Making sure I do what the patient wants
I have a new patient with a gastric ulcer. Although this patient has a genetic condition which shapes her life quite dramatically and several other pathologies which impact somewhat, the main presentation in this patient is her painful stomach ulcer. This is what she ultimately wanted addressed.
It was surprising that she was unremittingly cheerful and uncomplaining. We tried to untangle her complex medical history and shape a timeline that could perhaps clarify what had been going on and why. When there is a complex symptom pattern, and possibly multiple conditions thriving in a patient at any one time, it is possible to be diverted and go down many rabbit holes which can be oh so interesting.
Long story short, she had been on a raft of various medications from 2012 which could have been responsible for the development of her ulcer. I went through all her drugs with a fine tooth comb and spent quite some time reading research, studies and articles on each one. All this I found interesting, and many thoughts were running through my brain about how to approach this whole panoply of complaints.
Then I decided that this particular rabbit hole was making life too complicated.
All she really wanted was the pain of her ulcer fixed.
Could I do it?
I had taken a current drug history and so could see that most of the drugs that could have started the ulcer had been tapered off, so I could start to develop a plan.
Which was;
1. Dull the pain, and soothe the area
2. Reduce inflammation
3. Heal the ulcer
These were some of the herbs I included in her prescription of a tincture and a tea:
Calendula [anti-inflammatory and healing to mucosa]
Chamomile [soothes and heals gastric mucosa]
Irish Moss [demulcent to gastric mucosa]
Marshmallow [demulcent to gastric mucosa]
Meadowsweet [digestive tonic, soothes and astringent to gastric mucosa]
She went home with a powerful set of herbs to reduce inflammation, sooth and protect the sore area and dull the pain.
Calendula may be used safely wherever there is inflammation, and it has robust anti-inflammatory actions in the digestive system, making it very useful in the treatment of gastric and duodenal ulcers. Calendula contains allantoin which is reported to stimulate physiological regeneration and granulation of wounds, and an ulcer is a type of ‘wound’.
Chamomile is what is termed a ‘vulnerary’, which means it heals.
Both Irish Moss and Marshmallow are fantastic demulcents, and a demulcent action relieves irritation of the mucous membranes in the stomach by forming a protective film against the destructive action of stomach acid.
Meadowsweet is one of the best specific digestive herbs we have, it has a brilliant array of actions which include: protecting and soothing the mucous membranes of the gut, reducing excess acidity, and relieving pain. It is widely used in the treatment of peptic ulceration as it is also gently astringent which would contain the beginnings of any local bleeding.
How will I monitor progress when I can’t repeat the endoscopy she had in hospital? I will ask her what it feels like. I will tell her to monitor the pain and give it a score out of 10. I will see how her diet impacts on her pain. Does it still hurt to eat?
Nobody can guarantee success, but one thing I do know. The herbs that she has in her prescription are nutritive and are not treated as toxic by the body as they are organic, natural compounds and have not been fabricated in a factory.
If we do manage to fix her ulcer [and she has a few things in her mixes to help relieve stress which could be a factor] we may turn our attention to a couple of the other conditions that she has. This is the best way to work, start at one end of the problem and work steadily through the rest. If you try and fix everything at once it gets confusing and doesn’t usually work.
As the proverb goes, slow and steady wins the race.
Which I think may be one of Aesop’s fables, indicating that one is better off being methodical than rushing into something unprepared. And after all my years of training to be a medical herbalist, at least I am not ‘unprepared’.
