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Lymphland International Lymphedema Online
| See also under Treatments for alot more information on diuretics. "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. |