Archives for posts with tag: liposuction

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This was one of the many powerful presentations at the Conference, presented by Louise Koelmeyer of Macquarie University. What made it so powerful was that it was a case study of a patient who had undergone surgery and she and her husband were both there to discuss it with us first hand.  So many of the talks at the Conference are reports and statistics, so to be able to interact with an actual “case study” was invaluable.

The patient was 48, had six children and was then diagnosed with a gynaecological cancer, requiring surgery/chemo/radiation.  After her treatment she developed lymphoedema in her left leg.  She lived “out bush” so getting treatment was difficult but she did manage it fairly regularly but couldn’t attend often enough to control the swelling. She had to give up her work as a teacher as she couldn’t move easily but more importantly her leg was so large she couldn’t find clothes or shoes to fit so getting out was becoming increasingly difficult on numerous levels.

Her team of therapists spoke to her about surgical options being offered at Macquarie University and encouraged her to get in touch to see whether she was a good candidate for liposuction.  She went to the first assessment and struggled to get up the eight steps to the building, using her upper body strength to haul herself up.

She was found to be a suitable candidate for liposuction and from memory they removed 10 litres of fluid from her leg.  Directly after the surgery she was put in very heavy compression and she was sent for her recovery therapy to Mt Wilga Hospital in Hornsby.  The communication between her and Louise Koelmeyer was free flowing, they used Skype, texting and of course phone calls and when she developed an infection and communicated that to Louise she was quickly hauled back into hospital for treatment and monitoring.

Three months after her surgery, at a scheduled checkup, she was sitting with her good friend at the Opera Bar, looking up at the Harbour Bridge – she wondered what it would be like to climb it.  So, having had a glass of wine or two, she got on her phone and booked two tickets for the next day!  And three months after her surgery she climbed the 1332 steps on the bridge! Unbelievable!  At the six month mark she was running 10km.

Now I have to point out that one of the non-negotiables of this surgery is the wearing of compression 24/7.  If you cannot agree to this condition you will not be considered a suitable candidate.  This patient is 100% compliant with her compression.  She has two garments, the first is 30 mmHg and the second is 60 mmHg.  That’s some serious compression and getting it on requires her husband’s help.  Initially she was putting the 60 mmHg stocking on first but through trial and error has found it works better for her to put the 30 mmHg on first then the heavier compression glides on more easily.  It takes her about ten minutes daily to don her stockings.  She has on occasion fallen asleep after her shower at night, waiting for creams to dry (very important to look after the integrity of the skin) and woken up in the middle of the night and put her compression on straight away because it felt wrong to be without it.

Now here’s the result – so far (she is still being followed up and measured regularly and each time has a continued loss of fluid/circumference) – she and her husband have been on a round-the-world trip because … she can fit into normal clothes and shoes so can go to different climates with ease.  She is back working three days a week.  Energy levels are back.  She looks absolutely normal.  She’s costing her husband and absolute fortune in shoes!

There is hope with liposuction, but it takes work and commitment – daily.  If you feel you can commit to this, then please, talk to your therapist about your options.

Thursday 23rd June 2016 – a follow up … here’s a link to an article in the Sydney Morning Herald about the same patient, with photos of before and after.

http://ntpages.com.au/lisahiggins

 

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I can’t tell you how impressed, excited and amazed I am with the wonderful ladies of the Lipoedema Australia Support Society (LASS).  They have once again crossed boundaries and have been featured on The Project on Channel 10.  The Project went to the second LASS conference last weekend and filmed there as well but didn’t feature that footage in the package, but they did interview Dr Ramin Shayan of the University of Melbourne, Australia.  He is the group leader of the Lymphatic and Regenerative Surgery Group at the O’Brien Institute and his focus is surgery for lymphatic conditions, including Lipoedema.

I will be working on a post about Lipoedema news at the Asia Pacific Conference I attended a week and a half ago, including information from Dr Shayan’s presentations and will hopefully have that ready later today.

Here’s the link.  Have tissues handy!

 

http://ntpages.com.au/lisahiggins

 

It seems like a lifetime ago already – thank goodness I have my conference handbook to refer to because I wouldn’t remember one-tenth of the topics that were covered otherwise.

First up on Saturday morning there was a discussion on the relationship between clinical measures and underlying physiological changes – a couple of interesting points here – it has been demonstrated that tissue composition changes are evident in those with mild lymphoedema and that the impact of these changes depends on whether the affected arm is dominant or non-dominant.  What that means is that generally, there is more fat present in the unaffected limb if the non-dominant arm is affected!  Interesting.

Next was a presentation on segmental impedance thresholds for early detection and monitoring of upper limb lymphoedema. Early detection of LE is important for effective treatment outcomes so finding a way of measuring changes effectively is essential.  Segmental measurements of the arm with Bioimpedence Spectropscopy was shown to be a reliable way of measuring early changes after measuring one hundred women without a history of breast cancer or lymphoedema.

There was a clinical practice review of the pitting test.  The pitting test is widely used to assess oedema in healthcare, but there is no standardisation between clinicians – each person’s touch is significantly different.  Three different therapists performed a pitting test assessment on six women with unilateral breast cancer related lymphoedema.  The therapists were all reliable in determining whether the tissue was pitting or non-pitting but had less agreement on the tissue qualities.  This study reinforces the need to develop a standardised pitting test protocol with guidelines for interpreting the test results.

Assessment of oedema in the breast skin following skin-sparing mastectomy and immediate reconstruction.  As more women are choosing to undergo the above procedure it has been noticed that many experience oedema in the skin postoperatively but assessment of change has only been subjective so far.  53 patients were measured using the Delfin MoisturemeterD Compact to determine the percentage of fluid within the dermis.  The conclusion was that the use of the Mosituremeter allows accurate documentation of localised and sub-clinical oedema in breast skin following mastectomy and reconstruction.

A patient self examination survey for staging the severity of lymphoedema.  Fifty patients with either unilateral primary or secondary LE completed a number of questionnaires.  One form was repeated one week after either by email or posted off.  The patients were assessed with bioimpedance and staged by two therapists using the ISL staging system.  The results of this study are currently being collated.

Current overview of surgical treatment of lymphoedema.  Dr Suami spoke of the different types of surgical treatment available for LE: Liposuction, lymphovenous shunting, lymphatic grafts and vascularised lymph node transfers.  Refinements in microsurgical techniques and improved imaging devices may lead to the establishment of standard surgical treatment of lymphoedema – wouldn’t that be amazing!!

Liposuction.  The Macquarie University Cancer Institute is developing protocols for maximising outcomes for liposuction surgery for fatty lymphoedema limbs in Australia and NZ.  There are very specific criteria for eligibility and bioimpedance and MR imaging were used to determine eligible candidates.  Patients had pre-operative intensive treatment at Mt Wilga Hospital and there was a significant mean excess volume reduction pre-surgery.  The conclusion of this prospective study demonstrates that in patients with large non-pitting limbs with L-Dex and MRI indicating deep fluid pocketing, a brief pre-operative CLT (that’s MLD, bandaging and physio) session can reduce the liposuction volume needed to achieve maximum outcomes.

Liposuction in the management of persistent arm swelling following conservative management of LE – a similar study to the one above (Alex Munnoch happily admitted that Mt Wilga’s results of pre-surgical CLT seemed much more effective than what they were achieving!).  The conclusion of his study said that liposuction and continuous postoperative compression is an effective treatment for advanced arm lymphoedema.

Diet and its relationship to lymphoedema.  This was a very interesting talk by Dr Kieron Rooney, with whom I had the pleasure of talking during the lunch break – he had been drinking numerous fizzy drinks daily and eating junk food and suddenly realised he was doing research on diet but yet wasn’t reading his own advice!  He gave up sugar and lost a significant amount of weight which he has kept off easily simply by keeping off the refined sugar (yes, he does exercise too!).  He is looking to see what fuels the capacity for change of lymphatic fluid into adipose tissue.  It’s the advice we hear again and again, eat food in as close to its natural state as you can – avoid the processed food, stick with real food.  Right on!

Liposuction for advanced LE – impact of liposuction on limb volumes. Surgical treatment results from Macquarie University Advanced LE Assessment Clinic. The conclusion of this study stated that liposuction is a safe and effective option for carefully selected patients with advanced lymphoedema.

Liposuction for leg LE.  Alex Munnoch reviewed 7 years’ experience of performing liposuction for primary and secondary leg LE.  The conclusion of the review stated that liposuction and continuous postoperative compression is an effective treatment for leg lymphoedema, although obtaining 100% reduction is much more challenging, particularly in primary LE patients.

Vascularised lymph node transfer for secondary LE.  This was of particular interest to me because of my contact with Helen here in Sydney who has had the procedure.  (Helen, you have a lovely lymphoscintigraph!)  Lymph node transfer is emerging as a treatment for LE.  Eight patients who had tried conservative therapy and experience progressive swelling, frequent infections or inabilitly to tolerate compression garments were offered LNT.  All had MRIs, lymphoscintigrams, L-Dex readings and limb volume measurements pre and post operatively as well as ultrasound.  The early results indicated no significant volume reduction with LNT but there were subjective improvements in skin infection frequency, softer arms as well as maintenance of oedema control without garment wearing.

Finally, there was a presentation by Dr Susan Gordon of James Cook University on the prevention and management of lymphatic filariasis related LE. Very interesting talk – way too much info to put into a few words.

And that brought us to the conclusion of the Conference.  Oh wait.  There was the closing ceremony, the one with the Islander dancers, the one where they got poor victims up on the stage to try the death-defying hip gyrations that were exhausting to watch, far less try to do.  But well done to all who participated (I kept my head so far down it was almost in my lap!).

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Where to begin.  Well, let’s just say there is no way I’m going to cover even a fraction of what I saw/heard at the conference, there was just so much content. I’ve counted that there were 39 presentations in three days, one of those was broken into case studies with different presenters being allocated 2 minutes (in one hour there were 12 presentations)! So I’ll go for the stand-out highlights for me and I’ll do a few different posts over the next week or so to not bombard you with too much info.

I attended three workshops – we got to choose those when we registered and two of them I found fantastic.  The first was on Differential Diagnosis of Lymphoedema, presented by my favourite, Prof Neil Piller of Flinders University, and Vaughan Keeley of the Royal Derby Hospital, UK.  Was really pleased that they focussed on lipoedema and the difficulties of diagnosing some cases.

I found the presentations by Dr Hiroo Suami of the University of Texas MD Anderson Cancer Centre to be very interesting and amazingly upbeat and humourous (quite difficult I reckon when showing slides of cadavers).  He has pioneered The Lymphosome Concept, a way of “visualising the lymphatic system using hydrogen peroxide and a radio-opaque medium injected into cadavers then using radiographs and three-dimensional computed tomography scans to see how and where lymphatic fluid flows, which vessels, nodes and territories it uses.  Fascinating.  He also talked about surgical treatment for lymphoedema, including creating new channels to increase the capacity to transport lymph fluid; liposuction or lymphovenous shunting, lymphatic graft and vascularised lymph node transfer.

One of the most interesting things I heard was in one of the “breakaway sessions” of four talks.  It was by another of my favourite presenters, Alex Munnoch, of Ninewells Hospital in the UK.  He noted that surgical staff who perform long surgeries often complain of leg discomfort and oedema, so they set up a small trial to see whether T.E.D. stockings (those beautiful white stockings you are given when you’ve had some surgery in hospital) have an effect on the level of oedema.  One leg was randomised (by the flipping of a coin, very scientific criteria indeed!) to wear a T.E.D. stocking and the control leg (the other side) would receive no compression at all.  Fluid levels were measured before and after the surgeries.  40 legs were studied in all with an average operating time of 9.5 hours.  Results?  T.E.D. stockings were found to reduce the increase of fluid and interestingly, when they tried the experiment using compression stockings instead of T.E.D. stockings the degree of oedema increased!  What!! That was a surprise indeed.  He conceded that such a small study was perhaps not conclusive and more study was definitely warranted.

On the first day there I also attended presentations on head and neck lymphoedema management; lymphoedema and osteopathic care; reducing oedema after lower limb cellulitis; wounds and lymphoedema; and case study presentations on things such as; TRAM flap reconstruction; layered compression garments; liposuction; bioimpedance spectroscopy; kineseotape post radiotherapy; yellow nail syndrome …. the list goes on.

My head was swimming by the end of the day, that’s for sure.

If you’d like more info on any of the topics I mentioned, please leave me a comment and I’ll add some more infomation.  To access more information about lymphoedema and it’s treatment, visit the ALA website here.

But it wasn’t all hard work – here’s a photo from the closing ceremony of two of my favourites … Prof Piller and Alex Nunnoch, good on them for getting into the spirit of things!

 

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Prof Neil Piller and Alex Munnoch, letting their hair down