Case Study: Sophia, 26 harbal medicine

 

Sophia's case to practice identifying what makes botanicals unique 

from pharmaceuticals and using that knowledge to make some recommendations for her. 

You may recall that Sophia is a 26 year old female who was 

exploring options for managing her anxiety and mild stomach upset, 

and is interested in knowing how botanical options differ from conventional ones. 

Sophia reports that her anxiety is mild in nature and it's often 

associated with stressful work meetings that occur about 1-2 times per month. 

She reports intermittent stomach upset at times and notes that when her anxiety flares, 

it appears to get worse. 

Sophia has already had a thorough evaluation of her stomach upset from 

a gastroenterologist and no serious causes were found to be causing her symptoms. 

She was told that managing her stress and 

anxiety would likely helped her stomach discomfort. 

She doesn't like taking medicines unless she absolutely has 

to and prefers to avoid pills when possible. 

You are going to be asked some questions about 

Sophia's case and it may be helpful for you to use 

the comparing pharmaceuticals and 

botanicals reading included in this lesson as a reference. 

But first, can you identify which method describes a botanical medicine approach? 

If Sophia chose the botanical approach, 

how would she likely be told to take her medicine brand? 

While pharmaceutical and botanical approaches differ, 

each has its own advantages. 

Honestly, a lot of it comes down to patient preference. 

If Sophia doesn't mind taking pills on a regular basis and wants a stronger dose, 

she may choose the pharmaceutical approach. 

But perhaps Sophia would like to avoid taking pills or 

dislikes the side effect she's experiencing with some pharmaceuticals. 

In that case, a botanical offers her the chance to take her medicine as a T or 

Tincture and the milder strength can reduce side effects. 

If she likes the convenience of taking a pill, 

she can also consume her botanical in tablet or pill form if she desires. 

Each approach also has its own disadvantages. 

Due to the higher strength per dose, 

patients taking pharmaceuticals may experience more undesirable side effects. 

For example, Sophia could be prescribed 

the pharmaceutical benzodiazepine such as Xanax or Valium to help manage her anxiety. 

While these medicines are definitely often effective for relieving anxiety, 

this class of medications often induce sedation or drowsiness. 

Also, the body can build up a tolerance to these medicines, 

meaning it takes larger and larger doses to achieve the same effect. 

If Sophia were to stop taking 

benzodiazepines after taking them for a long period of time, 

she may also experience withdrawal symptoms which can be extremely uncomfortable. 

On the other hand patients may not be able to 

manage moderate to severe symptoms with just a botanical. 

For example, if Sophia suffers from moderate to 

severe anxiety that significantly impacts her quality of life, 

ability to work, et cetera, 

then a botanical is likely to be too mild to help manage her symptoms. 

In this instance, a pharmaceutical would be most likely the better option. 

A key takeaway in regard to pharmaceutical and botanical approaches is that 

recommendations for patients should be based 

largely off the severity of his or her symptoms. 

Generally speaking, due to their more mild effects, 

it's best to use botanicals for mild to moderate symptoms. 

Any persistent or severe symptoms are typically best managed with pharmaceuticals. 

For example, Aloe vera may be used for minor skin wounds, 

but if an infection develops on the skin such as cellulitis, 

antibiotics will be necessary for the treatment of this. 

It's also very inappropriate to use botanicals for any life-threatening conditions, 

such as heart attacks, strokes, et cetera, 

or any condition requiring surgical intervention such as Appendicitis. 

I sometimes get some good natured ribbing from 

my ER colleagues joking that I would use garlic to cure heart attack. 

Thankfully, they are joking and this is absolutely something 

that is not appropriate, but honestly, 

it is really just as important to know when not to 

use a botanical as it is to know when to use a botanical. 

Besides severity of symptoms, 

it is also important to consider a patient's preferences when making recommendations. 

Basing your recommendations around 

these two factors will help you identify the best way to 

meet that individual patient's needs and avoid a one size fits all approach. 

Now it's time for you to think about what you would do. 

For patient Sophia, since her symptoms are mild, 

a botanical would be a reasonable option for her. 

It's also important to note that her stomach problems were thoroughly evaluated by 

a gastrointestinal or GI specialist to make sure there is no underlying cause, 

such as an ulcer or other pathology that may be contributing to her symptoms. 

Really not serious causes of symptoms is crucial for every patient. 

Make sure to always treat patients within your scope of 

practice and refer for further evaluation when appropriate. 

For this particular patient, 

I'd recommend a blend of lemon balm and chamomile, 

both of which can help ease mild anxiety and settle the stomach. 

Sophia could consume this as a medicinal tea that she could drink as needed during 

work meetings that she found stressful or at 

any other time when anxiety or stomach upset flared.