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Dear Dr. Roach We are very fond of our family doctor. I was in to see him the other day, and it came up in conversation that he was going to be getting married this summer. We would like to acknowledge this event in his life with either a lovely card or a small gift. I know the old-school way of thinking is to never do things that are so personal when it comes to your physician. Do you think that still holds true today? — N.W.

Answer • Physicians are human beings, and a thoughtful card is always appreciated. Gifts can sometimes be OK, but the American Medical Association has some guidelines for physicians on accepting gifts. I agree with them and you might find them helpful:

Be sensitive to the size of the gift: Inappropriately large gifts should not be accepted.

Do not let a gift influence patient care.

Decline a gift that would present an emotional or financial hardship to the patient’s family.

Consider suggesting a charitable contribution in lieu of a gift.

I would add that sometimes rejecting a gift can be hurtful, and if accepting a gift conforms to the guidelines, I generally accept it with thanks.

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. 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.

Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.