blood thinners

January 24, 2006

In a message dated 1/24/2006 8:00:59 P.M. Eastern Standard Time,

d1tarlo writes:

As for herbs: no MD will ever allow it, nor should you

dispense herbs without the MD's approval.

I can not agree with that, if that is so what law is it.

January 24, 2006

ktarnower wrote:

> A patient was just put on Coumadin and is understandably concerned about

> receiving acupuncture and herbs. Could someone help me here with precautions

> and contraindications. Thanks.

> Regards,

> Karen

>

if an inadvertent needle into a venule occurs blood will ooze and a clot

will not form

*precautions*

1. make certain the patient understands risks involved

2. avoid subcutaneous vascular areas altogether

3. avoid spider nevi and venues

4. avoid bleeding the ear at apex

5. stay with the smallest insertion depth maybe 0.2 mm

6. apply, if you can, Japanese meridian acupuncture style

7. ask for detailed family bleeder/clotter history

*contraindications*

a. i would think being on a coumarin derivative is by itself a decided

contraindication

b. obvious veins, venules, vericosities

c. hypertension

d. a family or past history of bleeders

e. obvious debility, recuperative state, on drugs which may interfere

with awareness

f. herbal history, some substances also contain coumarin derivative

*what elemental pattern*?

this is decidedly verboten:

i. a Water on Fire pattern

in [ i ] the Blood in capillaries is already 'watery' so that a

hemoglobin % will tend to th leaner side

if there is an overlay of coumarin on this pattern the smallest nick

will lead to the nightmare ooze ooze ooze

*the unpleasant unseen coumarin state*

these are prone to coumarin content to various degree -

Horse chestnut seed, Sweet Clover, Red clover

for an exhaustive listing go to: http://tinyurl.com/bez5b

*referral*

identify where you will send a bleeder and keep referral docs ready, not

a good idea to do that when someone is on the table and oozing

*care*!

if a bleeding situation did occur do 911, don't let patient drive

herself or himself

it is possible for oozing to cease for a while, and patient goes home

rather that to emergency, has a leak, sleeps, and quietly begins to

bleed into the pillow

suggestion:

establish a bi phasal pattern and use alternate means to influence the

customary toning in one and reduction in the other

this can be dome through half a dozen ways using touch, color, decibels,

writing on points, meridian stretching, recreating symmetry

best

dr holmes

www.acu-free.com

January 24, 2006

Hi Karen,

I have a patient I have treated dozens of times who is on Coumadin. I

use no more caution than any other patient I treat as far as the

acupuncture goes. I have never had an excessive bleeding problem with

this patient. Where you need to be careful is with herbs. I may be

overly cautious, but I don't prescribe herbs to patients on Coumadin as

there are several known drug - herb interactions and I'd rather be safe

than sorry.

Christopher Vedeler L.Ac., C.Ht.

Oasis Acupuncture

<http://www.oasisacupuncture.com/> http://www.oasisacupuncture.com

8233 N. Via Paseo del Norte

Suite D-35

Scottsdale, AZ 85258

Phone: (480) 991-3650

Fax: (480) 247-4472

Chinese Medicine

Chinese Medicine On Behalf Of

ktarnower

Tuesday, January 24, 2006 2:28 PM

Chinese Medicine

Re: blood thinners

A patient was just put on Coumadin and is understandably concerned about

receiving acupuncture and herbs. Could someone help me here with

precautions and contraindications. Thanks.

Regards,

Karen

January 25, 2006

On the other side of the fence it would be malpractice for a MD to

prescribed a drug that is contraindicated for an herbal formula that the patient

may

be on because a DOM prescribed it, assuming the MD knew about the patient

informed them about the herbal medicine. And how is this different than 2 or

more

MDs working together to help a patient? With primary physicians, attending

physicians, residents, interns, and specialists - how is it that the DOM is

not just one more member of the healthcare team seeking the best outcome for the

patient, regardless of the underlying disorder and/or treatment?

As to the contraindications for combined therapies (herbals + synthetic

medications), part of many intake assessments for patients in professional

practice environments now inquire about OTCs, drugs, vitamins, and herbals that

the

patient may be taking or have taken. A good intake provides mutual safety

and therapeutic interventions for ANY healthcare provider. Blood thinners are no

more serious than cardiac meds, insulins, or any other drugs. All are to be

used therapeutically and with respect for the medications/ herbals AND the

patient's needs as individual healthcare practitioners provide the services

they are trained to provide. What is critical to this discussion is that we

stop

the pissing contest and take care of our patients.

Stan

January 25, 2006

I have not had problems with acupuncture and patients

on coumadin, but you have to be observant of the

patient, the age, any bruising, bleeding gums, and the

dosage, etc...

As for herbs: no MD will ever allow it, nor should you

dispense herbs without the MD's approval. MD's are

averse to anything that may influence the action of

coumadin, (as all know, the stuff is dangerous, eg:

Israel's Premier having a massive stroke after being

put on coumadin, makes one wonder?) even if the

coumadin can be reduced, because they check blood

levels of the meds and that is the only way (as I

understand at this moment) they can control (??) and

track it's action or inaction. If anything alters, or

threatens, the blood-level without their knowledge,

they will NOT be HAPPY with you.

D. Tarlo L.Ac.

--- ktarnower wrote:

> A patient was just put on Coumadin and is

> understandably concerned about receiving acupuncture

> and herbs. Could someone help me here with

> precautions and contraindications. Thanks.

> Regards,

> Karen

>

> [Non-text portions of this message have been

> removed]

>

January 25, 2006

Just have personal experience as a person on Warfarin (ie Coumadin).

Since February 2001 I have been on Warfarin. For the first year or 2

the target clotting time was in the 2.5 to 3.0 times normal. Since

then the target has been in the 2.0 to 2.5 times normal range. I have

not experienced any problems with acupuncture treatments which I've

gotten 2 or 3 times a year.

I am quite interested in where this thread goes as I start my 2nd

semester of Acupuncture school next week and part of the Point

Locations Class is needling. What is the difference in exposure

between someone who has been needling for 10 years and a fellow

student who is taking his first crack at it? Can't help but smile at

the things one stumbles on.

In Light,

On Jan 24, 2006, at 1:27 PM, ktarnower wrote:

> A patient was just put on Coumadin and is understandably concerned

> about receiving acupuncture and herbs. Could someone help me here

> with precautions and contraindications. Thanks.

> Regards,

> Karen

>

John Flavin Dipl. A.B.T. (NCCAOM) phone: 650-248-6721

4161 El Camino Way fax: 650-498-1846

Suite B

email: jflavin

Palo Alto, Ca 94306 home:

www.BalanceThePoint.com

January 25, 2006

What herbs are those, Christopher?

On Jan 24, 2006, at 9:31 PM, Christopher Vedeler L.Ac. wrote:

> Alon, coumadin has a very narrow therapeutic index (i.e. the

> therapeutic

> dose and the lethal dose are very close together), perhaps the

> narrowest

> of any prescription drug. This makes it very dangerous and there are

> several Chinese herbs that have known adverse interactions with

> coumadin. I simply don't prescribe herbs at all for my patients on

> coumadin. It isn't worth the risk IMO.

January 25, 2006

I know leaving the medical decision up to the patient sounds good, but

in some cases it can open you up to possible legal trouble. If you

recommend one thing, and their MD recommends something different and

they choose to follow your advice and have an adverse reaction, you just

opened yourself up to some serious liability. I ALWAYS tell my patients

that I will not recommend them going against their MD's advice. I may

have a different opinion, and I may express it to the patient, but I

would never recommend they follow my advice over their MD's. The

furthest I have gone was to suggest that the patient find another MD and

get a 2nd opinion on their condition because in that particular case I

knew their doctor was giving them bad advice.

Christopher Vedeler L.Ac., C.Ht.

Oasis Acupuncture

http://www.oasisacupuncture.com

8233 N. Via Paseo del Norte

Suite D-35

Scottsdale, AZ 85258

Phone: (480) 991-3650

Fax: (480) 247-4472

Chinese Medicine

Chinese Medicine On Behalf Of Alon

Marcus DOM

Tuesday, January 24, 2006 9:38 PM

Chinese Medicine

Re: Re: blood thinners

Texas

acupuncture licensure (L.Ac) was limited as written,

but this past year it went through sunset (revision)

and has become more restrictive.

>>>>>>

So we have another example of going backwards. How sad. I work with my

patients. They are in the driver seat. If i give herbs to someone on

blood thinners i tell the patient they must inform their MD but at the

same time i am comfortable ordering PPT to see effects. I have never had

any trouble working with their MD because i call them and clearly

explain my plan. If they would not work with me i would leave it to my

patient to decide

Oakland, CA 94609

January 25, 2006

Ladies and Gentlemen,

" What is critical to this discussion is that we stop

the pissing contest and take care of our patients.

Stan "

No reply to that. Acupuncturist everywhere practice

by the grace of the " power that be " . Unfortunately,

in Texas, the law is restrictive and a phone call can

place an acupuncturist's license at risk. The last

thing an L.Ac. should do is create friction with MD's

and the Medical Board.

Vaya Con Dios Amigos,

D. Tarlo L.Ac.

--- KarateStan wrote:

> On the other side of the fence it would be

> malpractice for a MD to

> prescribed a drug that is contraindicated for an

> herbal formula that the patient may

> be on because a DOM prescribed it, assuming the MD

> knew about the patient

> informed them about the herbal medicine. And how is

> this different than 2 or more

> MDs working together to help a patient? With primary

> physicians, attending

> physicians, residents, interns, and specialists -

> how is it that the DOM is

> not just one more member of the healthcare team

> seeking the best outcome for the

> patient, regardless of the underlying disorder

> and/or treatment?

>

> As to the contraindications for combined therapies

> (herbals + synthetic

> medications), part of many intake assessments for

> patients in professional

> practice environments now inquire about OTCs, drugs,

> vitamins, and herbals that the

> patient may be taking or have taken. A good intake

> provides mutual safety

> and therapeutic interventions for ANY healthcare

> provider. Blood thinners are no

> more serious than cardiac meds, insulins, or any

> other drugs. All are to be

> used therapeutically and with respect for the

> medications/ herbals AND the

> patient's needs as individual healthcare

> practitioners provide the services

> they are trained to provide. What is critical to

> this discussion is that we stop

> the pissing contest and take care of our patients.

>

> Stan

>

> [Non-text portions of this message have been

> removed]

>

January 25, 2006

perhaps i am more comfortable defending my medical suggestion and may be i will

get burnt one day

Oakland, CA 94609

-

Christopher Vedeler L.Ac.

Chinese Medicine

Tuesday, January 24, 2006 10:04 PM

RE: Re: blood thinners