Ibuprofen and LE

Hi, Bomber!

(I know your name is Debbie, but I love "Bomber" -- really packs a wallop!)

Okay, it appears that a rare but possible site-effect of all the NSAID's is fluid retention (from what I can make out, generally in the legs and feet), caused by fluid leakage from the blood vessels (this is a very rough description, you understand!) Which is not LE and is treated with diuretics. So there's the potential for Ibuprofen to cause extra swelling. If it seems to be doing that you might want to stop using it and see if that helps. Stopping is probably better than taking diuretics, which are hard to regulate with LE because you don't want to wring the water out of your tissues and leave the large protein molecules behind to clog up your arm.

Our friend Pat O'Connor (LymphedemaPeople), who has LE in his legs, can't use Ibuprofen at all or his legs swell up.

Does that help any? Anything to stop the "Swelling of the Lymph Nodes following Surgical Removal of the Breast," right! (Good grief!)

I'll keep looking and report back if I find out anything startling.

Be well!
Binney

Hey Everyone

The lymphatics move fluids through muscle action and through minute contractions of the lymphatic system.

Ibuprofen and all NSAID's cause these contractions to cease, thereby contributing to the fluid retention.

I loved the liquid gel ones, but had to stop because it just make the swelling worse. 

Pat

 (Lymphedema People)

Okay, so now I'm really confused.

I was just starting to believe some of the papers I've read lately that hint at an association between LE and previous or concurrent inflammation.  Some papers even suggest that inflammation plays an important role in persistent LE.

Try googling "lymphedema" and "inflammation", and you'll see what I mean.  Although most of those papers are still very early and are dealing with pathogenesis of LE rather than its treatment, it didn't take me long to start thinking maybe NSAIDs and other anti-inflammatory drugs might help relieve the swelling of LE.

Here's an example of some of the stuff I've read.  Ironically, the page is from the "Lymphedema People" website:  http://www.lymphedemapeople.com/phpBB3/viewtopic.php?f=6&t=1116

So, along comes this thread, with supportive statements from Lymphedema People, saying that ibuprofen is contraindicated in LE because it increases the swelling.

I went to my favorite pharm site, www.rxlist.com, to see if I could find a warning like the one Debbie got about her ibuprofen.  I read the whole entry for "Motrin", which is one of the old-time, high-dose, prescription forms of ibuprofen.  This is all I could find that might suggest an increased risk of swelling from ibuprofen: 

Hypertension

NSAIDs including MOTRIN tablets, can lead to onset of new hypertension or worsening of pre-existing hypertension, either of which may contribute to the increased incidence of CV events. Patients taking thiazides or loop diuretics may have impaired response to these therapies when taking NSAIDs. NSAIDs, including MOTRIN tablets, should be used with caution in patients with hypertension. Blood pressure (BP) should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy.

Congestive Heart Failure and Edema

Fluid retention and edema have been observed in some patients taking NSAIDs. MOTRIN tablets should be used with caution in patients with fluid retention or heart failure.

So, maybe people who already have systemic problems with fluid retention might see it worsen if they take high-dose ibuprofen.  But, does that risk also extend to those of us who take an occasional Advil for a stiff neck or headache?  And, what about the "new" theory that chronic inflammation may be a component of LE?  Wouldn't ibuprofen help with the inflammatory component?

I guess maybe I'll stop reading now.  I'm also thinking maybe each of us has our own group of factors that influence how we'll react to things...including ibuprofen.

otter 

otter, I do think this is partly an individual thing, but it's something to watch for if you're using motrin. Bomber, when you stopped taking it did you notice a difference in LE control?

I recall this being mentioned at the NLN Conference, but it wasn't suggested that it was contraindicated, only that it could have the effect of slowing the lymph system. As to there being an inflammatory component to LE, there certainly is. The presence of too much protein in the tissues sets up an inflammatory reaction that leads to fibrosis and the accumulation of fat beneath the skin. But whether this can be controlled by motrin or not hasn't, to my knowledge, been studied. I believe the Lymphatic Research Foundation has an special interest in this subject, but at this time they're not making any recommendations about a type of anti-inflammatory agent, much less a suggested dosage. And obviously if the motrin slows the lymph system, that's not gonna work for everyone.

On the other hand, what confuses me about this is that pain results in more swelling, so you'd think reducing the pain would reduce the swelling. And maybe it does for some of us, despite the effect Pat mentioned. Perhaps it's a balancing act, and some of us fall one way, and some the other.

Bottom line: know thyself! (Hmmm. I don't believe that was an original line....) If it makes you swell, stop using it.

Ruth, I'm really sorry about your rotten new diagnosis, but delighted that you're on your way to getting it under control. Please let us know how we can help! (((((Hugs!!!)))))

Be well!
Binney