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| Why are Herbal Medicines important to NPs and PAs? |
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by Bob Blumm, MA, PA-C, DFAAPA - January 2, 2012
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Today the largest majority of Americans are taking some type of herbal medications. They have followed the Pied Piper wherever he has marched, in streets, on ad boards, in magazines and journals, on TV and radio ads, on net sites, observing the comments of famous musicians and actors, from providers of health care, there is nowhere that this modality has not been spoken of. Even this site and sister sites such as Clinician1.com proudly extol the virtues of herbals in the health care diet. I am a believer, to an extent, in alternative medicine but am also aware that sometimes these good guys can be deleterious to us prior to surgical procedures and when taking other medications. Therefore, our responsibility is to find the offenders or those that can possibly cause harm and share the information with our patients and our colleagues and perhaps ask the makers of these supplements to aid us in this campaign.
Considering the fact that more than 60 million Americans are taking these supplements, it is only reasonable to believe that your patient is among this heterogeneous group. When the patient is visiting this becomes yet one more question that should be asked at a time when people are looking over our backs when we spend excess time. The problem relates to whether we are intimidated by those people or whether we care to deliver a certain standard of medicine. It is also a question of professional liability as drug interactions and a proper history are incumbent upon the clinician prior to a pre-operative physical exam. How long do you think it will take prosecuting attorneys to do the math and compile evidence that we have fallen short of the mark in this area and will weave a web that encourages a jury to find our brand of medicine abhorable? There are internet sites that can help us gain information such as (www.ncamm.nih.gov) and www.fda.gov/medwatch) The information lies at our fingertips and it’s time to let our finger do the walking or possible face the consequences.
The stores such as Barnes and Nobel and the internet sites such as Amazon.com have many Herbal Encyclopedias available and they are a worthwhile purchase and a daily fifteen minute read for general information as well as specifics when we are dealing with prescribing for our patients. When we boast that our specialty or profession is a commitment to seeking new knowledge daily, this too is a part of the commitment. I thought I would just use this as a word of advice for the New Year.
Warmly,
Bob Blumm
Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 300 plus articles and is a sought out conference speaker throughout the United States.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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| Bob Blumm (Amityville, NY) |
on 04 Jan 2012 at 4:32 pm |
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In response to the last post I concur with you that there is certainly a place for alternative medicine in the care and treatment of our patients as I have been on 7 drugs in the past three years and am now down to two as I take Mega Red and Advanced walk something by Squibb and it increased my tolerance for climbing because of the chondrotion and glucosamine as well as the D3. There is no set format for prescribing but the gist of this article is that as clinicians, we need to be aware of all medicines and herbals that our patients take because there are definite interactions. you can have an interaction by taking Verapamil with Oxycotin and you can cause excessive bleeding prior to surgery when there is an increase of vitamin E and Fish Oil.
Clinicians need to be more responsible in gathering data such as medications which can contribute to health or health related problems.
Please look for the balance in the article as well as the responses as the subject matter is of great importance and there is a time to utilize these herbs as well as a time to refrain.
Bob |
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| ML (TX) |
on 04 Jan 2012 at 3:14 pm |
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| Personally, I believe in educated use of supplements, if one desires. It is arrogant of us to believe that our chemical concoctions are the "only" way to practice medicine. How many years in FP does it take to dose our patients up on 3 BP meds, 2 cholesterol meds, a few meds for their diabetes, something for depression, nausea, impotence, and joint pain...before all of our patients are on 10 meds and are not any healthier for it? I firmly believe that dietary choices are first line in disease prevention, but most of us are not even adequately trained in that field. We take FDA recommendations as gospel, in spite of evidence that maybe they are not always right. Special interests seem to rule our practice, and we don't seem to notice the bias, and we are amazingly fearful or unwilling to consider that other options may be viable. I suspect fear of lawsuits may play a part in that. Additionally, many of our patients spend a great deal of time studying on the internet, yet we tend to discount their knowledge base without fully understanding exactly what they are talking about. So, they don't mention to us what they are really doing. In the end, we all want healthy patients. It is important to know what is safe, what interactions are and most importantly, what can our patients do to prevent these diseases in the first place. |
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| Bob Blumm |
on 03 Jan 2012 at 9:54 pm |
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All solid comments and evidently there is both knowledge and strong feelings on this subject.
Bob |
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| Dave Jones |
on 03 Jan 2012 at 9:52 pm |
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The folks who do Prescriber's Letter also put out a book called "Natural Medicines, A comprehensive Database". It is an excellent reference. It lists many herbs and "natural" preps, says what they are used for, what they are safe for, what they are probably safe for and what they are unsafe for. The part I like best is that it also lists interactions with standard meds, which makes it much easier to figure out the dangers with things you are prescribing. Also Epocrates, for an extra price, will also list natural meds and you can then run them in their interactions program.
dave jones |
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| Rene McCartny |
on 03 Jan 2012 at 9:32 pm |
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Epocrates has many listings on herbs and supplements also.
I over heard a conversation at lunch today where a man was explaining to his lunch partner that the fish oil brand he was taking was "6 times more effective" than other brands. I had to wonder - more effective at what and who says so?
So much misinformation and partial information out there.
Rene' |
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| Bob Franks (Goldsboro, NC) |
on 03 Jan 2012 at 9:30 pm |
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J. Robert Franks to me,
The marketing of herbal \\\'medicines\\\' concerns me deeply. I remember a patient
many years ago telling me she took only herbal preparations because, \\\"they
have no side effects.\\\"
No chemical we can introduce into our bodies is entirely free of side effects,
not even food. Turnip greens give me urticaria!
When I was in Boy Scouts, I came in contact with Rhus radicans, also known as
Poison Ivy. Try it, since it\\\'s herbal, of course it has no side effects.
Ask Socrates if hemlock is toxic.
Will you let your cat try diffenbachia, AKA Dumb Cane?
How about trying nightshade, jimson weed, or mandrake? They all contain
atropine. They\\\'ll help you slow down, w-a-y down.
Fava beans are tasty, unless you have G6PD deficiency.
Chronic cannabis use can lead to depression, as can opiates and ethanol, all
are natural.
Ergot fungus on rye can produce LSD-25.
Coca leaves can keep you going. And going. And going.
St John\\\'s Wort is good for mild depression, unless it\\\'s mixed with an SSRI,
narcotic analgesics, or a 5-HT agonist like sumatriptan, and gives you
serotonin syndrome.
Lets continue to warn our patients to be brutally frank in telling us what
they are dosing themselves with, and educate them on the possibility of side
effects.
bob franks
Goldsboro, NC |
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