Even with his medical issues, surgery is relatively low risk, and the benefits in understanding treatment options and their expected benefits, as well as reducing risk of complications from local tumor growth, makes this a strong recommendation. Of course, it’s your father’s decision, but I agree with his doctor’s recommendation.
DEAR DR. ROACH: I have diabetes, and I was looking at different types of traditional herbal teas to cut down on caffeine and to try to help my diabetes. I always double-check to make sure none of the ingredients interacts with my medications. I read the tea that I am considering is an inactivator of cytochrome P450 3A4. I am taking metformin, Arthrotec, Paxil, Eltroxin and Ventolin. Must I worry? — N.E.
ANSWER: The cytochrome P450 system is a major way the body has of detoxifying medications. Some medicines and a few foods (notably grapefruit juice) can affect the P450 system, especially the important enzyme CYP3A4. Depending on the medicine, increasing the activity of 3A4 can make a medication more toxic or less effective. However, the effect on the enzyme by foods is relatively small, and significant drug-food interactions are uncommon.
Your tea, like grapefruit juice, inhibits the activity of 3A4. I have access to a program that can look up drug-drug and drug-food interactions, and I found that one of the teas (Abies balsamea, also called balsam fir) will increase the effective dose of Paxil by about 40%. That is a large-enough effect that I recommend you talk to your doctor about it. They may wish to lower your dose or recommend against this particular tea.