Dr. ROACH: Apple cider vinegar helps blood in urine

DEAR DR. ROACH : Recently, I had anal cancer and was treated with chemo and radiation. The radiation burned my insides and severely damaged most of my internal organs. One of the aftereffects was occasional blood and small clots in my urine. A few months ago, both the frequency and amount of blood, especially the clots, increased dramatically. The size and number of the clots got so large that they blocked my urethra.

During a visit to my urologist, he looked into my bladder and declared it “angry.” Then he told me the same thing every doctor has told me about every problem caused by my treatment: “It was caused by the radiation, and there is nothing that can be done.”

Shortly after this, I began to take unfiltered apple cider vinegar in hopes that it would improve my digestive problems. It helped a little, but the big difference was that I have not had a single recurrence of either blood or clots in my urine. Can you tell me if this is due to the vinegar or if it is just a coincidence? — A.G.

ANSWER : No, I can’t definitively tell you whether the vinegar helped. It was probably by chance, but let me explain a little about it.

Rectal cancer is often treated with radiation, or combined chemotherapy and radiation, either prior to or after surgery. The dose of radiation is quite high compared to some other cancers, and the complications can be significant.

In addition to damage to the bowel and bladder, radiation treatment can damage the bones and bone marrow, leading to poor blood-cell production, infertility, premature menopause, and more cancer years later. On the other hand, radiation is used when it is expected to improve the cure rate of cancer. Still, the side effects can be challenging.

Hemorrhagic cystitis (bleeding from the bladder) can be caused by chemotherapy or radiation. It may start within a few months or as long as 20 years after radiation.

I am surprised your urologist did not offer any treatments, as there are certainly ones available. Although none of the currently available systemic drugs are proven to be very effective, hyperbaric oxygen is one treatment that is, at least, moderately effective. Medicines placed into the bladder and laser bladder treatments are sometimes tried as well.

I was unable to find any study that evaluated the effectiveness of apple cider vinegar. I am skeptical, but reports like yours of apparent improvement associated with its use might convince a researcher to conduct a study to determine whether it really is effective.

Gabapentin helps with neuropathy

DEAR DR. ROACH : I am presently taking 300 mg of gabapentin once daily for neuropathy, which had become increasingly severe with burning, itching, and pins and needles. It is helping, but not 100%. I still need ice packs at night for relief sometimes. Do you have any suggestions for alternative treatment? — B.R.

ANSWER: Gabapentin is an effective drug for painful neuropathy, whether the cause is known or not. However, its side effect of sedation limits its use, and the medicine needs to be advanced slowly to be tolerated.

In my experience, 300 mg once daily is not adequate for most people, but 300 mg three times daily is effective for many. The recommended dose in one type of severe neuropathy, postherpetic neuralgia, is 1,200 mg three times daily. It may take months to be able to get to this dose.

I have also had some success with anti-inflammatory medicines as an adjunctive treatment.