"Buildup of protein-rich fluid causes inflammation, as the
body tries to break down the excess proteins.
Progression of the condition leads to chronic lymphedema, which no longer responds to elevation, gentle
exercise, or elastic compression garments." [Henkel
2002]
"Diuretics may be harmful because dehydration of soft tissues
may increase interstitial protein concentration
and potentiate
inflammation and tissue fibrosis." [Mortimer 1997]
"Lymphedema
remains an incurable consequence of axillary node surgery and radiation. It has
been defined
as an abnormal accumulation of tissue proteins, edema,
and chronic inflammation within an extremity."
[Grabois
199
-------
DIEURETICS AND LYMPHEDEMA:
A question that came up
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) circumstances."
Tony Reid MD
Ph.D
hypovolemia)
Muscle cramps
Renal disorders
Dizziness when
standing up
(orthostatic hypotension)
Heart rhythm abnormalities
(arrhythmias
Diuretics, often prescribed, usually make the lymphedema worse.
Diuretics are able to draw off the water
content of the edema while
the protein molecules remain in the tissue spaces. These proteins continue to
draw water to the edematous areas as soon as the diuretic loses its
effectiveness. These accumulated
proteins also lead to a higher
concentration of proteins in the edema fluid and cause the tissues to become
even more fibrotic and indurated. Benzopyrones for lymphedema have
been tried for many years, primarily
in other countries. Their
therapeutic effect as it relates to lymphedema continues to be debated.
Furthermore, the product lacks FDA approval.
body tries to break down the excess proteins.
Progression of the condition leads to chronic lymphedema, which no longer responds to elevation, gentle
exercise, or elastic compression garments." [Henkel
2002]
"Diuretics may be harmful because dehydration of soft tissues
may increase interstitial protein concentration
and potentiate
inflammation and tissue fibrosis." [Mortimer 1997]
"Lymphedema
remains an incurable consequence of axillary node surgery and radiation. It has
been defined
as an abnormal accumulation of tissue proteins, edema,
and chronic inflammation within an extremity."
[Grabois
199
-------
DIEURETICS AND LYMPHEDEMA:
A question that came up
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) circumstances."
Tony Reid MD
Ph.D
hypovolemia)
Muscle cramps
Renal disorders
Dizziness when
standing up
(orthostatic hypotension)
Heart rhythm abnormalities
(arrhythmias
Diuretics, often prescribed, usually make the lymphedema worse.
Diuretics are able to draw off the water
content of the edema while
the protein molecules remain in the tissue spaces. These proteins continue to
draw water to the edematous areas as soon as the diuretic loses its
effectiveness. These accumulated
proteins also lead to a higher
concentration of proteins in the edema fluid and cause the tissues to become
even more fibrotic and indurated. Benzopyrones for lymphedema have
been tried for many years, primarily
in other countries. Their
therapeutic effect as it relates to lymphedema continues to be debated.
Furthermore, the product lacks FDA approval.