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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 comments hit 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 diuret
ics 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 f
luid 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 e
xcessive 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 f
or 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
To participate in this survey click here and look for the results in upcoming eNews.
Breast reconstruction and pregnancy with lymphedema
Additional results were presented at the Healthtronix Lymphedema Conference in Dallas on the previous surveys of breast reconstruction and pregnancy with lymphedema. In the next eNews we will get that additional information to you.
Some of you may have been on our website recently and have seen our announcement of our new fitting clinic. This is the newest edition Peninsula Medical as added in our continuous strive to provide services, education and hope for the lymphedema community.
We have certified fitters on staff to measure and fit all of our products as well as for the patient that has an existing ReidSleeve product and would like the fit evaluated. Our production facility is within minutes of the fitting clinic so quick alterations can be made. We also have been able to measure patients for garments in the morning and have them return the same day to be fit.
This is ideal for patients who reside in the San Francisco, Monterey Bay and surrounding areas. Many of the eNews subscribers this is not ideal for, however, we felt we would let people know that this is available should you be in the area or vacationing in the area and would like to take advantage of this new service.
If you would like to check out more information on our fitting clinic click here.
The OptiFlow CS for the Lower Extremity!
Finally, after much anticipation and many requests Peninsula Medical has the OptiFlow CS available for the lower extremity. This has been in development and testing for a couple years, and finally we are happy to announce it's availability. We should be having some information up on our website shortly about this new product, so keep checking back on our main page under "latest products."
Modern Concepts in Identifying and Treating Lymphedema
Healthtronix Lymphedema Conference 2000
Peninsula Medical had several staff members present at this event and I wish to comment in addition to Dr. Reid's comments. I thank Healthtronix for the opportunity to participate in such a conference and all of us at Peninsula Medical thoroughly enjoyed the conference as well as learned more valuable information about lymphedema and the various surrounding issues. The event was well organized and we are looking forward to the 2nd annual Healthtronix conference! I encourage anyone who missed this conferenc
e to definitely slate their calendar for the next year.
Hats off to you Healthtronix!
Check out Healthtronix's website here.