TREATMENTS- Pumps/Diuretics

Information is courtesy of: Lymphedema People http://www.lymphedemapeople.com Lymphedema Treatment - Compression Pumps - Lasers - Diuretics =============================================================== Compression pumps were at one time a standard of treatment for lymphedema. Due to complications and possible further damage to existing lymphatics, many are no longer in favor of using them. ------------------------------------------------------------- Extremity Pumps for the Treatment of Peripheral Lymphedema Report - Clinical Study Alberta Heritage for Medical Research http://www.ahfmr.ab.ca/hta/hta-publications/technotes/tn25.pdf ............................................ Compression Pumps: Frequently Asked Questions http://www.lymphedemapumps.com/FrequentlyAskedPump.htm ............................. The Role of Pneumatic Compression Pumps: preliminary results from a current study http://www.healthquest-nf.com/CompressonPumpsInfo.htm ............................. Compression Therapy with Bandages and Elastic Compression Garments http://www.nortonschool.com/pages/compressiontherapy.html ........................ CONSERVATIVE THERAPY FOR VENOUS DISEASE Helane S. Fronek, MD, FACP http://www.phlebology.org/topics.htm ------------------------------------------------------------ Laser May Reduce Arm Swelling After Mastectomy NEW YORK (Reuters Health) - The zap of a low-level laser seems to relieve some cases of chronic swelling in the arm that often occurs after a mastectomy, new research suggests In a study, swelling diminished significantly in nearly a third of women *****ceived laser treatment for the condition, known as lymphedema. "It's not a quick fix, but it does seem to help in some people and is not invasive," Dr. Colin J. Carati, the study's lead author, told Reuters Health"Lymphedema is a chronic and progressive condition for which there are few effective treatment options," explained Carati, who is at Flinders University in Adelaide, Australia. Low-level laser treatment has proved effective in improving wound healing and scarring, "so we decided to give it a try in lymphedema," he explained. In the trial, 61 women who had had a mastectomy were randomly assigned to receive one or two cycles of laser therapy or a sham therapy using a disabled laser. Laser therapy did not have an immediate effect on symptoms, but 2 to 3 months later, women who had undergone two cycles of laser therapy were more likely to have experienced improvements than women given the sham treatment, the researchers report in the journal Cancer. Swelling was reduced in about 31 percent of women in the laser group. Women who had undergone two cycles of laser therapy also had softer skin on their upper arm than women treated with the disabled laser. Hardening of the skin is an effect of lymphedema. Despite the reduction in swelling, laser therapy did not seem to improve the range of movement in the arm, according to the report. Also, there was no significant difference between the groups in quality of life and the ability to perform daily activities. Exactly how low-level lasers may relieve lymphedema remains a mystery, according to Carati. One possibility, he said, is that the laser has an effect at a cellular level, "possibly encouraging cells to work harder." According to the Australian researcher, lasers are rarely used to treat lymphedema outside of Australia. The treatment is under consideration by the U.S. Food and Drug and Administration, however, he said. The study was funded by an Australian government grant to Flinders University and RIAN Corporation, which makes the laser used in the study. SOURCE: Cancer, September 15, 2003 ------------------------------------------------------------ DIURETICS AND LYMPHEDEMA TREATMENT Modern Concepts in Identifying and Treating Lymphedema Healthtronix Lymphedema Conference, March 2000 First, I want to thank all the doctors, therapists and patients who attended the Healthtronix Lymphedema conference in Dallas. There were many good discussions and I enjoyed meeting our friends from across the country again. The conference was recorded on Video tape and we hope copies of this tape will be available soon. Healthtronix did an outstanding job of putting together this important event. During the course of the meeting I had the opportunity to ask the therapists and patients about their feelings about lymphedema and what advice they would give other patients. Several comment**** home and resulted in a very interesting exchange of thoughts and ideas. I have put some of those comments on our website. Consider them, agree or disagree and respond if you like. The results will be presented in our next eNews. One of the questions that came up at the meeting is whether diuretics should be used in the treatment of lymphedema. In my opinion, the answer is usually no. There are some exceptions and I will explain. Diuretics are one of the best treatments for patients suffering from edema of the legs due to congestive heart failure. When the right side of the heart does not work efficiently, the pressure in the venous system increases and this, in turn, results in increased pressure in the tissues and edema results. The edema is not from the lymphatic system and is not lymphedema. Diuretics, such as lasix, cause the kidney to eliminate water from the blood. This in turn reduces the pressure in the venous system and allows the edema to drain into the venous system. Unfortunately, when someone drinks additional water the fluid and edema returns and so many patients require fluid and salt restriction to have the best results. Diuretics must be given regularly to eliminate as much water from the blood system as possible and control the edema. In some case, even when high doses of diuretics are given, the edema cannot be controlled by drugs alone and compression garments can be of additional benefit for these patients. The lymphatic system can be completely normal and patients will still develop edema due to congestive heart failure. The lymphatic system drains through the lymph nodes and lymphedema generally arises due to an obstruction in the lymphatic system. This can occur due to surgery, radiation or trauma. Decreasing the pressure in the venous system by removing water from the venous system does not help reduce lymphedema. In fact, patients with normal cardiac function do not have excess tissue edema. As a result, fluid removed by diuretics must be replaced by oral intake to maintain a normal fluid balance and any reduction in fluid due to diuretics in normal people is temporary. Diuretics have no value for the treatment of lymphedema in patients who do not have edema due to congestive heart failure or other similar conditions. A patient could have a mixed condition where lymphedema is complicated by edema due to congestive heart failure. These patients may benefit from treatment with diuretics because of the mixed condition. Check with your doctor to see if you have some component of edema. Dr. Mortimer addressed this question in a recent publication in Angiology 48:87-91, 1997. He said, "Lymphedema, regardless of etiology, is essentially incurable but different therapy approaches exist which serve to contain swelling. The objectives of treatment are to reduce swelling, restore shape, and prevent inflammatory episodes, eg, recurrent cellulitis. There are essentially three main approaches to lymphedema treatment: physical therapy, drug therapy, and surgery. Any edema arises from an imbalance between capillary filtration and lymph drainage. The principle of physical therapy is to a) reduce excessive capillary filtration and b) improve drainage of interstitial fluid and macromolecules from congested regions to normally draining lymph node sites. This is achieved through a combination of compression, exercise, and if possible, massage. Control of recurrent inflammatory episodes can only be achieved through diabetic type skin care, a reduction in swelling, and if necessary, prophylactic antibiotics. Drug therapy comprises diuretics or the coumarin/flavonoid group of drugs. The use of diuretics for pure lymphedema is physiologically unsound but may be of use in edema of mixed origin and in palliative (cancer) cir****tances." Sincerely, Tony Reid MD Ph.D. http://www.lymphedema.com/mar00.htm