Herbs and Surgery!

[Guest guest]

Hi, everyone - I thought this was interesting since many take herbal

supplements.

all the best,

teresa

lap DS with gallbladder removal

Dr. Gagner/Dr. Quinn assisting/Mt. Sinai/NYC

January 25, 2001

This article can be accessed directly at:

http://www.healthscout.com/cgi-bin/WebObjects/Af?ap=55&id=110266

Herbs and Surgery: A Risky Mix

Supplements can cause extra bleeding, bruising

By Searing

HealthScout Reporter

WEDNESDAY, April 25 (HealthScout) -- A variety of herbs, and even some

vitamins, can cause serious problems in the operating room, warns a New York

plastic surgeon. And these problems seem to be cropping up more and more.

A range of herbal supplements -- from the popular St. 's wort and ginkgo

biloba to garlic, ginger, ginseng and feverfew -- can cause increased

bleeding during surgery, contends Dr. Philip , a clinical assistant

professor at New York University's School of Medicine who specializes in

facial plastic and reconstructive surgery. So, he says, can vitamin E.

That's not only risky during the actual operation, he says, but can lead to

complications later.

" Patients in the operating room are just oozing as if they're on aspirin, "

says of a trend he's noticed in the past six to nine months. Surgeons

routinely warn people away from aspirin before an operation, he says, because

aspirin tends to keep blood from clotting.

But people are taking herbal supplements unbeknownst to their doctors,

says.

" They swear they didn't take anything, and I trust my patients, " he says. But

after further checking, he says, " I've been able to elicit a history of

herbal use that they've not disclosed to their physicians. "

About 70 percent of people slated for surgery don't disclose herbal use, says

, citing a recent survey. Herbs generally aren't prescribed by a

doctor, and people just don't consider them a medication, he says.

But herbs and vitamins do affect the inner workings of the body -- and not

always in a positive way when it comes to surgery, says.

Ginkgo biloba -- which people take to improve their memory -- " can cause

spontaneous bleeding, " he says, " and interferes with the process by which the

body causes blood clots. " It's also been blamed for post-operative bleeding.

" Underneath the skin, [it] can ooze itself into the tissue, much like mud or

water might invade itself into a rug if you have a flood, ultimately causing

a diffused discoloration, " he says, referring to the black-and-blue of

bruising.

Some bruising, he says, is part of the process. " But after having performed

enough surgeries, there's a certain level you expect and anticipate and,

beyond that, you go, 'Hmm, that seems a little strange,' " says.

" I'm the same doctor, doing the same operations, but you guys [the patients]

are the difference, " he says.

A growing number of people now take herbal supplements of one kind or

another. One medical group estimates that Americans will spend about $5

billion this year on herbal products they believe will help them treat

depression, raise their energy level, improve their memory or otherwise

improve their well-being. A survey last summer showed that nearly a quarter

of all Americans regularly take some herbal supplement.

But anyone going in for surgery should stop risky medications -- including

herbs -- at least two weeks before their operation, says. Herbal

advocates generally agree with that.

" It's a good idea to stop taking all medication, including herbal

supplements, before surgery, " says Mindy Green, director of education for the

Herb Research Foundation, a nonprofit educational library located in Boulder,

Colo.

Even some foods, she says, interact with medications and can affect bleeding.

" But surgeons should know that if they're doing surgery, they should do some

kind of test for bleeding time before the surgery, " Green says. " The surgeon

is blaming [the problem] on herbs, and the patient is not relaying [important

details], either out of ignorance or fear. But surgeons should ask

specifically about dietary supplements. "

But even when they do, says, sometimes things sneak through.

" Some of these supplements [like ginseng] are finding themselves into iced

teas, herbal energy drinks, herbal teas, " he says. Because of this, people

can be honest with their doctors and say they're not taking anything, yet

still be at risk, says.

And it's not just people scheduled for surgery who need to worry, he says.

Anyone who's having nosebleeds might want to check his herb use, says,

as should anyone at risk for a stroke and anyone who must take the

blood-thinning drug Coumadin.

One of the first times noticed the herb-bleeding link, he says, was

when a man on whom he did a facelift developed " a collection of blood. "

" He swore he didn't take anything, " says, " but on further

investigation, [we learned] he'd taken diet pills with ephedrine in them. "

Ephedrine comes from the herb ephedra, also called ma huang, which has been

implicated in heart attacks and strokes. It also causes the blood pressure to

rise, says, and that can cause bleeding during an operation.

St. 's wort can cause that same effect, he says. An estimated 7.5 million

Americans take this supplement to ease anxiety, mild depression and sleep

disorders.

The problem with vitamin E, on the other hand, appears to be more like that

with aspirin, says. Many people take a vitamin E supplement regularly

because they believe it helps prevent heart disease.

But people who " mega-dose " on vitamin E, which says can happen simply

by taking a 400-unit pill regularly, can " get sort of an acquired clotting

disorder, which results in excessive bleeding [and] interferes with platelets

sticking to one another and forming the clot. " Platelets are fragments of

blood cells that help the blood clot, or form a scab.

isn't alone in his observations. The American Society of

Anesthesiologists also wants people to stop taking herbal supplements at

least two weeks before surgery, saying that just because something is

considered " natural, " it's not automatically " safe. " A survey the group did

of people awaiting surgery reveals that 22 percent had used herbal remedies

of some sort and 51 percent had taken vitamins.

And earlier this month, doctors attending an Atlanta conference of the

American College of Physicians and American Society of Internal Medicine were

advised of the need to be more aware of the interactions between vitamins,

herbs and traditional prescribed medications because more and more of their

patients are turning to alternative therapies.

The blood-thinning effect of some herbs, in fact, " is very useful in many

cases, but not if you're going under the knife, " Green says. " That's very

often how and why they're used. "

" That doesn't mean any of these things are bad, " she says.

But for people anticipating cosmetic surgery, says, the results can be

particularly upsetting.

" They're undergoing a purely 100 percent elective procedure, and right or

wrong they have an expectation to be back out in public … and back to work …

as soon as possible, " he says. " Significant bruising can really impair their

recovery. "

Physicians have to start asking -- specifically -- about vitamin and herbal

supplement use in their pre-operative evaluations, says.

" If you have more bleeding than normal [during an operation], you'll spend a

fair amount of time stopping that bleeding, and visualization can be

impaired, too, " says. " Never mind just the short-term influence on the

post-operative course, but this [bleeding] can interfere with the entire

result, based on your inability to perform the surgery to the best it can be

done. "

What To Do

Anyone scheduled for surgery, medical experts agree, should stop taking

herbal supplements two weeks before an operation. They also should avoid

aspirin. And perhaps equally important, they should fully disclose to their

doctor everything they take, prescribed or not.

For people anticipating cosmetic surgery, also recommends that they

stop smoking, because it, too, can contribute to excessive bleeding during

surgery, and that they stay out of the sun because burned skin must heal

before it can be operated on.

He also suggests that his patients do try one particular herbal preparation

-- arnica, sold as SinEcch -- after surgery to help reduce bruising and

swelling.

To find out more about herbal health products, the risks and benefits, visit

the American Academy of Family Physicians or the American Botanical Council

online. To learn more about specific herbs and vitamins, go to the Herbal

Information Center or the Herb Research Foundation.

If you're contemplating surgery, check out information on what you should

find out from your doctor, provided by the Agency for HealthCare Research and

Quality and on what to expect, provided by the Food and Drug Administration.

Or, you might want to read previous HealthScout articles on herbal supplements

or others on cosmetic surgery.

SOURCES: Interviews with Philip J. , M.D., plastic surgeon, clinical

assistant professor, School of Medicine, New York University, New York City;

and Mindy Green, director of education, Herb Research Foundation, Boulder,

Colo.

Copyright © 2001 Rx Remedy, Inc.

Last updated 04/25/01

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