Emergency-room physician Timothy Erickson has more to worry about these days than patients with asthma, broken bones, gunshot wounds and heart attacks.

The Chicago doctor now sees occasional patients whose persistent headaches appear to be connected to too much gingko or whose rapid heart rates may be due to ephedra combined with caffeine.

Once in a while, he said, the side effects of herbal remedies have been life-threatening - such as the 15-year-old girl who went into liver failure after drinking a tea made with pennyroyal.

Herbal remedies can be "a big problem" in the ER, Erickson said at the recent annual conference of the American College of Emergency Physicians in Philadelphia. In general, he said, "our patient population knows more about these medical therapies than we do." But they often don't tell their doctors what they're taking, a study shows.

Erickson said people most often ran into trouble because they overused the remedy, a product was not labeled properly, or an herbal substance interacted with another medication.

He said emergency-room doctors need to pointedly ask patients what herbs, supplements and other complementary therapies they are taking. Both the side effects of alternatives and their interactions with traditional medicines can be dangerous, Erickson said. But often doctors don't ask.

When he has polled colleagues informally, he said, only about one in four posed the question. And it's an estimate that may be a little too high, said Jay Kaplan, chairman of emergency services at St. Barnabas Health Care System in New Jersey.

"You are not going to ask the most severely injured patients, but you should probably be asking more questions" of other patients, Kaplan said.

A 1997 national survey indicated that about two out of five Americans use a complementary medicine, including herbal remedies and mega-vitamins. An unrelated study presented at the emergency-physicians conference, found that a third of 163 emergency-room patients at Morristown Memorial Hospital in New Jersey used herbal remedies.

And if doctors don't ask, patients often don't tell. Earlier this year, a University of Pennsylvania study of 196 cancer patients showed that 40 percent used alternatives, but the majority did not tell their doctor unless they were asked specific questions.

During every shift in his emergency room, Erickson said, he has seen at least one patient who was using an alternative remedy. The most common problems that he believed could be linked to alternative medicines were headaches, rapid heartbeat and high blood pressure. Often, the problem went away simply by stopping the treatment, he said.

But he believes some patients he's seen have been made seriously ill by using herbals:

A 33-year-old woman came to the emergency room complaining of headaches and vomiting. Her face drooped slightly on the right side. An MRI revealed she had bleeding inside her head. He linked it to long-term use of ginkgo biloba, which she had used to enhance her memory.

A 15-year-old girl had consumed the herb pennyroyal in tea to abort her fetus. But the herb caused liver failure, he said, and she nearly required a liver transplant.

A 32-year-old normally healthy man complained of chest pain, heart palpitations and a headache. He also had an erection that would not subside. The patient acknowledged that he had intentionally taken more than the recommended dosage of yohimbine to enhance his sexual prowess.

In the hustle of an emergency room, however, it's not always simple - or even possible - to find out about alternative-therapy use.

"I don't routinely ask the question of everyone I see," said Robert Lowe, assistant professor of emergency medicine and epidemiology at the University of Pennsylvania School of Medicine in Philadelphia, who believes alternatives have a place in medical practice.

"I think patients would look at it as funny, if they sprained their ankle and I asked whether they went for acupuncture. But when I think it will help my patient, I will ask about other kinds of treatments they may use. And there certainly have been times when having that information has made a difference."

Steven Rosenzweig, an ER doctor and director of Jefferson University's Center for Integrative Medicine in Philadelphia, said he had not seen any patients in the emergency room with the types of extreme cases described by Erickson.

"My sense is that it is fairly unusual for patients to come to the emergency department for" reaction to an herb, Rosenzweig said.

But he agreed that many people use herbal medicines without adequate information and could be taking risks, especially if they are also on prescription drugs.

Erickson also urged caution. "I am not against" alternatives, Erickson said, "as long as they are followed or monitored by a health-care professional."

(From seattletimes)