Re: warfarin and digoxin & herbal treatment

February 19, 2006

I wonder if anyone can help me with any advice on treating a patient who

is currently on warfarin and digoxin for irregular heartbeat. This 80

year old gentleman is in otherwise excellent health but was prescribed

these drugs 18 months ago when he semi-collapsed whilst out walking. 50

years ago he had a couple of episodes of blacking out when cycling but

had been absolutely fine ever since. He was in hospital for 19 days and

had tests done - all they told him was he had an irregular heartbeat

(didn't say what type of arrhythmia) and put him on the drugs.

Unfortunately they do not seem to be having much effect; in fact his

fortnightly INR tests are consistently low - about 1.6 rather than 2 -

3, suggesting he cannot get the desired effects. He has feelings of

racing heart and about to blackout every couple of weeks or so, no

obvious pattern. The one thing he has noticed is that it only happens

when he goes out, never when at home, even when he's been up and down

stairs a few times. So he wonders if there is a psychological aspect to

it. The main important information he gave me is that onset coincided

with his wife becoming ill with rheumatoid arthritis - an extremely

aggressive form. Within 5 weeks she went from a fit healthy woman to

being bed-bound and frequently in and out of hospital. The medication

she was given also appeared to have done more harm than good, which has

jaundiced his opinion quite strongly. Five weeks ago, after a terrible

time, she died. He says he is just beginning to settle down after being

constantly on the go. He says he did not feel too stressed at the time,

other than the last fortnight she was in the hospice, as 'you just have

to get on with it'. In January, they also lost a very loved pet. He

wants to come off the warfarin and digoxin if he can. His blood pressure

was 110/78, pulse not very strong and irregular irregular. I listened to

his heart, but in all honesty I am no expert, as I have not had many

patients with heart problems. It certainly wasn't normal; I think I

recognised a gallop in the aortic and pulmonic areas but I really can't

be sure. Hands and fingers were fine but there was a mild cyanosis to

the lips and buccal mucosa.

To me, this all ties in with a psycho-emotional response to his wife's

illness and death. When he rang me to arrange the consultation he asked

if hawthorn would be good for him but when he mentioned the drugs I

warned him he has to take care as they are both strongly involved in

interactions that could be harmful. I spent about 4 hours on the

Internet looking up and downloading information on magnesium/herb/drug

interactions as I know that magnesium is often deficient in these cases,

which in itself can cause arrhythmia. (I've used it myself for a benign

arrhythmia and it's very effective.) I found a good site -

www.itmonline.org/arts/herbdrug2.htm - that made me feel that herbs may

be useful in helping this gentleman but great caution is needed. I

explained this and gave him some copies of my research to look through

and perhaps show his GP/consultant, so that informed choices may be

made. He is very much on the ball and an intelligent man. If I had not

agreed to a consultation he told me he would have started

self-medicating on hawthorn, having read about it in a herb book. He

wants to come off the drugs but I feel that it is something that needs

to be done with the input of his doctors, keeping a check on INR etc. It

seems that herbs may actually help to potentiate the effects of the

drugs, which in this case may actually be quite beneficial as the docs

can't get his figures high enough to be therapeutic. In any case the

hope would be that he could be weaned off the drugs and if he needs to

carry on with the herbs he is happy to do so. I have not yet dispensed

any remedy; he is to get back to me after his reading. I am strongly

swayed towards Winston's remedy for bereavement, that he told us

about at one of his seminars - Albizzia julibrissin, and Crataegus.

I note that Albizzia has saponin components, so may have additional

blood-thinning activities? I just want to make sure I don't do more

harm than good.

So I would like to know if anyone has dealt with this kind of situation

and if they have any words of advice. I use drop doses anyway so the

amounts of herbal remedy are very small, yet still act very potently.

Sorry if this is a bit long. I look forward to any replies.

--

MNIMH MCThA Featherstone, Staffs

February 19, 2006

Hi

Sounds like this could be atrial fibrillation. Look out for pulse deficit ie

the discrepancy between apex beat and radial pulse. Ideally it needs two

people to record both at the same time. Could be that he needs medical

treatment to control this. The risk is atrial clots which could embolise and

cause a stroke. Odd that his INR is not responding to warfarin, and the

digoxin should be helping with the irregularities. Is it possible he's not

always taking his orthodox meds?? It's a risky one to take on if he refuses

medical treatment. At the least you can support with nervines, with Leonurus

being specific I would think, possibly valerian, and maybe warming herbs,

but treat according to consitution, health history etc.

Good luck

Helen Duxbury

Re: warfarin and digoxin & herbal treatment

>I wonder if anyone can help me with any advice on treating a patient who

> is currently on warfarin and digoxin for irregular heartbeat. This 80

> year old gentleman is in otherwise excellent health but was prescribed

> these drugs 18 months ago when he semi-collapsed whilst out walking. 50

> years ago he had a couple of episodes of blacking out when cycling but

> had been absolutely fine ever since. He was in hospital for 19 days and

> had tests done - all they told him was he had an irregular heartbeat

> (didn't say what type of arrhythmia) and put him on the drugs.

> Unfortunately they do not seem to be having much effect; in fact his

> fortnightly INR tests are consistently low - about 1.6 rather than 2 -

> 3, suggesting he cannot get the desired effects. He has feelings of

> racing heart and about to blackout every couple of weeks or so, no

> obvious pattern. The one thing he has noticed is that it only happens

> when he goes out, never when at home, even when he's been up and down

> stairs a few times. So he wonders if there is a psychological aspect to

> it. The main important information he gave me is that onset coincided

> with his wife becoming ill with rheumatoid arthritis - an extremely

> aggressive form. Within 5 weeks she went from a fit healthy woman to

> being bed-bound and frequently in and out of hospital. The medication

> she was given also appeared to have done more harm than good, which has

> jaundiced his opinion quite strongly. Five weeks ago, after a terrible

> time, she died. He says he is just beginning to settle down after being

> constantly on the go. He says he did not feel too stressed at the time,

> other than the last fortnight she was in the hospice, as 'you just have

> to get on with it'. In January, they also lost a very loved pet. He

> wants to come off the warfarin and digoxin if he can. His blood pressure

> was 110/78, pulse not very strong and irregular irregular. I listened to

> his heart, but in all honesty I am no expert, as I have not had many

> patients with heart problems. It certainly wasn't normal; I think I

> recognised a gallop in the aortic and pulmonic areas but I really can't

> be sure. Hands and fingers were fine but there was a mild cyanosis to

> the lips and buccal mucosa.

>

> To me, this all ties in with a psycho-emotional response to his wife's

> illness and death. When he rang me to arrange the consultation he asked

> if hawthorn would be good for him but when he mentioned the drugs I

> warned him he has to take care as they are both strongly involved in

> interactions that could be harmful. I spent about 4 hours on the

> Internet looking up and downloading information on magnesium/herb/drug

> interactions as I know that magnesium is often deficient in these cases,

> which in itself can cause arrhythmia. (I've used it myself for a benign

> arrhythmia and it's very effective.) I found a good site -

> www.itmonline.org/arts/herbdrug2.htm - that made me feel that herbs may

> be useful in helping this gentleman but great caution is needed. I

> explained this and gave him some copies of my research to look through

> and perhaps show his GP/consultant, so that informed choices may be

> made. He is very much on the ball and an intelligent man. If I had not

> agreed to a consultation he told me he would have started

> self-medicating on hawthorn, having read about it in a herb book. He

> wants to come off the drugs but I feel that it is something that needs

> to be done with the input of his doctors, keeping a check on INR etc. It

> seems that herbs may actually help to potentiate the effects of the

> drugs, which in this case may actually be quite beneficial as the docs

> can't get his figures high enough to be therapeutic. In any case the

> hope would be that he could be weaned off the drugs and if he needs to

> carry on with the herbs he is happy to do so. I have not yet dispensed

> any remedy; he is to get back to me after his reading. I am strongly

> swayed towards Winston's remedy for bereavement, that he told us

> about at one of his seminars - Albizzia julibrissin, and Crataegus.

> I note that Albizzia has saponin components, so may have additional

> blood-thinning activities? I just want to make sure I don't do more

> harm than good.

>

> So I would like to know if anyone has dealt with this kind of situation

> and if they have any words of advice. I use drop doses anyway so the

> amounts of herbal remedy are very small, yet still act very potently.

>

> Sorry if this is a bit long. I look forward to any replies.

> --

> MNIMH MCThA Featherstone, Staffs

>

> List Owner: Graham White, MNIMH

>

February 19, 2006

Dear Helen,

Thanks for that. I think I've persuaded him that this does need to be

mix of orthodox and herbs, but he may still opt for wanting to be rid of

drugs. As he put it, he's 80, enjoyed life, has an extremely spiritual

outlook and is not afraid of death; it comes to us all. In fact, as

consultations go this was one of the most uplifting and positive

patients that I have ever met :-). Hopefully, we can help the medication

work better for him and then he may feel better about it. I personally

would prefer to work with his docs on this one and he knows that. I

believe that he is taking his medications regularly but if he's as good

at remembering as I am then the chances are doses get missed. I will

check that again with him next time we speak.

Once again many thanks

In message <000c01c63580$fa6cacf0$db416a51@helenrn4hru6kt>, Helen

Duxbury writes

>Hi

>Sounds like this could be atrial fibrillation. Look out for pulse deficit ie

>the discrepancy between apex beat and radial pulse. Ideally it needs two

>people to record both at the same time. Could be that he needs medical

>treatment to control this. The risk is atrial clots which could embolise and

>cause a stroke. Odd that his INR is not responding to warfarin, and the

>digoxin should be helping with the irregularities. Is it possible he's not

>always taking his orthodox meds?? It's a risky one to take on if he refuses

>medical treatment. At the least you can support with nervines, with Leonurus

>being specific I would think, possibly valerian, and maybe warming herbs,

>but treat according to consitution, health history etc.

>Good luck

>Helen Duxbury

>----

--

February 20, 2006

Hi and everyone,

I have just come off the phone from a patient of some years standing who I

haven't seen for a while with (probably) the same problem. She started treatment

for asthma which began after the death of her daughter in a car accident. She

responded well to herbal treatment and avoided the use of orthodox meds and

hospitalisations while she was taking the herbs but due to financial probs and

distance (I moved) she hasn't taken the herbs regularly for 2 years. She has

been suffering from an arrhythmia and has been put on medication including

warfarin. Because she doesn't want to take so many conventional meds she has

stopped taking her asthma meds and has come back to me for herbs - just for the

asthma. I am now unsure as to what to do - what would be safe to give her - can

I treat her while she's taking warfain?. Herbs work better for her than her

conventional asthma meds and the asthma will only put more strain on her heart.

This lady is not even 60 yet, lives at the top of a mountain

in portugal and is responsible for bringing up a five year old child! Help!

wrote: