Complementary medicine

Question 1

When admitting an 81 year old patient for an elective colonoscopy, you note that she takes 12 complementary medications, which are given to her by her son, to “keep her healthy”. They include Co enzyme Q10, fish oil, thiamine, magnesium, zinc, selenium, chromium, vitamin C, vitamin B complex, DHEAS, curcumin and gingko. She asks if they are necessary as she no longer wishes to take them. How would you counsel her?

Answer 1

Impression
Elderly woman pre-colonoscopy with multiple CAM use.

• consider elder abuse/neglect

Goals

• Take targeted Hx and any relevant further assessment to understand concerns/ideas/beliefs underlining CAMs use and reasons for cessation
• screen for any contraindications to proposed elective surgery, any additional risks posed by CAMs, and rule out interaction; inform superiors of any concerns and decide on whether to proceed with procedure or not
• Counsel woman on choice regarding CAMs use using evidence based approach

Question 2

Complementary medicine – Assessment

Answer 2

Assessment

• Considerations: environment, interpreter, gauge patient understanding and beliefs/cultural considerations that may be relevant to the case
• CAMs taken, dosing, frequency, timing, any adverse effects?
• PMHx and any other prescription medications taken?
• Why wishes to cease?

Question 3

Complementary medicine – Examination

Answer 3

Examination

• general appearance + obs
• anaesthetic assessment (teeth, malampatti, neck mobility, etc)

Question 4

Complementary medicine – Investigations

Answer 4

Investigations

• Bedside: Vitals
• Bloods: if not already performed, pre-ops. Then FBC , UEC, LFT

Question 5

Complementary medicine – Management

Answer 5

Management

• overarching goals are effective patient counselling
• immediate concern re upcoming procedure, identify any additional risks and inform the team if so

CAMs and procedure;

• St Johns Wort can have blood-thinning effect, also somewhat serotonergic
• Fish oil, gingko, turmeric can have blood-thinning effect.

CAMs counselling
- Assess patient understanding and concerns regarding CAMs use
- Counsel how not essential for medical management
of any current medical conditions
- discuss certain risks posed by drug interactions, financial burden, poly pharmacy, risk of poisoning if dose too high (even with vitamins), lack of standardisation in dosing of these CAMs.
- highlight that medication regime is personal choice and she can cease if she wants to as not prescribed by registered medical doctor