Natural Integrative Therapies 
| Herbals and Your Surgery |
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With increasing interest in natural and herbal medications, it is important to watch out for the bad along with the good. It seems that there is increased risk for complications if you use herbs before your surgery. Here are EIGHT popular herbals that can really cause problems if you’re going under the knife. The recommendations provided about when to stop taking these herbals before surgery as only guidelines. They are based on limited information about something called a half-life, a measure of how long it takes your body to metabolize and eliminate the natural chemicals and byproducts from these herbal medications. Most surgeons would ask that you stop using these medications as long before surgery as possible. But here are the details...... Echinacea is very commonly used as an immune stimulant to prevent and treat early “colds”. But when used longer than 8 weeks, it can actually suppress your immune system. This could mean an easier chance of catching one of those mean bugs in the hospital while you’re trying to recover, and can also interfere with wound healing. Also, Echinacea can affect your liver, especially if you already have liver problems. When combined with surgical anesthesia medications, liver failure can result. For all these reasons, even a simple surgery can turn into a disaster just by taking this simple herbal medication. To reduce these complication risks, Echinacea should be discontinued at least several weeks before surgery. Ephedra, widely used as a weight loss supplement until it was banned in 2003, can increase blood pressure and heart rate. Fatal and near fatal events related to this were the reason it was banned. However, personal stockpiles are still out there and are doubly dangerous around the time of surgery. Ephedra, when used in combination with the common anesthesia gas Halothane, can lead to dangerous and life-threatening arrhythmias. In addition, other interaction with commonly used perioperative medications can lead to permanent heart damage and, in the worst case, coma. Ephedra should be discontinued at least 24 hours before surgery. Garlic is widely used to lower cholesterol, decrease the risk of blood clots and reduce blood pressure. The problem is that reduction in blood clot risk is accomplished by an effect on  platelets, something
you need to clot properly during and after surgery. So, while it is
doing its job it can lead to fatal uncontrolled bleeding. Stop using
Garlic at least 7 to 10 days prior to surgery. Ginko has long been used to improve memory, reduce atherosclerosis, treat erectile dysfunction, among other uses. There are several biochemical reasons for its effectiveness, one of which is inhibition of platelet function. Again, platelets are needed to help with blood clotting. Major complications and deaths have been reported. It is best to stop using Ginko at least 36 hours before surgery. Ginseng has multiple species which are used for medicinal treatment. The most commonly used are Asian and American Ginseng. A number of these ginsenosides have been labeled “adaptogens” because of their ability to help protect the body against stress and restore homeostasis (internal systems order). There is concern about reversible and irreversible effects on platelets, which can cause bleeding disasters. In addition, ginsenosides can lower blood glucose. Since there are multiple ginsenosides, a recommendation about when to stop them before surgery is difficult to make. However, at least a week is prudent. Kava, derived from the pepper plant Piper methysticum, is often used as a sedative and anxiety reducing agent. Since multiple sedatives are used around the time of surgery, additional sedation and interaction with these medications has led to coma. Kava should be discontinued at least a day or two before surgery. St John’s Wort, or Hypericum perforatum, is used by many for mild to moderate depression. It works by interfering with chemicals called neurotransmitters in your brain. It can also significantly increase the metabolism of many medications used around the time of surgery, reducing their effectiveness. These medications include lidocaine, midazolam hydrochloride,calcium channel blockers, serotonin receptor antagonists, steroids, digoxin and warfarin. While you many not be familiar with all or most of these, they are commonly used in routine care or for management of complications. St John’s Wort should be discontinued at least five days prior to surgery. Valerian is a sedative herbal, used in the treatment of insomnia. The more you take, the greater the effect. It also multiplies the effect of other sedatives routinely used around the time of surgery. Valerian withdrawal can be severe and further complicate surgical recovery. It is best to slowly reduce the dose of valerian if you have been taking it for a while to avoid withdrawal. If that is not possible because the surgery date is near, it may be best to continue valerian use and manage withdrawal as needed. Clearly, it is best to discuss use of herbal medications with your surgeon as soon as possible. Even the most innocent commonly used herbs can cause major problems. So, here’s a tip. Keep a running list of all medications that you take, prescription and natural. In the event of surgery you will run a lower risk of forgetting something critical.            |
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| Last Updated ( Sunday, 10 February 2008 ) |
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