascertain what is good about them, what is bad, and how to make sure that they are safe both in themselves and in their interaction with other medicines and medical practices.

I personally have chosen physicians for my care who are both educated in and favorable to both mainstream and alternative medicinal practices. At the hospital where I work, alternative approaches are now being studied and taught as well as integrated into a whole person approach to wellness and healing.

I also believe that I successfully delayed my need for valve surgery due to utilizing alternative approaches to maintaining my heart health, and my surgeon also believes that one reason I recovered so well from my surgery was due to the same.

So, we should definitely heed this warning about including consideration of what herbal supplements we may be taking in relation to surgery, but we should also be careful not to be unduly swayed by the pharmaceutical cartel's alarms, a tinge of which is often behind these reports, against the many wonderful benefits that people are rediscovering with natural God-given remedies, especially when it comes to heart health.

I hope I have not offended anyone, but these are my currrent thoughts on this subject.