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DEAR DR. ROACH: I am a 75-year-old male who was diagnosed two years ago with superficial venous insufficiency. Venous ablation was considered, but my cardiologist informed me that it most likely would not improve my condition. Therefore, the best treatment is to wear compression socks and elevate my legs as much as possible. I am following my cardiologist’s advice.
I recently read a recommendation to take horse chestnut seed extract (Aesculus hippocastanum) and to look for products that have had the toxic substance esculin removed. I discussed this with my cardiologist’s physician assistant, and she saw no reason not to try it. What do you think? – M.P.
ANSWER: Some years ago, I saw a well-done study showing that horse chestnut extract is an effective treatment for the swelling associated with venous insufficiency. The dose usually studied has been 300 mg of the extract, standardized to 50 mg of escin, twice daily. The side effects noted in studies have been both infrequent and mild, and I have had several patients try it.
Unfortunately, my patients’ experiences have not been successful. I don’t know whether that was just bad luck that I had patients who didn’t respond, or whether they did not get an effective medication.
One big problem with herbal treatments in the U.S., which are sold as dietary supplements, is that the purity and standardization cannot be guaranteed. They are not well regulated, as compared with pharmaceuticals. I am sure there are ethical manufacturers who follow good practices, but the literature on supplements in general has shown that some products for sale do not contain the amount of the substance they purport to. There is no brand I feel comfortable recommending.
Nonetheless, I think it is reasonable to try, especially in combination with standard therapy, which includes compression stockings during the day and at least three sessions of raising the legs above the heart for 30 minutes at a time.
DEAR DR. ROACH: My 57-year-old son has been diagnosed with stage 1 pancreatic cancer. He has chosen not to have surgery, nor take chemotherapy or radiation. He has his own personal reasons and I respect that. Do you know of any other treatments, such as diet? – Anon.
ANSWER: Every person has the right to seek or refuse treatment. However, stage 1 pancreatic cancer is potentially curable with surgery, and time is of the essence. Many people have changed their minds about seeking standard treatment only after alternative treatment fails and their disease progresses. While I understand your respect for his decision, it is hard for an outsider like me to see someone refuse potentially curative treatment for a disease that will shortly become incurable in all likelihood. Hopefully his decision was made based on a thorough and careful review of the facts.
While a healthy diet, herbs, massage and other therapies may be helpful in making people feel better, there is no good evidence that they will cure this terrible disease.
Dr. Roach regrets he is unable to answer individual questions, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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