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Communication Gap between Caregivivers and Patients Using Complementary Alternative Medicine.

Posted on: 11/30/1999
Thirty five to 57 per cent of people in the United States are using Complementary Alternative Medicine (CAM) of one sort or another. CAM is defined as a group of medical and healthcare systems, practices, and products that currently are not considered part of conventional medicine. These include therapies such as dietary supplements, herbs, mega-vitamins, homeopathic medicines, acupuncture, etc. Studies have also shown that over half of people using CAM do not inform their doctor(s).

The authors in this study chose to explore use of CAM in fracture patients. Because CAMS can interfere with anesthesia, or cause other complications during surgery such as bleeding, it is important for patients with fracture to disclose their CAM use to their orthopedic surgeon. It is important in managing them in the hospital and fracture clinic.

For example, chondroitin, gingko biloba, ginseng, and garlic supplements may lead to an increase in bleeding so should be stopped before surgery. Echinacea should be stopped two to three weeks before surgery. It can slow the clearance of certain medications. It may also affect allergic reactions, and cause suppression of the immune system. This could affect healing and fighting infection. Glucosamine should also be stopped two to three weeks prior to surgery as it may cause low blood sugar, fainting, and delayed recovery after anesthesia.

It is not clear which CAMS positively affect bone healing and just how much. Most studies have been done in the laboratory, not in humans. Laboratory studies suggest that Omega-3 fatty acids may help heal cartilage and bone. Black cohosh may stimulate cells that make new bone. Aloe vera may prevent arthritis and help bone growth. In animals, chrondroitin may help healing of bone. Boron may also help with bone healing.

Similar to other studies of the general population, 35 percent of the participants with fractures that were surveyed were using some form of CAM. Also similar to the general population of persons using CAM, 55 percent of the participants in the study had not informed or did not intend to inform their orthopedic surgeon of their CAM use. Participants responded that they did not feel it was important enough to discuss. Others felt the surgeon would not approve, or would not know a lot about CAMs.

This lack of communication can be problematic. Othopedic surgeons should be aware of CAMs and potential interactions, and the potential for impairment of fracture healing. For optimal safety and outcome, patients should disclose CAM use with their orthopedic surgeon upon initial evaluation.

References:
Sheila Sprague, MSc et al. Complementary and Alternative Medicine Use in Patiens with Fractures. Clinical Orthopaedics and Related Research. October 2007. Number 463. Pp. 173-178.

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