Lymphedema
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Lymph is the fluid
that is formed from the fluids that bathe and surround the
cells in the tissues of the body. This fluid is carried back
to the circulation through lymphatic vessels. When these
vessels do not drain properly the fluid collects in the
tissues causing edema, or more specifically
lymphedema. So, lymphedema is the swelling of tissue due to retention of fluid in the lymph vessels. Lymphedema can have many causes affects 175 million people worldwide, and can lead to infection, pain, severe disability and even increased risk of cancer. It is a disorder which is traditionally very difficult to treat. So you can realize why I was pleased to read the studies that were done with Wobenzym® treating lymphedema. What I found, was that a number of studies specifically looked at the affect that Wobenzym® has on lymphedema. It was noted that there was significant reduction in pain and swelling with a lower risk of infections. Even primary lymphedema (hereditary lymphedema) showed significant improvement. From FREQUENTLY ASKED QUESTIONS, with answers by Joseph J Collins, RN, ND Read the special section: : CARVIOVASCULAR AND LYMPHATIC SYSTEMS & WOBENZYM® |
What the literature says about Systemic Enzyme Support and:
Diagnosis
and treatment of Lymphedema
Wald M. Diagnosis and treatment of lymphedema. Interní medicína pro
praxi 2003, č. 8, str. 415-417.
Definition and etiology of lymphedema is briefly explained as well
as stages of the disease and possible complications. Clinical
finding and suitable examination methods are described.
Determination of lymphedema diagnosis is schematically depicted.
Medicamentous treatment using systemic enzyme therapy preparation
Wobenzym is mentioned in addition to physiotherapy.
Lymphedema.
Kafková H., Kojanová M. Lymphedema. Postgraduální medicína 2003, 5
(6), pp. 626 – 633
The
authors describe in detail lymphedema as an edema owing to an
impaired lymph transport caused by interruption of lymphatic routes,
infection or congenital abnormity. Moreover, possible complications
of lymphedema, mainly development of secondary infections, are
mentioned. An early and correct diagnosis using lymphoscintigraphy,
ultrasound and CT examination is stressed both in primary and
secondary lymphedema. Systemic enzyme therapy using combined
mixtures of proteolytic enzymes (chymotrypsin, trypsin, bromelain,
papain etc.) represents an effective treatment modality in
pharmacotherapy of lymphedema. Enzyme therapy can improve already
indurated and sclerotized tissue even in fully developed lymphedema.
Based on the results of clinical trial in patients after breast
cancer surgery it has been suggested that beginning of enzyme
treatment immediately after surgery is an optimum therapeutic
approach.
Poster Reference Number 40.
Systemic enzyme therapy and complex decongestive therapy in the
patients with primary and secondary lymphedema of lower extremity
Dzupina A., Morvay P., Dzupinova M. Systemic enzyme therapy and
complex decongestive therapy in the patients with primary and
secondary lymphedema of lower extremity. Lymfo 2000, Praha 13. - 14.
10. 2000. Praktická flebologie - supplement 2000, Roè. IX, str.
23-27. (17-13-2)-(17-12-1)
Summary:
The
goal of this trial is the evaluation of Wobenzym efficiency as an
additional therapy to the standard treatment of lymphedema. Two
groups of patients were observed: 12 women with primary lymphedema
of lower extremity (group I.) and 20 women suffering by secondary
lymphedema following erysipelas. The diagnosis of lymphedema was
confirmed by clinical examination, duplex sonography, radionuclide
lymphoscintigraphy, and by CT and MRI eventually. Complex
decongestive therapy (CDT) was used as a standard treatment
including manual lymph drainage, sequential gradient pneumatic
therapy, a bandaging and special exercises with aquatherapy. After 4
weeks of CDT both groups were randomly divided in two halves. The
subgroups I. A, II. A continue the treatment by CDT only. Subgroups
I. B and II. B received Wobenzym 3x3 tablets daily additionally to
CDT. The treatment of all groups continued following 6 weeks.
During the observation subjective symptoms were estimated by
questionnaire method, extremity volume differences and centripetal
fraction of venous flow were measured. Serum levels of liver
enzymes, creatinine and minerals were checked.
In
the groups receiving Wobenzym a statistically significant
amelioration of all objectives were evident comparing to groups
treated by CDT only. The comparison of control visit results after 4
and 10 weeks of treatment - subjective symptoms I. B p < 0,0004, II.
B p < 0,0002, extremity volumes I. B p < 0,005, II. B p < 0,003,
centripetal fraction of venous flow I. B p < 0,005, II. B p < 0,003.
The
treatment results in the patients with secondary lymphedema were
better then the results in the patients with primary lymphedema.
Nevertheless the results of the primary lymphedema patients showed
statistical significance what is remarkable in this type of
lymphedema with a generally known worse curability.
Key words: lymphedema - complex decongestive therapy - Wobenzym
Orally administered proteases in aesthetic surgery.
Dusková M, Wald M. Orally administered proteases in aesthetic
surgery. Aesthetic Plast Surg. 1999 Jan-Feb;23(1):41-4.
Increasing demand for shortening the sequel period after aesthetic
surgery hasled to comparative testing of optional approaches.
Systemic enzyme therapy withits pharmacological effects represents a
preventive and curative option forinflammatory process including
healing. Excellent results were presented, namely,in the treatment
of secondary lymphoedema. The incidence of hematoma, edema, and pain
was followed, and the results were compared in a randomized group of
20patients with upper eyelid blepharoplasty treated with proteases
(Wobenzym drg)and in a similar group treated with systemic antiedema
and hemostyptic therapy(Dicynone drg and Reparil drg). No
undesirable side effects were observed. Inaddition, proteases
apparently have no limitation for patients with the risk
ofconcurrent cardiovascular, hepatic, or renal diseases.
External Link:
PMID: 10022937
Proteolytic enzymes in lymphedema therapy
Dzupina A., Morvay P., Dzupina M. Proteolytic enzymes in lymphedema
therapy. 41st Annual World Congress - ICA'99, International College
of Angiology, Sapporo, Japan, July 3-10, 1999, Scientific Posters
pp. 76 601 KA
Department of Internal Medicine,City Hospital, Bardejov, Slovak
Republic Department of Immunoallergology, City Hospital, Bardejov,
Slovak Republic
Purpose: The goal of this study was to establish the effect of
Wobenzym in lymphedema therapy.
Material and Methods: Clinical examination, duplex sonography,
radionuclide lymphoscintigraphy, CT and MRI
established the diagnosis of lymphedema in 50 patients (12
primary, 38 secondary). After 4 weeks of standard treatment
consisting of manual lymph drainage, bandaging, sequential gradient
pneumatic therapy (Pneuven Bevuk), and special exercise therapy
including aqua therapy, 25 randomly selected patients continued in
standard therapy and 25 received 9 Wobenzym tablets daily for 6
weeks. A Wobenzym tablet contains pancreatin 100 mg, bromelain 45
mg, papain 60 mg, triacylglycerol lipase 10 mg, amylase 10 mg,
trypsin 24 mg, chymotrypsin 1 mg and rutoside 50 mg. Patients had
monitoring for common symptoms of pain, feelings of heaviness and
decreased mobility; extremity volume changes; and, serum levels of
liver enzymes, creatinine and minerals. Duplex sonography was used
to determine the centripetal fraction of venous flow.
Results: Wobenzym-treated patients noted significant beneficial
effects in subjective symptoms (56%, p < 0.005), reduction of
extremity volume (55%, p <0.005), duplex sonography measurements
(43%, p < 0.005) compared with the non-Wobenzym group.
Conclusion: Adding Wobenzym to complete standard therapy
significantly improves subjective and objective parameters of
lymphedema. No adverse effects or significant changes in laboratory
data were observed.
Poster Reference Number 43.
Wobenzyme and diuretic therapy in lymphedema after breast operation.
Korpan MI, Fialka V. Wobenzyme and diuretic therapy in lymphedema
after breast operation. Wien Med Wochenschr. 1996;146(4):67-72;
discussion 74.
The
authors of this clinical study report the results of a controlled
clinicaltrial in randomized parallel groups (Wobenzym vs. diuretics)
of 55 femalepatients suffering from brachial arm lymph edema
subsequent to ablatio mammae.All patients received manual and
machine lymph drainage as well as gymnastics as concomitant therapy.
After 7 weeks of therapy the results of the volometricassessments of
the arm, the circumference of the arm and the skinfold
thicknessshowed significant improvements compared to diuretics. In
addition, the patients receiving Wobenzym reported a significantly
higher proportion of patients free ofpain compared to the diuretics
patients. Overall safety assessment results aresatisfactory thus
resulting in a superior benefit/risk relation of the Wobenzymgroup.
External Link:
PMID: 8650941
Efficacy and tolerability of proteolytic enzymes as an
anti-inflammatory agent in lymphoedema after axillary dissection due
to mammary cancer
Kasseroller R., Wenning H.G. Efficacy and tolerability of
proteolytic enzymes as an anti-inflammatory agent in lymphoedema
after axillary dissection due to mammary cancer. The European
Journal of Lymphology, 2002-2003, Vol. 10, No. 37-38, pp. 18-26,
Lymphoedema is a chronic disease caused by the damage of lymphatic
vessels due to surgical treatment and/or radiotherapy (secondary).
Another cause is the malformation or lack of lymphatic vesels
(primary).
The
aim of the study was to demonstrate the efficacy and tolerability of
the proteolytic enzyme combination preparation Wobenzym in
additional reduction of arm volume (primary criterion) in patients
with secondary lymphedema after dissection of axillary nodes due to
mammary cancer. Secondary criteria were improvement of the skinfold
thickness, CRP values, tension, and global judgement of the efficacy
by both investigator and patient.
The
study population comprised of 88 female patients aged between 30 and
80 with one sided secondary arm lymphedema after dissection of the
axillary lymph nodes (level I or II according to the St. Gallen
consensus conference) due to mammary cancer, who have been treated
with combined decongestive therapy. All patients received the
standard treatment - a combined decongestive therapy, comprising the
manual lymphatic drainage on affected sites with consecutive
bandaging of the affected arm and specially designed exercises and
skin care from day 1 to day 20. The test group of patients received
additionally Wobenzym at a dose of 5 coated tablets three times
daily over 6.5 weeks.
Both treatment groups were well comparable. The median time between
the lymph node dissection and the baseline visit was 47.5 months in
the Wobenzym group and 48 months in the placebo group.
For
measuring the indicator volume reduction in arm lymphedema, a
Volometer was used. For the indicator tension, a four point rating
scale was used. All the measurements were carried out on days 1, 9,
19, and 45 (final visit). CRP value was measured on days 1 and 19.
On
the ill arm both groups showed a decrease of volume until visit 4
(day 45).
Both groups showed an almost identical course of the volumetric
development between baseline visit and final end point visit,
although there was a slight superiority of Wobenzym for the
development between visit 3 and 4 with regard to the percent changes
of –5% and more without statistical significance.
Both groups showed the greatest decrease of skinfold thickness
between visits 2 and 3 with a very similar development between
baseline visit and final visit with regard to the results of the ill
arm. The results of the
percent changes from baseline with regard to visit 2, 3, and 4
showed a mean reduction by –29.84% for the verum group and –15.73%
for placebo group. The development between visit 3 and 4 showed only
slight superiority for the verum group.
Both groups showed an almost similar decrease of tension in the ill
arm until visit 4. A percent change of 100 % (total improvement) was
reached by 62.79 % patients in the Wobenzym group and by 47.62 %
patients in the placebo group. The percent changes between visits 3
and 4 – time where no concomitant combined decongestive therapy was
applied – showed a clear superiority of the Wobenzym treated
patients.
CRP
was measured at visit 1 (baseline) and 3 (day 19). Wobenzym group
showed better results than placebo group with regard to the CRP
development between baseline visit and visit 3: out of 15 patients
with high baseline findings five patients normalized in the Wobenzym
group.
Out
of 13 patients with high baseline findings in the placebo group,
only one patient normalized. For patients with high CRP-values at
baseline there has been mean percent change from baseline of –39.8%,
while in the placebo group –17.4%.
There was a clear superiority for the verum group with regard to the
CRP development between visit 1 and 3.
Overall, 15 adverse events were recorded, 7 for the verum group and
8 for the placebo group. The adverse events in the verum group were
all gastrointestinal complaints of moderate intensity and rated as
possibly (6 cases) or definitely (1 case) related to the study
medication. All the patients showing adverse events completely
recovered without sequelae.
All
in all, the study failed to demonstrate efficacy in edema-related
criteria (most likely due to extensive concomitant physical therapy
in all patients) but demonstrated efficacy of Wobenzym with regard
to the inflammation-related criteria. The inflammation-related
criteria showed more than small superiority of Wobenzym. Moreover,
for the subgroup “no chemotherapy” the inflammation-related criteria
showed more than medium-sized superiority of Wobenzym. Reduced
inflammatory tissue conditions are the basis for minimizing fibrosis
thus preventing further inflammation and infection.
Poster Reference Number 45.