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To the Editor: The recent symposium by Ramani et al1 is a concisely written overview of the current management of chronic heart failure, surely to be of value to both the specialist and generalist. Absent from this review, however, is any mention of “Waon” or thermal therapy, likely in part because Waon therapy is not well known or appropriately used by most clinicians in the United States.
First described by Tei et al2 in 1995, the methodology of thermal therapy and its benefits for patients with chronic heart failure (CHF) have been detailed extensively in the literature.3-6 These studies demonstrate improved New York Heart Association classification, decreased heart size, improved cardiac function, lowered incidence of arrhythmias, reduced brain natriuretic peptide and norepinephrine levels, and improvement in endothelial function. Furthermore, although not germane to this article, additional benefits have been described for thermal therapy in several other diseases, including Sjögren syndrome, peripheral vascular disease, pulmonary hypertension, and fibromyalgia.
It is interesting to speculate about reasons for the failure to use this therapeutic modality in this country, including absence of any financial incentives, but clearly a deficiency in knowledge of Waon therapy plays an important role. A brief discussion of thermal therapy in CHF would have been appropriate in this symposium in Mayo Clinic Proceedings, especially because Tei's original research into this modality was done while he was an international fellow at Mayo Clinic.