Re: Hot flushes in pt with AS and Psoriatic arthritis with polypharmacy- help!

[Guest guest]

Hannah, For hot flushes, adding 5mls cooling bitter Artemisia absinthum to

your mix might help if appropriate for whatever gut probs she has, and/or

Humulus which is v.useful in flushes, tho perhaps not if she is depressed

from Tibilone.. Eupatorium perfoliatum, esp for sweats and immunity and

Crategus or Vaccinium to help stabilize venous response...Vitex FE 5mls

might help too, if the Cimicifuga doesn¹t.

Laird BSc DipPhyt MNIMH

Medical Herbalist

alsl@...

[Guest guest]

Dear Hannah

This is crying out for treating the gut; AS/psoriatic arthropathy very

connected with gut problems. Also brucellosis history strongly suggestive

(witness gastric disturbance) Have you considered lots of chamomile to start

with? Also maybe calendula. Her liver's going to be megastressed with all

those drugs, so milk thistle as well. (Kerry Bone advises different liver

herbs for different functions; a combination of Carduus, Berb. vulg and

Schisandra seems to work nicely)

What is Celecoxib?; doesn't appear in my BNF, which admittedly is a couple

of years old. She's on lots of morphine; is her pain so bad, and if so has

she been to a pain clinic? Although they don't usually get into treating

causes, they do manage to get people using pain relief as efficiently as

possible.

I'd be inclined to deal with one thing at a time; treat the gut first and

see what happens.

Good luck

Alison

>

>Reply-To: ukherbal-list

>To: <ukherbal-list >

>Subject: Hot flushes in pt with AS and Psoriatic arthritis

>with polypharmacy- help!

>Date: Wed, 17 Mar 2004 21:41:15 -0000

>

>Dear all,

>

>I have a query regarding a 48yr old female pt I saw today who came with

>hot

>flushes as main complaint esp. bad at night- every 20 mins, generally hot

>all the time. She has a concurrent p/c of Psoriatic arthropathy (with

>psoriasis only on hands and knees) and Ankylosing spondylitis onset when pt

>aged 10yrs.. Strong family history (maternal line) of arthritis. Pt

>also.c/o

>low libido, gastric disturbance and depression.

>

>PMH of chocolate cysts, ovarian cysts and twisted ovaries, total

>hysterectomy performed in stages over 6 years ( 1 ovary at a time and

>finally womb). 2 x severe viral infections URTI caused ITU admission, plus

>brucellosis (spelling??) infection from unpasturised milk in france.

>Impared

>hearing- congenital. Appendectomy and tonsillectomy. BP- 110/ 70.

>

> Drug history causing a bit of a H/A for me…

>Morphine slow release 25mg marne

>Morphine slow release 30mg nocte

>Celecoxib 200mg bds

>Sulphasalazine 1g tds

>Tibilone ( advised to consult gp with regards to coming off due to s/ eff

>of

>arthralgia, myalgia and depression)

>Oral morphine

>Lormetazepam 1mg prn a nocte

>

>Capsules of Cimmicifuga and vitex- recently self rxd.

>

>I have yet to look thoroughly at all these medications, which is what I

>elected to do before rx dispensed. Sent her off with a tea of trifolium and

>urtica 50:50. and advice on diet.

>Am considering Glycyrrhiza, verbena, leoorus, smilax and tarax rad for main

>medicine.

>

>Any thoughts or helpful suggestions gratefully received.

>Many thanks in advance,

>

>Hannah Barton MNIMH

>

>Mid-Devon.

>

>

>

>

>

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[Guest guest]

Dear Alison and ,

Many thanks for your thoughts on this patient.

In response to Alison's questions Celecoxib is an NSAID, not one I had come

across before. This pt had attended a pain management course already- which

she said was very helpful. Thanks for the reminder about the gut. I hope

that the glyc will help on this front. The brucellosis incident and URTI

infections are no doubt the side effect of the Sulphasalazine

(immunosuppressant of the methotrexate family). When she returns I will

probably put in a bitter, but wanted to tread cautiously to start.

Unfortunately she hates Chamamilla- I was going to give her some in her tea

until she told me. The calendula is a good idea though, perhaps I will add

that next visit. If I can get a good enough response from her bowel

movements without the Tarax I shall deffinately be putting in some Carduus

too.

With regards to the suggestions from on cimmicifuga/ vitex, I was under

the impression that these herbs would not be altogether effective in this

patient until she has ceased tibilone. I have advised her to consult her GP

and reduce slowly / cease immediately as appropriate. At which point I shall

be keen to get her on some Tr/ FE of the above- which I always feel stand a

better chance of working than some questionable quality shop bought

supplement.

Many thanks again!

Hannah.