and Surgery: A Risky Mix
-- 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. John's wort and ginkgo
biloba to garlic, ginger, ginseng and feverfew -- can cause increased
bleeding during surgery, contends Dr. Philip Miller, 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.
only risky during the actual operation, he says, but can lead
to complications later.
in the operating room are just oozing as if they're on aspirin,"
Miller 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.
are taking herbal supplements unbeknownst to their doctors, Miller
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 Miller,
citing a recent survey. Herbs generally aren't prescribed by a
doctor, and people just don't consider them a medication, he says.
and vitamins do affect the inner workings of the body -- and not
always in a positive way when it comes to surgery, Miller says.
-- 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
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
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,' " Miller
"I'm the same
doctor, doing the same operations, but you guys [the patients]
are the difference," he says.
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
going in for surgery should stop risky medications -- including
herbs -- at least two weeks before their operation, Miller 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.
foods, she says, interact with medications and can affect bleeding.
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, Miller 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, Miller says.
And it's not
just people scheduled for surgery who need to worry, he says.
having nosebleeds might want to check their herb use, Miller says,
as should anyone at risk for a stroke and anyone who must take
the blood-thinning drug Coumadin.
One of the
first times Miller noticed the herb-bleeding link, he says, was
when a man on whom he did a facelift developed "a collection of
he didn't take anything," Miller says, "but on further investigation,
[we learned] he'd taken diet pills with ephedrine in them."
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, Miller says, and that can cause bleeding during
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.
with vitamin E, on the other hand, appears to be more like that
with aspirin, Miller says. Many people take a vitamin E supplement
regularly because they believe it helps prevent heart disease.
who "mega-dose" on vitamin E, which Miller 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.
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.
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
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."
mean any of these things are bad," she says.
But for people
anticipating cosmetic surgery, Miller says, the results can be
a purely 100 percent elective procedure, and right or wrong they
have an expectation to be back out in public
and back to
as soon as possible," he says. "Significant bruising
can really impair their recovery."
have to start asking -- specifically -- about vitamin and herbal
supplement use in their pre-operative evaluations, Miller 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," Miller 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."
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.
anticipating cosmetic surgery, Miller 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
find out more about herbal health products, the risks and benefits,
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.
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.
Reference Source 101