LYMPHEDEMA DIURETICS TREATMENT
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Diuretics are not for Lymphedema
A class of drugs or other substance that promotes the formation and release of urine. Diuretics are used to decease the fluid volume in
the treatment of many underlying medical conditions. Commonly called a "water pill."
Examples of diuretics and the conditions they help treat:
chlorthalidone, Hygroton, Thalidone - a diuretic (trade names Hygroton and Thalidone) used to control
Edecrin, ethacrynic acid - diuretic (trade name Edecrin) used to treat edema
furosemide, Lasix - commonly used diuretic (trade name Lasix) used to treat hypertension and edema
indapamide, Lozal - diuretic (trade name Lozal) used in the treatment of hypertension
mannitol, Osmitrol - a diuretic (trade name Osmitrol) used to promote the excretion of urine
thiazide - any of a group of drugs commonly used as diuretics in the treatment of hypertension; they block the reabsorption of sodium in the kidneys
To understand why these agents ar not recommended for the treatment of lymphedema we must first start with a basic definition of edema and lymphedema.
Edema: Abnormal pooling or build up of fluid in tissues. Generally caused by underlying medical conditions such as hypertension, varicose veins, thrombophlebitis, congestive heart failure, kidney failure steroid therapy, inflammatory reactions, or injury or trauma.
Diuretics are used to assist in the correction of the base problem causing the edema.
Lymphedema: A disorder in which "lymph" collects usually in a limb as a result of a congenital, hereditary malformation of the lymphatic system, or is a result secondary conditions such as node removal for biopsies, damage to the lymphatics from radiation, injury or trauma or by parasitic infection. Diuretics cannot help the underlying condition of lymphedema.
Why not use diuretics for lymphedema?
Perhaps the single most important consideration is in the composition of the lymph fluid caused by lymphedema. The fluid i a protein-rich substance that provides a breeding and nourishment center for bacteria. This has to be removed to lesson the risks of cellulitis and lymphangitis.
This fluid also has to be removed so as to prevent the formation and progression of fibrosis as lymphedema advances through the various stages.
Diuretics remove none of this waste fluid.
Diuretics & 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
Penninsula Medical - "The Reidsleeve People"
Diuretics, Benzopyrones and Lymphedema
Diuretics ("water pills") are medications that removes excess water from your whole body. But they are generally NOT recommended for treating lymphedema. That's because they don't eliminate the protein that attracts and hangs onto the extra lymph fluid. Once you stop taking the medicine, the protein pulls the fluid back to your arm, and it swells up again.
It's best to first try treatments that specifically deal with your arm, and not your whole body. An occasional use of a diuretic before a special event, like an outdoor wedding, is not unreasonable.
On the other hand, you might have to use diuretics if you have certain medical conditions that cause general swelling throughout the body. These conditions include high blood pressure, congestive heart failure, or general edema.
Taking diuretics requires a doctor's supervision. Regular use of a diuretic also requires regular blood tests to make sure there is no problem with your blood chemistry.
Benzopyrones are used in Europe to treat lymphedema, but the Food and Drug Administration has not approved these drugs for use in the United States.
Coumarin is the most commonly used benzopyrone. (Don't confuse it with Coumadin, a blood thinner.) The manufacturer claims the drug helps to "eat up" proteins in stagnant lymphatic fluid, reducing both the water and the swelling. Therapists who use it say it can take weeks, maybe years, to experience the drug's benefits.
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Diuretics and Lymphedema
Excerpt - Norton School of Lymphatic Therapy
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. Some patients who have used the drug here in the United States have discontinued its use after having experienced adverse side effects.
Norton School of Lymphatic Therapy
Norton School of Lymphatic Therapy - Home Site
Index of articles of LYMPHEDEMA TREATMENT OPTIONS
Lymphedema Treatment Options
Manual Lymphatic Drainage (MLD) - Complex Decongestive Therapy (CDT)
Laser Treatment - Sara's Experience
Lymphedema Treatments are Poorly Utilized
Lymphedema Treatment Programs Canada
Short Stretch Bandages
Bandages and Bandaging
Light Beam Generator Therapy
Kinesio Taping (R)
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While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.
Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
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This page has been updated, for current information please see:
Diuretics are not for Lymphedema
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Page Updated: Reviewed Jan. 15, 2012