You keep emphasizing the importance of going to reputable shops to buy herbal medicine. Isn't all the information we need on the label?

Not necessarily! A recent study looked at 30 different boxes of feverfew, used to help migraine and arthritis. Only two preparations contained any feverfew at all. The problem is that medications are rigorously checked but herb preparations are not (currently) regulated. Drugs on the Internet are totally uncontrolled.

Are Chinese herbs the same as our herbal medicines and can they help?

Chinese herbal medicine is based on a different philosophy and uses different preparations and diagnostic techniques to those in the

West, so it is considered a separate branch of herbal medicine. Again, many claims are made, but there is little scientific evidence available.

When I studied one Chinese herb recommended for angina, compared to placebo all it did was to cause more headaches!

Are you in favour or against alternative methods of treatment?

If any treatment makes you feel better and does no harm, I cannot be against it. You must, however, have a full medical history and examination to make sure that nothing is being missed. Herbal medicine is slow-acting and best for chronic conditions, so it may help angina. Certain herbs in excess can lead to side effects - parsley in very large quantities can cause liver damage, celery and angelica can cause the skin to be sensitive to sunlight, and many other herbs can cause stomach upsets. Some are even poisonous! This means that you should go only to a qualified medical herbalist who knows how to handle the herbs and select the right ones for you. The same goes for homeopathy and acupuncture - only go to accredited people. There are some addresses in Appendix 2.

I thought alternative medicine practitioners were all trained. Isn't this so?

No. Anyone can set up as a specialist in complementary or alternative medicine and there are no government requirements for training. This means that in the wrong hands, you could be harmed or have a medical condition missed. Always check if the practitioner is registered, has qualifications, is insured and is well established in practice in the area. Do not use the Internet unless it is a reputable pharmacy.

Why are doctors so sceptical about alternative medicine?

Doctors, and for that matter nurses and other trained medical people, have to qualify to certain standards and practise their craft following strict guidelines and codes of ethics. They are naturally suspicious of those who do not have to follow these rigorous rules and can make claims which are not or cannot be scientifically proven. Doctors are now being urged to practise only 'evidence-based medicine' which is medicine absolutely proven to be of benefit. They obviously wonder why others are not strictly policed.

Do you think there is place then for alternative medicine or should I ignore it?

Yes there is a place for alternative medicine, provided that a full medical assessment has been performed on you and that the practitioner is fully qualified. Quality of life can be improved by many things, including a placebo. Provided that there is no evidence of harm, alternative treatments can be tried. There is no evidence that alternative medicine will lengthen your life, so if your life is threatened by heart disease, conventional medicine will be essential for your protection.

Can complementary therapies do any harm?

he short answer is yes - so always go to your doctor if you are taking these products; if you have a heart condition, check before you try them. Here are some reported dangers.

• Ma huang (Ephedra) used for weight loss and energy enhancement may cause stroke, heart attacks and sudden death.

• Chelation has killed some patients.

• Siberian ginseng can falsely elevate digoxin drug levels, leading to incorrect decisions.

• Gingko inhibits clotting and may increase the effect of warfarin (ginger, garlic and ginseng do this also).

• St John's wort and gingko can deepen the effects of anaesthetics, cause blood pressure problems and bleeding. St John's wort can cause a fatal irregularity of the heartbeat -avoid it!

I have read in the paper about laser surgery. This sounds exciting - is it being used everywhere?

The word 'laser' sells newspapers and excites the reader. Laser balloons have come and gone because of a lack of benefit. The technique of transmyocardial laser revascularisation (doctors like long names!) is a treatment using lasers to create tiny channels in the heart muscle from the inside. It can be done by opening the chest (surgically) or via the arteries, like a catheter procedure. Patients for whom angioplasty or bypass surgery are not suitable can undergo this procedure, the idea being that blood from the inside of the ventricle (pump) feeds the muscle via the channels. The results vary a lot and it is still experimental. So, if this procedure is offered to you, make sure that there are no other options (if need be, get a second opinion), and that the centre has ethical approval and a lot of experience. (There are cowboy doctors as well as cowboy builders!)

What drugs should I be on to help stop my angina problems coming back?

All patients with coronary disease should be taking:

• aspirin (or clopidogrel);

• a statin (dose increased to get LDL 2.0 mmol/litre or less);

• a beta-blocker (such as bisoprolol 2.5-5 mg or atenolol 50 mg daily); and

• an ACE inhibitor (such as perindopril up to 8 mg, ramipril 5-10 mg daily) or an AII inhibitor (such as valsartan, candesartan, losartan, irbesartan) providing there are no specific contraindications or side effects.

If you are not on one of these drugs, ask why.

Drugs are much cheaper on the Internet - is it safe to buy them?

If you buy drugs this way you have no idea what you are taking.

There is no control over the content of the tablets, or of the 'vehicle' which is used to keep the drug in the tablet, which may be a banned substance. In addition, the content may clash with your prescribed drugs. So only buy from a reputable online pharmacy and not 'Dave' who can sell you Viagra for 50p a tablet.

 
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