Archives for posts with tag: Prof Neil Piller

I’m just back from a week in Darwin in the Northern Territory of Australia having attended the 2016 Asia Pacific Lymphology Conference.  I’ve made a very short video giving a few highlights for you to view  here.  I’ll be working on a few blog posts over the coming weeks to talk about what I learnt at the Conference.  I’m still processing all the information – my brain hurts!

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The most commonly searched term on my blog is “lipoedema”.  There is little understanding out there of the condition and frustrated ladies take to the internet to see what they can find out for themselves, because there are precious few in the medical arena who have any understanding of the condition.

So I thought I’d write a blog on how you can get help – what I’ve found out over the last couple years as to what works and what doesn’t, keeping in mind of course that while one thing may work for you, it may not for someone else.  I’m not going to go into what lipoedema is today as I’ve written a blog on that before, here‘s a Wikipedia explanation.

The first place I send people is to LASS (Lipoedema Australia Support Society).  This is a group of fiercely strong women who are searching for answers and getting information out there in as many forms as possible.  This year a number of them did the unthinkable – they bared their bodies for photos to make posters to put in doctor’s surgeries (or anywhere else they felt it might raise awareness).  You have to understand that most of these courageous women have covered up for their entire lives.  They have a closed Facebook group that you can join and I’d strongly recommend this.  The group has many files with information on diets, treatments that women have tried, surgeons, therapists, compression, financial support available through the government, and much more. They are organising their second Lipoedema conference for June 2016, to be held in Melbourne.

Lipoedema ladies, photo courtesy LASS

Lipoedema ladies, photo courtesy LASS

I’ve learned (from the LASS FB page) that a Lymphoedema and Lipoedema Community Seminar is being held on the Gold Coast on the 10th September at the Beenleigh Distillery/Tavern, 114 Distillery Road Yatala, late notice I know, but if anyone is in the area you should check it out.

On to concrete things I’ve learnt.  Again and again I hear from various sources (including the patron of LASS and my lecturer, Prof Neil Piller) that water exercise is the BEST thing for lipoedema.  That could be as little as floating around in the water if your knees or hips can’t cope with too much more, walking in the water, swimming or doing water aerobics.

If you can’t get into the water, then walking is always good.  Or rebounding.  Or whatever exercise you are used to doing, the main thing is to keep your body moving and active as much as you are able within the constraints of the condition.

Diet.  Now here’s the thing.  There isn’t any one diet that has been proven to help, but there are many diets that have been tried with some success.  The RAD diet by Dr Karen Herbst seems to be very effective.  Prof Piller recommends an anti-inflammatory diet.  To me, they all seem to agree that eating a diet high in whole, unprocessed foods is going to be beneficial.

Treatment.  The most frustrating thing of all is the lack of treatment (other than of course the lack of diagnosis or belief that the condition exists).  Common sense tells us to keep up the exercise and watch the diet but what else has been proven to work?  Nothing.  But, most women do respond favourably to manual lymphatic drainage and compression (obviously if they can tolerate it).  Dry body brushing also seems to help.  There are  deep breathing exercises that have been proven to stimulate the lymphatic system (thank you Prof Piller for his research).  There has been discussion on vibration plates and Prof Piller has done some research and found that these can be beneficial if used on a very low setting for a short period of time.  Care must be taken with other pathologies such as weak knees or hips.

The Rolls Royce of treatment is WAL (water assisted liposuction).  The link is to a study published on PubMed.  This is a specialised form of liposuction which minimises the damage to the lymphatic system, uses local anaesthetic rather than a putting you completely under and harvests fat rather than general tissue.  There are a number of procedures over a few weeks and compression is worn afterwards to maximise the results.   Post operative recovery is excellent.  This treatment is not available in Australia yet but Germany is advanced and experienced in the procedure and the follow up recovery period.  German clinics and hospitals are at the forefront of lymphatic research and treatment.  The main form of liposuction used for lipoedema in Australia is called Tumescent Liposuction.

Where to from here?  That’s up to you.  If you haven’t been diagnosed yet, but suspect that you have lipoedema then I’d suggest finding a doctor, physiotherapist or massage therapist who can diagnose you.  Easier said than done.  There is a list of therapist and doctors on the LASS FB page that may be of assistance.  In Australia you can get a care plan to see a physiotherapist for five sessions that Medicare will subsidise.  Massage therapists are not covered by Medicare but most will be registered with private health funds which can offer rebates to help offset the costs.

I am more than happy to talk to anyone about options if you’d like to send me a message.  This condition is something I am passionate about and education is vital, there is not enough information available and it can be very confusing and overwhelming trying to sift through what is out there.

http://www.lisahiggins.ntpages.com.au

People are often surprised when I tell them that the number one function of the Lymphatic System is to transport immune cells around the body.  Basically, your lymphatic system IS your immune system.  And yet if you go to the doctor because you are constantly getting sick you could be offered a script for antibiotics because they “may” help, but if you ask them about getting a Lymphatic Drainage treatment their response generally goes along the lines of … “well, it can’t hurt you I guess”.   You can’t blame the doctors though, my lecturer (Neil Piller, himself a Doctor and lecturer in medicine) says that GPs have one class on the lymphatic system in all of their training.  That’s one class, not one semester – four hours.  I have no words for this.  It makes my blood boil.  Apparently it’s exactly the same for nutrition – one class.  OK, I’m going to move on because I get really riled up thinking about that.

So, what does it mean to say the lymphatic system transports immune cells?  Immune cells are stored in lymph nodes for the most part, though there are also some circulating immune cells that do exactly that – circulate around the body looking for infection.  Lymph nodes can also be referred to as “glands” and that’s probably how you are most familiar with them – your can sometimes feel your glands come up when you are sick, particularly in illnesses like glandular fever (or Mono if you’re from the US) or tonsillitis.  You go to the doctor and he has a feel in your neck, under your armpits or in the groin area to see if the nodes are “up” (these are some of the areas where there are large collections of nodes).  And this is a normal thing to happen when your body is fighting infection – the body is signalled to produce more antibodies so the nodes kick into action to make them (getting bigger in the process) and then circulate them through the body to the site of the infection, via you guessed it – the lymphatic system.

immunesystem

Photo courtesy http://www.humanvitaminhealth.com on google images

What can happen is that with the winter weather our lymphatic systems can become sluggish and inefficient.  That can be due to lots of different things e.g. cold temperatures or exercising less.  When this happens the immune cells circulating around the body aren’t cleared out and replaced with new ones as efficiently as they should be, so the body is slower to respond to an attack of a virus and we succumb to illness.

A regular maintenance session of lymphatic drainage massage helps to stimulate the immune system, increasing circulation and moving out the old immune cells and replacing them with freshly produced immune cells which are more effective at fighting off the viruses.  Immune cells circulating in the lymphatic system can target a pathogen and transport it to the nearest lymph nodes where that cell is neutralised and then the waste material is transported through the heart and kidneys then excreted out of the body.  It’s a very efficient system when it is fully functioning.

I suggest that people who want to keep on top of their immune systems have a regular Lymphatic Drainage massage.  If you are generally healthy and are looking to maintain that health, then I suggest a session at the change of season, so once every three months.  If your immune system is more compromised, then I’d aim for once a month, at least during the colder months when we can all be a little more run down.

If you’d like more information on ways to build your immune system using lymphatic drainage please send me a message or visit my website here.

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

I’ve managed to survive another week.  In no small way thanks to the amazing people I’ve spent the last two weeks with – the ones who have kept me laughing when we all felt like crying.  Day one we were advised by our lecturer, Jan Douglass (http://movinglymph.com), that for the next few weeks we had “no life” – which lead to two of us instantly sticking our hands in the air and singing … “no life, without wife”.  If you’re not into movies then you won’t get the reference – that’s from a movie called Bride and Prejudice, a fabulous adaptation of Pride and Prejudice, set in India (http://en.wikipedia.org/wiki/Bride_and_Prejudice).  After two weeks of singing that refrain I just couldn’t resist, I had to watch the movie tonight to celebrate being half way through the course.  And to celebrate passing my first lot of exams.

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Vodder Therapy 1 certificate

This week involved a lot of physiology study, a lot of talking about how the lymphatic system works, a lot of practices of sequences, “specials” – special tests and treatment for specific areas that are commonly problematic, like the shoulders, elbows, wrists, hips, knees, ankles, and a fair amount of panic.  On Thursday morning we had our theory exam and this morning we had to pick a slip of paper with two body parts on it and do the sequence for treating the areas – without any notes.  If only you knew the volume of new information we have been subjected to in the last two weeks then you might understand the panic of trying to memorise every sequence for the entire body on top of all the theory.  I had to perform the sequences for the bum and right arm on my “client” and she had to do the nape of the neck and the breast on me.  Let me point out here that all manual lymphatic drainage is done skin on skin, think about it.  I have had the breast sequence done on me three times in the last two weeks, twice by men!  I guess you lose all inhibitions after a few days.

On Monday and Tuesday next week it will be all theory with Prof Neil Pillar (http://www.flinders.edu.au/medicine/sites/surgical-diseases-and-sciences/staff/professor-neil-piller.cfm), followed by another exam.  The rest of the time will be spent with Koby Blanchfield (http://vodderschool.com/accredited_practical_instructors) who will teach us the practical component for treatment of people with impaired lymphatic systems and all our bandaging.

Another week with “no life” … but lots of learning!

So … pause for effect.

Next week I will commence a four week training course in the Vodder technique of Manual Lymphatic Drainage.  I paused for effect because, well, I already use the Vodder technique – I was taught it when I did my diploma at Nature Care College back in 2005/2006. (http://www.naturecare.com.au/) .   Updated 16/7/13 – I suddenly thought that I should clarify here – the teaching I received was based on the Vodder Technique, not the actual technique itself.  The problem is that Nature Care no longer teaches the Diploma and hasn’t offered any follow up sessions until this year when they offered an oncology seminar.  I tried twice to attend this, they were both cancelled.  Frustrating.

The even bigger issue is that the ALA (Australasian Lymphology Association – http://www.lymphoedema.org.au) – which is the place to find out all about lymphology, treatment, research, practitioners and education in lymphology – does not recognise the Diploma I received.  As a massage therapist, to be registered as a practitioner on the ALA website (there are different levels of registration – medical practitioners, physiotherapists, nurses and other allied practitioners and massage therapists) they require a qualification in the Vodder or Foldi techniques (whom I consider the ultimate in lymphatic drainage) or in the Casley-Smith technique (another excellent method) or a certificate from the Academy of Lymphatic Studies (I haven’t come across them before).

What frustrates me the most is that I haven’t been able to do any continuing education in lymphatic drainage since I qualified in 2006.  (My diploma consisted of 126 hours of class time and 52 hours of clinic time.)  I decided that seven years is enough, I needed an update.

And the only way I can do that is to redo my entire qualification.  So.  Next Monday I start four weeks of intensive training in the Vodder technique through The Vodder School (http://www.vodderschool.com/).  I am excited, even though I have to start from scratch I know that I will learn lots of new things and being able to ask questions from a much deeper level of understanding than the first time round will be immensely beneficial.  And one of the most exciting things is that Prof Neil Piller will be delivering some of the course (http://www.flinders.edu.au/people/neil.piller).  He is considered an expert in lymphoedema treatment in Australia and carries out research in all aspects of lymphology, amongst other things.  It will be an honour to be able to spend time learning and speaking with him.

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Image courtesy google images, http://www.lymphdrainage.com.au

What this means for me is four weeks off work. The course runs Monday to Friday, 8.30am to 4.30pm and I’ll be travelling 1.5 hrs each way.  Not sure how I’m going to go with all of that but I guess it’s one day at a time.

But I’m thinking that there may not be too many blog posts during that time, I’ll have to see how much energy I’ve got.  But then again, there may be so many interesting things to pass on that I just have to sit and write about them.  Watch this space.