A patient with a Barrett oesophageal carcinoma and a resection of the oesophagus with gastric pull-up developed swallowing disorders 6 years and 2 months after the operation. Within 1 year and 7 months two recurrences of the tumor at the anastomosis were found and treated with combined chemoradiotherapy or chemotherapy respectively. 7 years and 9 months after the operation local tumor masses and destruction were present with no ability to orally drink or eat (full feeding by jejunal PEG tube): quality of life was poor, as saliva and mucus were very viscous (pulling filaments) and could not be swallowed and had to be spat out throughout the day and night resulting in short periods of sleep (awaking from the necessity to spit out). In total the situation was interpreted more as a problem related to a feeling of choking (with food or fluid) in the sense of a functional dysphagia rather than as a swallowing disorder from a structural stenosis.
At that time a liquefying substance – acetylcysteine (2 times 200 mg per day, given via the PEG tube) – and irradiation with water-filtered infrared-A (wIRA), a special form of heat radiation, of the ventral part of the neck and the thorax were added to the therapy. Within 1 day with acetylcysteine saliva and mucus became less viscous. Within 2 days with wIRA (one day with 4 to 5 hours with irradiation with wIRA at home) salivation decreased markedly and quality of life clearly improved: For the first time the patient slept without interruption and without the need for sleep-inducing medication. After 5 days with wIRA the patient could eat his first soft dumpling. After 2½ weeks with wIRA the patient could eat his first minced schnitzel (escalope). The ability to swallow concentrated/incrassated fluids, more in the sense of an eating than a drinking, was regained.
Following the commencement of wIRA (with typically approximately 90–150 minutes irradiation with wIRA per day) the patient had 8 months with good quality of life with only small amounts of liquid saliva and mucus and without the necessity to spit out. During this period the patient was able to sleep during the night.
In the mentioned patient case the decrease of hypersecretion (hypersalivation) and the overcoming of a swallowing disorder (interpreted for most of the time span more as a problem of choking in the sense of a functional dysphagia rather than as a swallowing disorder from a structural stenosis; swallowing as a complex nerve function), possibly interpretable as regeneration of nerve function, were the two most important underlying effects of wIRA concerning improving his quality of life.
The patient clearly benefited from some general features of wIRA: All irradiations of the patient with wIRA were done at home and were contact-free without the use of expendable materials and were felt to be pleasant. A moderate irradiance was always used by choosing enough distance between radiator and uncovered skin (see Figure 2), approximately two times the length of the distance rod (distance rod = minimum irradiation distance). After receiving instructions in proper and safe use of wIRA the patient could easily apply wIRA at home by himself. This allowed long daily irradiation times and use of wIRA even at weekends and avoided the necessity of visiting a physician or a physiotherapist with a wIRA radiator for each treatment, thereby saving both time and money.
The main physiological effects of water-filtered infrared-A (wIRA) are: wIRA increases tissue temperature, tissue oxygen partial pressure and tissue perfusion markedly.
The five main clinical effects of wIRA are: wIRA decreases pain, inflammation and exudation/hypersecretion, and promotes infection defense and regeneration, all in a cross-indication manner. Therefore there is a wide range of indications for wIRA.
The effects of wIRA are based on both its thermal effects (relying on transfer of heat energy) and thermic effects (temperature-dependent effects, occurring together with temperature changes) as well as on non-thermal and temperature-independent effects like direct effects on cells, cell structures or cell substances.
It should be emphasized that in this case report wIRA was used only symptomatically and not as part of a causal therapy, although wIRA can be combined successfully in oncology with radiation therapy or with chemotherapy.
Besides in a variety of other indications for wIRA, in cases of swallowing disorders (functional dysphagia) and hypersalivation or hypersecretion of mucus the use of wIRA should be considered as part of the treatment regime for improving a patient’s quality of life.
Prof. Dr. med. Gerd Hoffmann
Institute of Sports Sciences, Johann Wolfgang Goethe University, Ginnheimer Landstraße 39, 60487 Frankfurt/Main, Germany, Phone+Q: +49-6181-62287
Publication (freely available):
 Hoffmann G. Water-filtered infrared-A (wIRA) overcomes swallowing disorders and hypersalivation – a case report. GMS Ger Med Sci. 2017;15:Doc11.
DOI: 10.3205/000252, URN: urn:nbn:de:0183-0002523
http://www.egms.de/de/journals/gms/2017-15/000252.shtml (shtml, German)
http://www.egms.de/en/journals/gms/2017-15/000252.shtml (shtml, English)
http://www.egms.de/pdf/journals/gms/2017-15/000252.pdf (PDF, English and German)
Extensive presentation of a variety of applications of water-filtered infrared-A (wIRA) (besides swallowing disorders) (in German with abbreviated English review) is freely available from:
Legend concerning Figure 1:
Comparison of the spectra of the Sun, a radiator with water-filtered infrared-A (wIRA) and of two different halogen radiators without water-filter: the three different radiators with their depicted spectral irradiances cause the same skin surface temperature. For certain clinically relevant wavelengths, such as 820 nm, the applicable irradiance can be 6-30fold compared to infrared lamps without water-filter.
Legend concerning Figure 2:
Irradiation with water-filtered infrared-A (wIRA) at home.