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Q&A with Suzanne Zwicker, clinical pharmacist
In this Q&A, Suzanne Zwicker, Clinical Pharmacist on the National Pharmacy Team for Innomar in Dartmouth, Nova Scotia, responds to your questions about herbal supplements and ileostomy care.
Question: I was told not to take anything (vitamins, herb supplements during chemo and radiation). I also hear that some herbs do not work well with these types of treatments but not sure why. Now that my treatments are over I am taking supplements again under the guidance of doctor and naturopath, I wonder if the pharmacist can comment on the power of herbs vs other medicines
Considering being told not to take anything during chemo and radiation:
The usual recommendation is to avoid natural health products during chemo and radiation. This is because the effects of taking certain products or combinations of products can produce unpredictable effects.
Possible risks of taking natural and herbal products include:
• Depending on the source the exact amount of the natural or herbal medicine may not be known
• They may decrease the effectiveness of the cancer treatment (chemotherapy or radiation) by reducing it in the bloodstream or blocking its action.
• They may increase the amount of chemotherapy in the bloodstream by interfering with drug metabolism and increasing toxicity
• Depending on the source -they may have unsafe substances in them because natural and herbal products do not go through the same testing as other medicines
• They may have side effects that can make the effects of chemo or radiation worse. For example, some supplements like garlic, ginkgo biloba, ginseng and Vitamin E can increase risk of bleeding. Also, some supplements can have effects on Blood Pressure, Nausea, Diarrhea, Constipation, Headaches and dizziness for example.
• There is conflicting information about antioxidants during cancer treatment
The Memorial Sloan Kettering Cancer Center in the United States looked at how herbal medicines can change the way drugs work:
Herbal Remedies and Cancer Treatment:
Comment on Herbs:
It is very important to discuss all complimentary treatments with your healthcare team. These treatments can affect your cancer treatments and/ or your other health conditions (like diabetes or high blood pressure).
Many patients use complimentary medicine, and it is important for your healthcare team to know so that they understand the benefits and the risks involved with your whole treatment plan. Supplements are important and relevant to your treatment.
It is important to be fully aware of the product you are purchasing. All NPHs sold in Canada must have either an NPN (Natural Product Number) or DIN-HM (Drug Identification Number – Homeopathic Medicine). These numbers tell you that the product meets Canadian regulations and is licensed by Health Canada. Health Canada’s rules do not cover NHPs bought in other countries or from Internet pharmacies. Health Canada does not regulate whole plants or herbs or products made by a practitioner. For example, if a naturopathic doctor or traditional Chinese medicine practitioner prepares a tea from herbs, that tea is not covered by these rules.
CAMEO (Complimentary Medicine Education and Outcomes Program) from the University of Manitoba offers some very useful resources and patient education courses for patients wishing to know more about evidenced based research in complimentary medicine.
It is important to know that many chemotherapeutic drugs used in cancer are in fact derived from plants. These drugs have been developed after rigorous clinical trials for safety and efficacy. Likewise, advice for complimentary medicine needs to be based on current and evidence -based evaluations. There are a number of very good resources to assist patients and Health Care Professionals in making a good, informed decision about supplements or herbals and what can be used when.
The National Cancer Institute (US Site) has a useful resource called CAM (Complimentary and Alternative Medicine) Therapies: A – Z: https://cam.cancer.gov/health_information/cam_therapies_a-z.htm
Question: Are there any symptoms to watch out for if we have an ileostomy during heat waves?
Answer: The key thing to watch out for if you have an ileostomy during hot weather is the increased risk of dehydration. When you have an ileostomy there is no functioning colon (large intestine) to absorb water from food waste. In the hot weather we lose more fluid due to the heat itself and increased perspiration. Some symptoms of dehydration include headache, fatigue, dark or decreased urine, dry mouth, lips and eyes, dry skin, stomach cramps, leg cramps, feeling thirsty, feeling dizzy or light-headed. It is important always to monitor fluid intake and stoma output, but doubly important in hot weather. Fluid replacement is very important and the type of fluid likewise. Consider electrolyte replacement (Like Sports Drinks) and avoid artificial sweeteners, caffeine (diuretic effect can be more dehydrating) and alcohol (dehydrating). Salty snacks are a good idea for electrolyte intake too, if permitted.
Keeping cool and planning to keep cool in hot weather is a strategy to prevent heat stroke and dehydration. Wearing breathable fabrics like cotton or linen are more comfortable in the heat. Staying in the shade versus the sun will help you to manage the heat more easily. Thinking about the hot weather may involve a little more planning for supplies and skin protection. It is good to prepare for summer activities such as swimming and discussing with your entero-stomal therapy nurse the needed supplies. It is good to have extra supplies and have a strategy for skin protection around the stoma site should hot weather contribute to more frequent ostomy changes, perspiration, leaks, and skin rashes. Always remember sunscreen for skin protection all over to prevent a sunburn which, in itself, can cause dehydration. Remember to avoid application of creams in an area that may affect adhesives of base plates or other ostomy supplies.
In summary prepare well for outings, have a strategy for staying hydrated, keeping cool, and monitoring (signs of dehydration, ostomy output, fluid and electrolyte intake, skin condition, and amount and storage of ostomy supplies).