Integrated Treatment for FILARIASIS &LYMPHOEDEMA

We combine Allopathy,Ayurveda,Homoeopathy,

Yoga and Physiotherapy to treat Lymphoedema .

please visit :

http://www.lymphovenous-canada.ca/shleepadaregieme.htm

Lymphology, USA based official organ of international society of lymphology has written an editorial on Integrated Dermatology treatment developed inKerala. Click here http://www.u.arizona.edu/~witte/contents/2007.40.1.witte.pdf

A low cost treatment protocol was outlined by Vaqas & Ryan (2002)  to replace the high cost systems of management, termed complex decongestive physiotherapy (CDP), originating in Europe.  Their low cost management technique for resource poor settings suggests improving the lymphatic flow by accentuation of physiologic mechanisms of lymph drainage and good skin hygiene.  Based on their outline, initially a case study was conducted at the Institute of Applied Dermatology on a 60 years old female patient with 36 years duration of lower limb lymphoedema. We undertook this larger study with an aim to develop an effective and alternative method of treatment to achieve the morbidity reduction at low cost in filarial lymphoedema patients. In Ayurveda, filarial manifestations are described as Shleepada, from the Sanskrit terms Shila = stone and Paada = foot, i.e. stony appearance of the foot.  Now we have succefuly treated over 350 patients of lower limb lymphodema and published finding in World’s leading journals on lymphology

TREATMENT METHODOLOGY:The treatment included an initial 14 days of hospitalization followed by 6 months of treatment at home.

Patients are admitted in a KPO (Knowledge process outsourcing) hospital, of Institute of Applied Dermatology. Baseline data are recorded on indicators of improvement and the status of the skin was documented with photographs. The entire team attending the patient makes the baseline assessment of the patient.  The Ayurvedic doctor selects the ayurvedic herbal medicines used for the patient after discussions with the dermatologists in the team. In the case of multiple nodules on the limb, the homeopathy doctor selects their drugs after discussions with the other members of the team. Before the onset of treatment, each patient’s management strategy and details are discussed in the team. In case of difficult cases details are being e-mailed to Prof Terence J Ryan, Emeritus professor, department of dermatology, Oxford Medical School and member of the lymphatic filariasis-working group on clinical management trials under GAELF for his agreement & advice. 

DIFFERENT  STAGES OF TREATMENT :

Skin care measures: this includes treating the skin with ayurvedic skin tonic called phanta. Yoga Pretreatment: Following the phanta soaking, a series of yoga exercises are performed.  Pre and post treatment yoga exercises are taught to the patient by a yoga therapist with special attention to breathing co-ordination. Pre and post treatment yoga exercises are performed as explained in English translations of classical yoga texts. A yoga therapist who spends 2-3 hours a day with the patient, coaches yoga exercises.  A CD-rom containing the complete details of yoga exercises is provided to the patients. Manual lymph drainage of central lymph nodes, a mandatory pre treatment procedure as part of Foldi’s complex decongestive physiotherapy practiced in Germany is not performed in our patients. Instead, series of Yoga exercises done. Indian Manual Lymph drainage (IMLD): Immediately following pre treatment yoga patients are subjected to IMLD. Compression Bandaging: 20 minutes after IMLD compression bandages are applied using the products of an Indian manufacturer. Post treatment yoga: Post treatment yoga is done wearing the compression bandage and on an empty stomach

Pretreatment counseling is given using the power point presentation with evidence for the reduction in limb size and improvement in quality of life scores to all the patients as routine. Once convinced the patients are requested to fix a suitable date for their treatment.

 During the two weeks stay in the hospital the patient and a family member is trained to perform all these activities so as to carry them out at home.  Handouts containing the details are given in their local language. Comprehensive education about the importance of each component of ongoing therapy is given to every patient. Patients are strictly advised to stop monthly penicillin injections or antibiotics, if they take as a preventive measure for inflammatory episodes.   The diuretic Frusemide is discontinued unless the patient has signs of heart failure

CONTINUATION OF THERAPY: Patients are asked to perform all these procedures, everyday for six months in the sequence as trained during hospitalization.  In addition they are advised to take two oral medications of Ayurveda described for lymphoedema, as recommended by ayurvedic formulary of India.  DIET: Patients are advised to observe certain diet restrictions while on oral medications. They are advised to avoid cold water & cool drinks, milk and milk products, black gram, horse gram, cashew nut, ground nut, tamarind, jaggery, sesame and brinjal and to be strictly vegetarian in diet. 

FOLLOW UP:Patients are scheduled for follow up at 4 weeks, 12 weeks and 24 weeks following the discharge.  During each follow up, the patients shall demonstrate procedures; they are doing at home including all the exercises of yoga in order to perfect the procedures.

This treatment is to be carried out at home for life long

Three  national seminars held during 2005 2007& 2008   supported by Indian Council for Medical Research , Department of Science & Technology, New Delhi ,department of AYUSH New Delhi & Kerala State Council for Science, Technology and Environment, Thiruvananthapuram has approved this new treatment and recommended that the new treatment developed as through international collaboration may be  adopted for the national program