Herbal Medicine Debate

I was intrigued by a reader’s comments on herbal medicine and have replied to her comments below, in italics.  Which position do you take?

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Ssurvy states:

Relying overmuch on what science says about herbs is ridiculous. Science doesn’t study herbs, it studies constituents of herbs in isolation, and at huge doses. Herbs work differently than that – the various medicinal aspects work together on the specific person/situation.

Science has studied herbs both in and out of context, in various doses, trying to understand and quantify the mechanism of action.  The case of foxglove and the related drug digitalis is probably the best-known example.  How does foxglove help the heart?  It couldn’t be every chemical or protein the plant contains.  Identifying the active compound helps understand not only how the plant works, but how the heart works.  On a biochemical basis, this knowledge is not acquired from herbal medicine alone.  This is not to discount thousands of years of experience, but many ineffective treatments have been used for years as well, some of which do harm people.  Saying that the various components of herbs work synergistically is probably true, but with so many variables, it becomes difficult to solve the “equation.”  Using several medicines in conjunction creates much the same problem, and polypharmacy is a significant problem, especially for older patients.  Scientists need to learn from knowledgeable herbalists, but the opposite is also true.

Example – antimalarial drugs – usually have huge bad side effects for some, one specific drug (and I can’t name names, for obvious reasons) with harsh side effects is entirely derived from one plant, but isolates some chemicals in the plant, adds fillers. But if you take the plant as an antimalarial, it has none of the side-effects. Why? Because the other plant chemicals, and their total interaction, either prevent or avoid those side effects.

Living in America, I have not had the opportunity to treat malaria, so what the reader says regarding herbal therapy may be  somewhat true.  However, most patients do not experience harsh side-effects from medical treatment, and it is unlikely that no one experiences deleterious effects from plant therapy.  (If this plant is so effective in malaria-prone regions, why is it that malaria is such a problem?) 

Looking to science is great, but traditional use, across cultures, may lead to more accurate information. Scientists don’t know WHY or HOW yarrow stops bleeding, and some scientists say it does, others say it doesn’t. But it does (thousands of years of human-yarrow experience, and personal experience are the proof I need, not whether science can agree), regardless of what science might think that day.

A big problem with scientific research is the cost of randomized, double-blind placebo-controlled studies.  Smaller, case-control or similar studies could be done in the field of herbal medicine, but getting them published in respected journals remains a problem.  If I had the financial freedom (and hence, time) to perform such research, I would.

Not that science is bad. It isn’t, but it is also not the whole story. Herbs don’t work the way drugs work.

I would argue this point.  On a biochemical level, the active compounds must work similarly, on the same receptors, proteins, binding sites, enzymes, etc.

Many herbs are only useful in, for example, some types of high blood pressure, with a specific cause, but won’t do a thing for the other types/causes – which makes great sense, but to science, that just means it doesn’t work. if you have a greatly overweight middle-aged man under lots of work stress who eats lots of carbs and fats and sits all day, a pregnant woman at week 29 with swollen legs, high bp, and can’t eat or drink, and a older thin woman with no previous history of high bp who is also experiencing dizziness and confusion, you have three very different situations.  Why one would expect that their remedy would be identical is a mystery to me.

Excellent point, but the same is true of medications.  Physicians do not use the same approach to elevated blood pressure in every situation either.  The underlying cause is essential to the understanding and treatment of most conditions.

 Yes, science says many herbs, if not most, are useless, but that is a flaw of science, not herbs. Herbalism has been practiced throughout human history. It’s not the new kid on the block, our so called modern medicine is.

Another excellent point, but science attempts to bring greater understanding to the table.  Taking the example a few paragraphs back, it’s great to say that yarrow slows bleeding.  Applying a few leaves to a minor wound is unlikely to cause much harm, and may help a little.  Does this suggest it might slow heavy menstrual bleeding?  Or benefit those with hemophilia?  Would too much thicken the blood and cause blood clots?  Like other active compounds, does it produce other actions within the body?  Are there any drug interactions?  Where do you turn for information?  Effects observed in nature are often the starting point, but we need to understand the chemistry as fully as possible.

I applaud this writer for the depth of understanding he or she has expressed.  Many good points have been raised.  Much research remains undone, especially for treatment of serious disease.  My thanks to the contributor of these comments. – Doc Cindy

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Posted in Herbal and complementary, Herbal medicine, High blood pressure, Medical archives, See medications - herbal | 7 Comments

Week 11 – Question of the Week: What lab procedures are you preparing to provide at TEOTWAWKI?

Week 11: 2011-05-19

Today I’m asking our professionals to consider this question:

What lab procedures are you preparing to provide at TEOTWAWKI?

Anyone else with opinions, questions, or concerns is invited to reply as well in the box below.

Check back soon and see what our panel of over 100 professionals has to say.

– Doc Cindy
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from “The Gods of the Copybook Headings” – Rudyard Kipling

NSRW Rudyard Kipling

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Our friendly dentist sent this today, a reminder from days gone by.

“….Then the Gods of the Market tumbled, and their smooth-tongued wizards withdrew

And the hearts of the meanest were humbled and began to believe it was true

That All is not Gold that Glitters, and Two and Two make Four

And the Gods of the Copybook Headings limped up to explain it once more. 

As it will be in the future, it was at the birth of Man

There are only four things certain since Social Progress began.

That the Dog returns to his Vomit and the Sow returns to her Mire,

And the burnt Fool’s bandaged finger goes wabbling back to the Fire;

And that after this is accomplished, and the brave new world begins

When all men are paid for existing and no man must pay for his sins,

As surely as Water will wet us, as surely as Fire will burn,

The Gods of the Copybook Headings with terror and slaughter return!”

 – Rudyard Kipling, “The Gods of the Copybook Headings”, 1919

Rudyard Kipling from John Palmer

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Clinical Laboratory Procedures under Austere Conditions: Part I – Introduction

The following post on clinical laboratory procedures is contributed by Pete Farmer,  who holds advanced degrees in research biology and history, and is also an RN and EMT. 

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Among the many unsung heroes and heroines of modern medicine are clinical laboratory scientists, the pathologists, histologists, microbiologists, med technicians and others who perform the myriad tests required by physicians and nurses in the diagnosis, treatment, and care of patients. They collect and analyze tissue samples (including blood, urine, synovial fluid, cerebrospinal fluid, organ and other tissues) for the presence or absence of pathogens, identification of disease causative agents, antibodies, blood cell type and number, electrolytes, and much more. They perform qualitative (detection, separation, and identification) and quantitative (determination of concentration or amount) analyses, together or separately. The clinical lab of a large hospital or a stand-alone clinical laboratory service (such as Lab Corp) may perform hundreds of tests on a routine or semi-routine basis; if non-standard tests are counted, these labs do thousands of different assays, procedures, and tests annually on huge numbers of specimens from millions of patients across the healthcare system. 

Despite years of sophisticated training, doctors and nurses involved in direct patient care are, in effect, blind without clinical lab data upon which to act. Reflective of the complexity and importance of the clinical lab sciences, physicians may specialize in pathology, and there are also doctoral (Ph.D.) degrees in the field, as well as related ones, such as toxicology.  Clinical diagnostics is a multi-billion dollar business for pharmaceutical, medical device, and healthcare companies.  The field is mature, technologically-sophisticated, and enormously complex.

The medical professional practicing under austere conditions is thus faced with a dilemma: how to obtain the necessary lab data for diagnosis, treatmen,t and care when the normal clinical lab infrastructure may be absent, inoperative, functioning at reduced capacity, or swamped with too many tests to handle? There are several methods available to us to handle this problem; let’s examine some of them.

First, forewarned is forearmed. Plan ahead and lay in the necessary equipment and supplies for doing as many tests on-site as possible, and acquire the knowledge (or hire someone who has it) necessary to perform them.  Circumstances permitting, have enough inventory on hand to permit normal operations for an extended interval without access to outside supplies; the “just-in-time” system won’t cut it here. Disaster relief organizations like Doctors without Borders are a useful model , as are military healthcare professionals; they practice expeditionary – or operational – medicine, and are prepared to function independently or semi-autonomously for extended periods in remote locations where there isn’t a pathology lab, MRI, supply room or pharmacy around the corner. They know if they don’t bring it with them, they will have to do without.  Special operations medics are trained to function in this manner, as are some army medics and navy corpsmen.  Because the armed forces are often short of full-fledged physicians, they have learned to train ancillary personnel to a high standard – and then use them as the first echelon of care in the field in remote locations. 

A properly-equipped special operations medical sergeant can set up and run a basic primary care clinic in the field, and will have the ability to perform basic laboratory tests using easily-transportable, portable equipment. Even if one is not a soldier, the operational/expeditionary mindset provides a useful means of framing the problem, and can lead to greater independence and resiliency in a crisis situation.

The Special Operations Medical Handbook (U.S. Government publication, ISBN # 9780160808968, 2nd ed., 2008), the standard field reference for SOF medical personnel, includes the following laboratory tests which may be done in the field: UA (urinalysis), gram stain, brucellosis stain, Wright’s stain, Gemsa stain, Tzanck preparation, fecal analysis (microscopic and fecal occult blood), CBC (complete blood count) and cross-matching and typing. These and similar techniques offer a good jumping-off point for our examination of lab tests in the austere environments, and will be covered in subsequent installments of this series.

 Copyright © 2011 Peter Farmer

 

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Dangers of pill splitting?

Craig asks: 

A lot of data sheets I have seen for medicines in tablet form say something along the lines of “Do not halve the tablet. Dose equivalence when the tablet is divided has not been established.”

How accurate is this statement? Would dividing tablets with this warning be acceptable in a TEOTWAWKI situation?

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As author of 101 Ways to Save Money on Health Care, I frequently recommend pill-splitting as a cost-saving measure.  For TEOTWAWKI purposes, it is reasonable to stock higher doses of certain medications, with the thought of possibly splitting them later if needed.  Higher dosage forms often cost the same as lower dosages, and may take up little additional space.

Unless a tablet is scored, the manufacturer does not intend it to be split, and studies on dose equivalency on divided tablets are unlikely to have been performed. Much of the time, however, this does not matter.

The biggest concern with pill-splitting is extended-release medications.  There are numerous ways to alter the delivery system of a drug with a short half-life, making it possible to administer the medicine once or twice daily instead of three or four.  Often the mechanism lies in the tablet coating.  If this is disrupted, the long-acting pill will “revert” to a short-acting pill, by disabling the delivery system.  Some long-acting pills may be split, however, when the delivery system is built into the micro-structure of the pill rather than the macro-structure.  An example of this is certain verapamil formulations.

An example of how pill-splitting may be harmful is extended-release beta-blockers, which if split may allow the entire dose to be “dumped” into the circulation rapidly, resulting in cyclic low blood pressure and/or slow heart rate, alternating with high blood pressure and/or rapid heart rate before the next dose is given.  Steady-state levels and consistent BP lowering are preferable.

However, for many medications pill-splitting causes no discernable harm. For example, with Synthroid (levothyroxine) doctors aim at a specific dose, say 100 mcg per day.  Splitting a 200-mcg tablet may result in a dose of 95 mcg one day and 105 the next (or even losing several mcg as pill-dust) but over the long run this evens out.  With the bioavailability of generic drugs varying as much as +/- 20%, a little inaccuracy in pill-splitting causes similar variability, with little if any detrimental effect.

The same holds true for antibiotics, many pain pills, anti-inflammatories, cold medicines, diabetic pills, anti-depressants, cholesterol pills, and many more.   For conditions or medications where blood levels are critical, pill-splitting may be inadvisable, although even warfarin is often split for adjustable dosing. 

Another concern of pill-splitting is structural stability.  Once a pill is split, it is more easily subject to physical trauma, as well as effects of humidity and heat.  Storing pills whole is advisable, with splitting done shortly before use.

Regarding capsules, although these cannot be split, some can be opened and the contents evenly divided.  This question arises most frequently with expensive medications such as Prevacid, a capsule which may be opened and sprinkled on food.

In summary, while the statement Craig references is true, it has little clinical relevance for many conditions.  However, before resorting to pill-splitting, ask your doctor or pharmacist if he or she has any particular concerns.  “By-the-book” professionals may be against the practice, but still should be able to give you an answer for what is likely to occur if you do split a particular pill. 

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Week 10 – Question of the Week: What steps have you taken to establish structured medical care?

Week 10:  2011-05-12

Today I’m asking all our readers to respond to this question:

What steps have you taken to establish structured medical care for an end-of-life-as-we-know-it scenario? 

Will you simply be on your own amidst the chaos, or have you networked with others in your locale or group? 

Hopefully many of you will speak up – even if only to say you haven’t gotten this far in your planning.

Check back soon and see what our readers have to say. 

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Cholera – Lessons from Haiti

Haiti had not experienced a cholera epidemic in over a century. The January 2010 earthquake changed that.

In the wake of the destruction and misery, cholera paid a visit.  By October 2010 an epidemic had been identified.  By six weeks later 91,770 cases had been reported, 43,243 of whom had been hospitalized – this from a country a little smaller than my home state of Ohio.

In response, the CDC developed a free 50-page downloadable training manual:

Haiti Cholera Training Manual: A Full Course for Healthcare Providers

at: http://www.cdc.gov/haiticholera/pdf/haiticholera_trainingmanual_en.pdf.

Here are a few highlights:

  1. Without laboratory examination to detect the Vibrio cholerae bacterium (a gram-negative rod), the diagnosis must be made clinically (according to symptoms only).
  2. Transmission occurs through contaminated water or food (not person to person).  Contamination of water with feces from infected individuals is the usual cause, although the organism can live in warm coastal waters as well.
  3. Profuse watery diarrhea may rapidly produce dehydration, electrolyte loss with muscle cramping, acidosis, vomiting, and death.
  4. Although this is a bacterial infection, the mainstay of treatment is oral (or IV) rehydration therapy.  If using IV fluids, Ringer’s Lactate is preferred.
  5. Moderate to severely ill patients should receive antibiotic therapy to help decrease diarrhea volume and duration (doxycycline 300 mg x 1 dose; or azithromycin 1gm x 1 dose; or tetracycline or erythromycin 500 mg 4x daily x 3 days)
  6. Avoid anti-diarrheal medicines, which may prolong cholera infection.
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Kidney stones and the end of the world

Kidney stones successfully removed from an eld...

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A kidney stone:  don’t tell me it’s not the end of the world. 

Sure, I’m better today, but yesterday I was dying.  At least it felt like it.  I hadn’t had pain like that since my son was born 17 years ago.  Very similar. 

Scary, too – what if the pain hadn’t gone away????

In the era of modern medicine we have an answer for kidney stones that don’t pass.  Lithotripsy, surgery, basket retrieval – there is an option for everyone. 

In post-modern medicine, what will we do?  Perhaps what I did yesterday:  wait it out.

Of course, I, a trained doctor, could diagnose myself.  I could monitor the passage of the stone down the ureter and into the bladder.  Fortunately (?) I’d just had a root canal and had a few narcotics on hand.  Unfortunately, they didn’t help the dental pain nor the kidney stone pain.  Either the ibuprofen helped or the stone had already entered the bladder.  Either way, after about 6 hours I could finally rest (with the help of a hot bath and some Benadryl).

But at TEOTWAWKI how will people cope?  And taking that back a step, how will they know what’s wrong with them?  Of course, anyone who’s had one may recognize another, but a large number of kidney stones occur in patients who’ve never had one.

Interestingly, not all kidney stones produce pain.  The pain from a kidney stone is related to obstruction of a hollow viscus.  In plain English that means that a tube-like structure in the body, one which normally allows passage of a fluid (or feces), is obstructed by a stone (or a baby, or a plug of feces).  In an effort to expel the obstruction, the muscular lining of the tube contracts, much like labor contractions.  Just as not every woman has severe labor pains, however, not every person with a kidney stone suffers extreme pains.  This is partly related to the size of the stone, but probably also related to a person’s internal neurologic wiring.  Kidney stone pain is generally one-sided and is little-relieved by change in position.  The onset is often sudden, as a stone lodges in the ureter tubing.  The pain may come in waves or be fairly constant. 

Kidney stones may also produce bleeding as the stone scrapes along the ureter (tube between the kidneys and bladder).  Once it reaches the bladder, the pain usually lets up, though both bleeding and pain may recur as the stone passes from the bladder through the urethra, out of the body. 

Other symptoms of kidney stones include the urge to urinate, frequent urination of small amounts, inability to urinate, burning on urination, nausea, and vomiting. 

In 25+ years of medical experience, I would estimate that over 95% of kidney stones pass on their own, that is, without surgical intervention. 

At TEOTWAWKI having a skilled health professional to diagnose the condition would be ideal.  Visible blood in the urine supports the diagnosis, though infection may cause this as well.  Usually urinary infection has a more gradual onset than symptoms of passing a kidney stone.

Patients with mild to moderate pain require no or minimal medication.  Tylenol or ibuprofen may suffice.  Drinking extra water helps push the stone through the ureter (which may hurt).  Sometimes diuretics (water pills) are used to encourage the kidney to make more urine, and help the stone along.  In a person with a history of infection or a significant amount of bleeding, taking an oral antibiotic for at least 1-3 days may be advisable to prevent infection (trimethoprim-sulfa DS twice daily, ciprofloxin 250-500 mg twice daily, macrodantin 50-100 mg twice daily, possibly amoxicillin 250-500 mg. three times daily, although this is less effective). 

In a person with severe pain, some sort of pain relief is required.  Narcotics usually help most people, but a supply may not be available.  Tramadol may be sufficient in many cases (50-100 mg. every 3 to 6 hours), as may ibuprofen (600-800 mg. every 4-6 hours).  Either of these may be combined with acetaminophen (Tylenol, 500-1000 mg every 4-8 hours).  (If you’re not sure of the diagnosis, don’t use ibuprofen or aspirin, as these may make stomach problems worse.) 

A hot bath may relieve the discomfort to some degree.  OTC anti-emetic meds (Dramamine, Bonine, meclizine – 25 mg every 6-12 hours) can alleviate nausea and vomiting.  If the pain isn’t too bad and you’re hoping to sleep it off, diphenhydramine (Benadryl) 25-50 mg. orally may help you rest.  It didn’t occur to me to try a glass of wine.  If one is sure of the diagnosis, a little alcohol may allow you to rest.  However, alcohol can irritate the stomach as well, and should be used with caution. 

Straining the urine through a fine strainer, a coffee filter, or even a T-shirt may help you recover a kidney stone and confirm the diagnosis. 

These days, if you think you have a kidney stone or are experiencing similar symptoms, I advise seeking professional help.  But in the aftermath of global crisis, you may be on your own.  For most people, if the stone doesn’t pass in a day, it will within a few days of taking increased fluids. 

For the few percent who don’t obtain relief, let’s hope a surgeon or two is still available. 

 

Kidney Stones
Image by Trevor Blake via Flickr

 

  

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Medical-prepper links

One of our contributing professionals asked about placing my research on a hotmail sky drive.  Perhaps in the future I’ll find time to add this feature, but in the meantime he has offered to share his own extensive prepper research from his own sky drive, at the following link:

SKY DRIVE LINK – CLICK HERE

The drive includes extensive information on a variety of topics, in a somewhat random order (but don’t let that dissuade you).  As pa4ortho says, “pre-crunch is the time for us to help others prepare. Post-crunch, if we did not prep our communities, they will be at our doorsteps.”

Also, partly in response to this, I’m adding a new page of medical and prepper links (see list of pages, upper right).  Please let me know of any that shouldn’t be missed.

Enjoy, and thanks, pa4ortho.

Posted in Disaster Relief, Education, Free downloads, Medical archives, Perennial Favorites, Preparation, Public health | 1 Comment

Week 9 – Question of the Week: How far are you prepared to stray from your area of expertise?

Week 9: 2011-05-05

Today I’m asking our professionals to comment on the following question:

At TEOTWAWKI, how far are you prepared to stray from your area of expertise?

Would a veterinarian be willing to perform an appendectomy?  As an EMT do you feel prepared to treat pneumonia?  Is a geriatrician happy to deliver a newborn?  Please answer from the perspective of your own training and additional experience.

Readers are welcome to post responses, questions, and comments below.

Check back soon and see what our panel of over 120 professionals has to say.

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