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Well, the plastic surgeon recommended arnica
I never actually intended to harm anyone. Honestly. In fact, I think the waiter is to blame.
I was dining at a restaurant with my sister when the waiter casually asked if I was enjoying the evening with my daughter. I tried to shrug off the comment but couldn't. I decided to get a second opinion and soon found myself walking into the office of a plastic surgeon.
I entered through a marbled anteroom centered with a pedestal table and a stunning, if stiff, floral arrangement. The tableau was reflected in a gilded mirror along with my worried face. I knew skin isn't like marble. It can't really be polished or chiseled, and it reacts to trauma by bleeding, bruising and sometimes scarring. I hoped to be discouraged from going "under the knife."
No such luck. The surgeon, whose credentials were impeccable, spoke with authority. "I think you'll be pleased with the results," he said, assuring me I would undoubtedly look more youthful. "Before" and "after" pictures of clients proved his skill. If there was any lingering doubt, one needed only to look at his office manager, a lovely, ageless woman.
"Me? I've had everything done," she said with a conspiratorial laugh, proceeding to review the issues of cost, scheduling and "down time." When it came to actually setting a date for the procedure, however, I demurred. I bruise easily and wondered if this might affect the results.
The surgeon outlined the preoperative steps used to minimize bleeding, including avoidance of aspirin and other non-steroidal anti-inflammatories and vitamin C and vitamin E, all of which affect coagulation. If I was still concerned, he suggested, I could try a homeopathic medication called arnica. He explained that oral arnica is a centuries-old remedy for treating bruises that some of his clients swore by and that the pills were readily available without prescription at most health food stores.
This piqued my interest. I left with visions of a more youthful self and plans to schedule the surgery in the near future. On the way home, I made a beeline for the local health food store to pick up a bottle of Arnica montana. It is derived from a daisy-like flower. The instructions advised users to take five pellets three times a day for swelling, stiffness, muscle aches and bruising. "Great," I thought, "this just might come in handy."
A week later my mother phoned, upset and anxious because she had tripped and hit her face against a lamp. I hurried over to assess the damage. Nothing appeared to be fractured. Despite my urgings, a trip to the emergency room was out of the question. My mom expected me, an OB-GYN, or my husband, a family physician, to diagnose and treat her ailments. She was especially distressed about the bruising and swelling on her face, and ice packs weren't helping. She pleaded with me to give her something to hasten the resolution of the bruises.
I thought for a moment. "You could try arnica. The plastic surgeons recommend it." My mother didn't need much convincing. She wanted the bruises to go away and trusted me to give her good advice. I retrieved the vial, which was still in my purse, and reviewed the instructions with her. She was grateful and liked the fact that the pills were derived from a plant similar to a daisy — one of her favorite flowers.
Four days later, my mom called again. She was having abdominal pain, cramps and nausea. I wasn't sure what was going on but thought she might have gastroenteritis. Reassuringly, the bruises were fading, though not as rapidly as she had hoped. The next day her pain worsened. My husband and I took her to the emergency room despite her protest. We now feared she had appendicitis. Her abdominal exam was inconclusive, and a CT scan was negative. The ER physician suspected a urinary tract infection and prescribed antibiotics.
Over the next 24 hours, my mom's pain continued unabated and she developed diarrhea. She felt very weak, and her whole body ached. She could barely get out of bed. My husband was perplexed. "It's almost like she's being poisoned."
Poisoned! I felt a stab of pain and reminded him that I had given her arnica for bruising.
He looked at me thoughtfully. "So what do you really know about arnica?" he asked.
All I really knew was advice received from another physician and the information on the vial, which did not list any potentially adverse side effects. I also knew a little about homeopathy — that it was based on the principle of "like curing like" and used very dilute formulations of natural substances derived from minerals, plants or animals. It had never occurred to me that a homeopathic medication had the potential to cause harm simply because these preparations are so diluted.
A belated Internet search revealed disturbing information. Arnica, or "leopard's bane," is indeed an ancient remedy — used without much scientific evidence — to treat swelling and bruising. When taken orally, it can have severe, even fatal, consequences. The biologically active ingredients have intense musculoskeletal, gastrointestinal and cardio-toxic effects. Among the common symptoms of arnica toxicity are abdominal pain, nausea, diarrhea, muscle aches and weakness — all symptoms my mother had. At high doses, the herb could potentially cause death from cardiac arrest.
As far as I could tell, cases of toxicity seem to be limited to "full strength" preparations or ingestions of the plant itself, not homeopathic formulations. Still, the FDA has listed arnica in it's poisonous plant database, and the agency doesn't guarantee the strength and purity of homeopathic or herbal medications. Most references concluded with the warning: Don't use without consulting a "knowledgeable" healthcare provider.
I had taken none of these facts into account when giving the tablets to my mother.
Armed with this information, I rushed over to my mother's house. I explained what I had discovered about arnica's possible side effects.
She listened carefully, then, with her soft blue eyes looking directly at me, said plaintively: "You mean you poisoned me?"
"I'm sorry, Mom" was all I could say. As I bent down to hug her, I couldn't help but notice there wasn't a trace of bruising left on her face.
Several weeks later, she was still suffering from generalized weakness and diffuse body aches, although the abdominal pain, cramps and nausea faded several days after stopping the arnica. One afternoon I found her still lying in bed. "I haven't felt well since you poisoned me," she said as she shrugged her shoulders and raised her palms heavenward, a gesture of resignation and faith.
Eventually, I persuaded her to see her primary physician. He dismissed arnica as a possible culprit and insisted that her symptoms were consistent with trauma from the fall. My husband and I thought otherwise, but there was no way to prove it.
A few months later, one of my sons fell while trying to get some "air" snowboarding. He wanted something for the bruising on his face. I hesitated, and then gave in. "Well, I guess you could try arnica — but it might cause problems," I cautioned him. My son jumped at the chance to take the pills because he didn't want to go to work with a bruised face, but by the third day he too began to have nausea and abdominal cramps. I told him to stop the pills immediately. He did so and quickly got better.
I was now convinced: Arnica, even at homeopathic doses, was, at least for my family, toxic.
Not long after this second incident, my cousin phoned. She had bumped into a wall and bruised her forehead. She wondered if I had any more of those "herbal pills" that I had given my mother for bruising. "Absolutely not!" I said.
As far as arnica was concerned, I was now a "knowledgeable" healthcare provider. Having already poisoned two family members, I wasn't going to do it a third time.
I won't poison myself either. I guess that face-lift will just have to wait.
Castro is a professor and chair of obstetrics- gynecology at Western University of Health Sciences in Pomona.