THE LYMPHATIC SYSTEM OF THE HUMAN BODY - We love your lymphatics We want you to love them too!
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THE LYMPHATIC SYSTEM OF THE HUMAN BODY
We love your lymphatics
We want you to love them too!
WHAT WE’RE COVERING TODAY
• Leaders in the field of lipoedema!
• Do I really have Lipoedema?
• What causes Lipoedema?
• How is it treated?
• Conservative Management
• Intervention
• Where can I get more information?
LEADERS IN THE FIELD
- WITH GRATEFUL THANKS!
• Dr Stanley Rockson (Researcher Stamford University - USA)
• Dr Matthew Carmody (MD Harvard Medical School USA)
• Dr Karen Herbst (Endocrinologist & researcher Arizona College Hospital - USA)
• Catherine A Seo (PHD Phycologist & Lipoedema sufferer – The Lipoedema Project)
• Prof. Neil Pillar (Flinders University – Mr Lymphoedema Australia)
• Helen Eason (Lymphoedema Physio & PHD candidate Sydney University)
• Jen Sanderson (Lymphoedema Physio & PHD cand. – clinical advisor Medirent Australia)
• Dr Chris Lekich (Phlebologist, Liposuction – Brisbane)
• Dr Adrian Brooks (Surgeon, plastic & reconstruction - hands, burns, body)
DO I HAVE LIPOEDEMA?
- LIPOEDEMA HAS SPECIFIC SYMPTOMS
• Female (very rarely male as oestrogen based) May also include:
• Body shape: • Tender/aching/painful legs
• disproportionate lower/upper body • Cankels (cuffs at ankles)
• mostly pear/apple shaped
• Soft skin, often hypothermic (cooler)
• changed at puberty/pregnancy/menopause
• Upper arms (tuckshop lady arms)
• Can’t lose weight off affected areas
• Lymphoedema (legs & arms)
• CVI (chronic venous insufficiency)
• Bruise easily • Genetic history (most likely somewhere)
• Skin appearance: • Hypermobility (60%)
• mattress/orange peel/large dimples • Joint issues / painful knees
• subcutaneous nodules (rice/peas/pebbles)
• Migraines?
• Abnormal gait
Ref: Földi's Textbook of Lymphology: For Physicians
and Lymphedema Therapists
BODY SHAPE?
– DISPROPORTIONATE DISTRIBUTION
Copyright Helen Eason Physiotherapy
CVI?
CVI – chronic venous insufficiency
• Valve issues
• Leaking nutrients
• Can be internal and not visible!
Spider Veins Varicose veins
SKIN APPEARANCE Mattressing fat VS Cellulite * Will always have nodules
GAIT
Copyright Helen Eason Physiotherapy
CANKELS & ARMS
GENETIC HISTORY
• Autosomal Dominant
• Can come down through
male side of the familyMH2
HYPERMOBILITY
(60% LIPOEDEMA SUFFERERS - BELTRAN & HERBST 2017 – 4 PTS)
King Cobra pose
Copyright Helen Eason PhysiotherapySlide 11 MH2 Mel Horton, 27/09/2020
WHAT STAGE?
Some women progress to later stages quicker than others
Some women never progress to stage 3
Some women develop lipolymphoedema while others don’t
WE DON’T KNOW WHY!WHAT CAUSES LIPOEDEMA?
VEGF – Vascular Endothelial
Growth Factor
Macrophages – part of the body
immunity system (i.e. part the
lymphatic system) & are the main
source of the cytokine immune
response.
Copyright Karen HerbstROLE OF THE LYMPHATIC SYSTEM • Sewerage System of the body • Fluids - uptake and clearance that can’t get back into the blood vessels • Absorption of fats (long chain fatty acids) • Maintains blood volume • Immune response – responsible for Lymphocytes (B & T cells), antibodies, Stop & Memory cells, and maturing Macrophages.
WASTE MAINTENANCE • Collects & drains: 2-4L Lymph per day. • 100mls lymph drain from each arm daily = about a ½ cup of tea. • 200-300mls drain from each leg daily = about 1½ cups of tea. • Works at about 20% of capacity.
Body Anatomy
THE VENOUS BIT - CVI
THE VENOUS BIT – VEGF
Dr Chris LekichTHE INFLAMMATORY BIT – MACROPHAGES & GAGS
HISTOLOGY – FIBROTIC CELL ENCASING
THE LOOSE CONNECTIVE TISSUE LAYER (LCT)
- THE INTERSTITIAL MATRIXWHAT IT ACTUALLY LOOKS LIKE Normal fat is feel firm to the touch, whereas lipoedema fat is soft and squidgy – due to its high fluid content.
THE PF4 MARKER - LATEST RESEARCH BY DR ROCKSON
– AMINO ACID
– MEASURE OF MACROPHAGES
• Proves Lipoedema is a Lymphatic disorder
• If you don’t have secondary lymphoedema or
phlepolymphoedema and you have a high PF4%
you likely have Lipoedema (assuming other
symptoms & no other causes)
• Lipoedema recognised in USA and Europe but
not yet in Australia – this research should assist
recognition (but don’t hold your breath!)
• Testing at research stage and not yet available
https://insight.jci.org/articles/view/135109 generally.A NEW DRUG - RZL-012
• Raziel Therapeutics – Israel
• Kills cells so lysosomes work
• Currently under trials in USA
• Conducted by Dr Karen Herbst
• Good for Dercums/Lipomas
• May be tricky for smaller Lipoedema nodules
• Phase III trials 2022
• https://medium.com/@thecarolnogueira/a-new-drug-
could-treat-dercums-disease-and-lipedema-2fedfcb5c3beHOW DO WE TREAT
LIPOEDEMA?
Conservative Treatment
Emotional support
Nutrition
Manage Pain & Exercise
Improve lymphatic flow
Intervention Treatment
Bariatric
Vein work
Liposuction
https://www.fatdisorders.org/treatments-summaryWHY SHOULD I DO ANY OF THIS?
• Likely continuous increase in size
• Brings additional risks:
• Diabetes
• Joint issues
• Heart issues
• Pregnancy issues
• Lipoedema is a disease – think of it like diabetes – it requires daily management
• Make a positive decision to adjust your lifestyle – small stepsPREGNANCY SURVEY RESULTS
REPLIES COMMENTS
• 6 replies / 5 had issues • “I was a blimp”
• Avg weight gain 20kg – some fat some • “There was nothing radiant about me”
fluid
• “I sloshed when I walked”
• Generally - more kids, more weight gain
• “My thighs got big”
• Avg loss time 11 months ( 2 – 60 mths )
• 1 gestational diabetesEMOTIONAL SUPPORT - #1 • Firstly - its NOT YOUR FAULT!! • Come to coffee mornings to meet other sufferers • Educate spouses/family/friends so they can support you • Educate your GP/surgeons/health workers/people in the street! • Join patient groups/facebook • Consider counselling • LOVE YOURESELF
THIS GUYS LOVES HIMSELF
NUTRITION - #2
• RAD diet
• Keto diet/Keto adjusted diet
• Paleo diet
• Anti-inflammatory diets
• Avoid salt
• Avoid simple carbohydrates
• Take supplements (with GP approval)
• Vit C/Vit D/Diosmin (flavonoid)
• Reed RK, Berg A Gjerde EA, Rubin K, Nemin Nephrol
2001;21:222-30
• Lympoedema & Lipoedema Nutrition Guide
https://www.angusrobertson.com.au/books/lymphedema-and-lipedema-nutrition-
guide-mandy-kenyon-emily-iker-linda-anne-kahn-dorothy-d-sears-chuck-ehrlich-
karen-louise-herbst-elizabeth-jane-mcmahon/p/9780976480686?zsrc=dsa-
feed&gclid=EAIaIQobChMI0pblr4aJ7AIV1KuWCh3NSgHAEAAYASAAEgI0tPD_B
wE
Karen HerbstMANAGE PAIN & LYMPHATIC FLOW - #3
• Rest with legs up at the end of the day • Exercise
• Wear compression (Bioflects) • Build muscle strength (quads)
• Warm up AND down!
• Get MLD
• Start slowly and work upwards
• Vibrate & Pump • Aquarobics
• Medications • Walking
• Lymphatic yoga
• Rebounding
• Cycling
• PilatesVIBRATE – GET A WOBBLE GOING
• Loosens LCT
• Separates Lipids
• Frees up fluid ready for transport
• Start slow, 5-10mins
• Work up to 20-30 mins
• Follow with pump
• What’s the best one to buy?
https://www.biohackerslab.com/reviews/best‐whole‐body‐vibration‐machine/THEN PUMP
- LYMPHAPRESS OPTIMAL WITH BI-LAT PANTS
• Moves fluid
• Stretches pre-adipocytes (inhibits full
adipocyte growth)*
• Body spends energy on ECM
remodelling/healing, not fat storage*
* Mariman & Wang. Cell Mol. Life Sci. (2010) 67:1277-1292
Bi-lateral pants lite $1165
• Start low pressure – up by 10s
• Start short 10-15mins – up to 60mins
• WEAR Bioflects
Optimal pump $1600
Bi-lateral adjustable pants $1640ABDOMINAL POSITION IMPORTANT
- WEAR BIOFLECTS/GARMENT/MOBIDERM
- ADDED BENEFIT OF FIBROSIS MANAGEMENTINTERVENTION - HOW DO I START
• Formal Diagnosis
• Lymphoedema Physio/OT/Nurse
• RMT referral & GP
• See Dr Keji
Oak Family Practice
Shop 6-7
5 Pipit Close
Huntingdale
WA 6110
Tel: 9490 3113CONSIDER BARIATRIC SURGERY • Gastric band/sleeve • Lose 5 BMI points to qualify for Medicare rebate ($3K?) • Need proof if can’t – BIS testing can help
CONSIDER VEIN WORK
• NO stripping or cut & strip! Dr Lekich recommends:
• Laser / Sclerotherpy (glue) only • Dr Matar – The Vein Clinic Subiaco
• 5 day recovery • Imaging and vein work on site
• 6 weeks for new vessel growth • Need GP referral for medicare rebate
• Done under twilight • Private clinic
• PRIOR to Liposuction • Consider costs
• Imaging $216
• Consult $ 225
• Per Leg costs $1000+ out of pocket
- Medicare contributes $1615VEIN WORK – WILL INCREASE INFLAMMATION TEMPORARILY
CONSIDER LIPOSUCTION
Liposuction only
• Tuminescent only (not laser/ultrasound)
• Water based with adrenolin
• Carried out under twilight
• Quick recovery 2-3 weeks
• Wear garments & MLD/pump
• May need later excess skin removal
Renuvion skin tightening?
With Skin Reduction
• Water based liposuction
• With excess skin removal
• General anaesthetic
• Longer recovery 4-6 weeks
• Requires scrupulous cleanliness
• Wear garments & MLD/PumpPOSSIBLE SURGEONS
Liposuction only: With (or without) Skin Reduction:
• Dr Lekich (Gold Coast Qld) • Dr Adrian Brooks
• $13,500 / thigh/abs/buttocks • Costs $10,000 for both thighs
• Dr Lansa – Perth clinic Dr Wong • + Overnight hospital
• $3,500/area - Thighs $7000 • + Anaesthetist
• Hoping to open later 2021 in Perth • Skin reduction enables Medicare rebate
for hospital & anaesthetic
• Dr Argie – Perth/Mandurah
• Dr Mark Hanikeri
• $5,500/section (5/6 litres)
• Costs $4,500/hour all inclusive
• Dr Murray – Perth • As above
• $3,300/area + theatre
• Does renuvion skin tightening?VALERIE’S EXPERIENCE
• Lipo with Dr Lekich
• Had 3 x ops on legs
• Nicer smaller but not beautiful!
• Skin - calves smooth, thighs saggy
• Ongoing Keto & fasting for thighs
• Gave up on flat knits -> bioflects
• Cost $11.5K? (+ travel & accom)
• THANK YOU VALERIE!WHERE TO GET MORE INFO • Mandurah Oedema Website https://mandurahoedema.com.au/lipoedema • Lipoedema Australia https://www.lipoedemaaustralia.com.au/ • Victoria Health https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/Lipoedema • The Lipedema Foundation https://www.lipedema.org/ • The Lipedema Project - The disease they call fat https://lipedemaproject.org/ebook/ • Victoria Health https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/Lipoedema • LE&RN Lymphatic Education & Research Network https://lymphaticnetwork.org/ • Fat Disorders Organisation https://Fatdisorders.org/lipoedema • Lipoedema Western Australia Facebook page run by Jennifer Free
WHERE TO GET MORE INFORMATION Good Articles: • Wounds UK. Best Practice Guidelines: The Management of Lipoedma https://www.wounds-uk.com/resources/details/best-practice-guidelines-management-lipoedema • Understanding Fibrosis in Lipedema: Inflamed Subcutaneous Adipose Tissue (SAT), and nodules https://lymphaticnetwork.org/news-events/understanding-fibrosis-in-lipedema-inflamed-subcutaneous-adipose-tissue- sat#:~:text=As%20lipedema%20progresses%2C%20chronic%20inflammation,or%20lymphedema%20secondary%20to%20lipedema. • Karen Herbst Q&A with Carol Nogueira https://medium.com/@thecarolnogueira/karen-herbst-q-a-eee41c714992 • Dr Stanley Rockson et al Platelet factor 4 biomarker for lymphatic-promoted disorders https://insight.jci.org/articles/view/135109 • Lipoedema Australia Information leaflet for medical professionals https://static1.squarespace.com/static/58999c876a496356e7f2191e/t/597173debe6594f000b680b4/1500607461403/MP+brochure+%281%29.pdf • New Insights on Lipedema: The Enigmatic Fat Disease https://www.lipedema.net/new-insights-on-lipedema-the-enigmatic-fat-disease.html
THANK YOU FOR LISTENING!
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