Herbal medicine

A group of Chicago researchers warns that patients slated for surgery often neglect to give their physicians a significant piece of medical information - the types and doses of herbal medications they've recently taken. As reported in a recent issue of the Journal of the American Medical Association, the researchers say that seemingly benign herbal preparations can be potent enough to significantly affect how well a person recovers from surgery.

To illustrate this point, the researchers scanned recent medical literature for information on the physical effects of eight of the most commonly used herbal medications: echinacea, ephedra, ginkgo, ginseng, garlic, kava, St. John's wort, and valerian. This search yielded several significant 'red flags' of which both patients and their physicians should be aware.

Potential problems

For instance, ginkgo and ginseng - popular herbs that many seniors take to bolster failing memory and boost energy - can interfere with normal blood clotting, increasing the risk of post-operative bleeding. Garlic consumed in therapeutic doses for 'heart health' can have a similar effect.

St. John's wort, used as a short-term treatment for mild depression, interferes with the action of medications used during and after surgery, including some anesthetics, warfarin (a blood thinner), and lidocaine (a pain killer). Ephedra, a common ingredient in weight loss medications, can cause serious cardiac irregularities when combined with anesthesia.

Echinacea - when used continually for more than 8 weeks - might suppress the immune system, a consequence that would lead to longer wound healing time and a greater risk of infection.

Both kava and valerian are sedatives, and as such may augment the effects of anesthetics and other medications used during surgery. Kava clears the system quickly, but people who regularly rely on valerian to help them sleep should taper off use of the herb over a period of weeks.

In fact, the American Society of Anesthesiologists suggests that patients discontinue all herbal medications 2 to 3 weeks before surgery. This is fine if surgery is scheduled for some time in the future. But since some procedures are performed on short notice, it is not always possible to insure that a person is 'herb-free' before surgery. This points to the importance of patients keeping their physicians fully informed of all dietary supplements that they are using to treat conditions - like a cold or sleeping problem - not listed on their medical records.

Unfortunately, patients don't always volunteer this information without prompting. Some people don't think of herbs as 'real medicine', and others are afraid that their physician will disapprove of their using alternative forms of medicine. To compound the problem, one in five people can't identify exactly what they are taking.

A sensible solution

So what should you do if you're scheduled for surgery? Make a list of all the dietary supplements that you currently take so you can provide a detailed account of what you've used in recent weeks. Armed with this knowledge before your surgery, your doctor can take steps to minimize the residual effects of your herbal medications.