title: Complementary and alternative medicine in epistaxis: a point worth considering during the patient's history.
abstract: A large number of patients take complementary and alternative medicine (CAM) for a variety of reasons, but most do not inform their physicians. This has implications for safety, as many forms of herbal CAM are thought to have a variety of side-effects and may interact with conventional medicines with potentially adverse consequences. We present the case of an otherwise healthy 25-year-old man with difficult-to-control epistaxis. On further questioning, we learnt that he had recently started self-medicating with a combination of aspirin, garlic tablets and milk thistle. Garlic increases bleeding time and milk thistle alters the function of liver enzymes, both of which may have contributed to the difficulty in his management of epistaxis. This case highlights the importance of asking about CAM use when taking a patient's history, as it may have implications for management.
authors.affiliation: Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Shakeel
authors.forename: Aaron
authors.initials: A
authors.lastname: Trinidade
authors.forename: Neil
authors.initials: N
authors.lastname: McCluney
authors.forename: Brewis
authors.initials: B
authors.lastname: Clive
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects; D001777:Blood Coagulation / Q000187:drug effects; D000529:Complementary Therapies / Q000009:adverse effects*; D004632:Emergency Medical Services; D004844:Epistaxis / Q000209:etiology*; D005737:Garlic / Q000009:adverse effects; D006801:Humans; D008297:Male; D008487:Medical History Taking; D020944:Silybum marianum / Q000009:adverse effects; D008517:Phytotherapy / Q000009:adverse effects
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin