Speaker 1: Apolgie production.
Speaker 2: Hi, my name's Beck Woodbine and welcome to Tenderness for Nurses.
Speaker 2: I'm grateful for the person that I have the opportunity
Speaker 2: to be.
Speaker 1: So I hit it and parked it for nearly four years.
Speaker 2: We always have free will, We always get to choose.
Speaker 1: We are autonomous.
Speaker 2: Welcome back to Tenderness for Nurses and part two of
Speaker 2: Beck's chat with Doctor Levine. In this episode, Beck goes
Speaker 2: through your questions submitted to doctor Devine about lipidemia. So
Speaker 2: I'm just going to start asking some of the questions
Speaker 2: that have been sent in to me.
Speaker 1: Happy to answer that.
Speaker 2: Okay, So, will lipidema ever be covered by Medicare? And
Speaker 2: who should the lipidema community talk to to get the
Speaker 2: word out.
Speaker 1: So it's a very difficult question to answer because coverage
Speaker 1: of Medicare is basically acknowledgement of lepidema as a disease,
Speaker 1: as in a medical condition. And this is where there
Speaker 1: is no acknowledgment of lipedemas a disease condition. It's as
Speaker 1: a multiple mentions of lipedema as a rare quote unquote
Speaker 1: fat disease. And usually when people talk about rare, it's
Speaker 1: usually talk about point one percent point two percent. This
Speaker 1: is like one in ten, and average medical students do
Speaker 1: not go through medical school learning about it. And my
Speaker 1: personal experience of lipedemas I went through specialist training and
Speaker 1: I didn't know about lapidema. We knew about lymphedema, but
Speaker 1: not lipidema. It's only when I started practicing as a specialist,
Speaker 1: when I'm kind of my first lip and patient, That's
Speaker 1: when I got to know about lipodma. And when you
Speaker 1: start to read the literature, there's plenty of papers around lipedema,
Speaker 1: but you have no ideas to how come this was hidden.
Speaker 1: What was interesting was most of the papers when I
Speaker 1: first read. In fact, most of the papers still are
Speaker 1: based out of Germany, and doctors in Germany have a
Speaker 1: better understanding, or probably an early understanding of lipedema, and
Speaker 1: they have kind of been pioneers in treating lipedema. It
Speaker 1: is coming to the English speaking world gradually, little by little.
Speaker 2: This is probably a question out of curiosity. Say you,
Speaker 2: as a parent have like p edema and you have
Speaker 2: a daughter, if you could control, you know, educate on diet, exercise, hormone,
Speaker 2: managing all of that side of things, can you control it?
Speaker 2: Can you manage it better, or at some stage will
Speaker 2: it just start to exploit explode.
Speaker 1: Look, it's a it's a common question to get asked because,
Speaker 1: as you imagine, if you treat somebody who's got lepidema,
Speaker 1: there's a good chance that their daughter may have the tendency.
Speaker 1: So it's a very very delicate question to delicate subject
Speaker 1: to broach with a teenager because if you know, the
Speaker 1: typical age of flare up of lipideemer its when you
Speaker 1: go through puberty. It also coincides with a lot of
Speaker 1: other changes in the teenager during the time, starting from
Speaker 1: being socially different, lack of exercise, so on and so forth.
Speaker 1: But at no point I tell my patients that you
Speaker 1: need to be focusing on the word diet, because that
Speaker 1: will make things very hard for the teenager, because we
Speaker 1: know that even if your diet, you will not see
Speaker 1: a reduction in your leg fat deposits of light padema.
Speaker 1: And if you tell someone you're not seeing any deposits
Speaker 1: of fat disappear because you're dieting, you need to diet more,
Speaker 1: you can tip them over into a condition that is
Speaker 1: actually quite awkward. Right with the disorted eating habit, and
Speaker 1: we see this very commonly. So it's a very difficult
Speaker 1: and a very delicate one, and I don't have an
Speaker 1: answer for that. So what I tell patients is, if
Speaker 1: you want to ever broach the topic with your young
Speaker 1: teenage daughter, will recommend that you somehow introduce the concept
Speaker 1: of restriction of sugar, restriction of processed food, go on
Speaker 1: a healthy diet, and maybe the entire family has a
Speaker 1: clean up diet. Right. Or if you're doing an exercise
Speaker 1: regime with your daughter, try and make it like it's
Speaker 1: a mom daughter yoga challenge, right, so you go with
Speaker 1: her to a yoga class or a pilates class, so
Speaker 1: as opposed to making it like sound like a chore. Right,
Speaker 1: So then you have buying from them, which will be
Speaker 1: a much more sustainable practice without having to go through
Speaker 1: the process of embarrassing them or shaming them. Yeah. Absolutely, Okay,
Speaker 1: it's a very delicate one. I've seen a lot of
Speaker 1: patients of mind who have gone through disordered eating phases,
Speaker 1: and we usually tell them that and look, it's natural.
Speaker 1: It's normal because you've been told diet, diet, diet, and
Speaker 1: you don't see no change, and you believe that you're
Speaker 1: not doing enough, and at one point when you draw
Speaker 1: the line is enough is enough?
Speaker 2: Well, that's right, you know, and at the end of
Speaker 2: the day you've got to have happy kids. Say why
Speaker 2: does it hurt to press the skin with lipaedema?
Speaker 1: Okay, this is nobody knows why. But there is a
Speaker 1: condition called in fat growth. Like we all know about lipomas,
Speaker 1: which is abnormal fat growth, there's a condition called angio
Speaker 1: lipomas where's a bit more clustered blood vessels. And these
Speaker 1: are small p shaped fat lumps in the body that
Speaker 1: are exquisitely tender. So there's some internal signaling that can
Speaker 1: trigger off either nerve increasing nerve sensitivity due to the
Speaker 1: pattern of signaling. That's what we don't know, right, So
Speaker 1: there is, and these fat pockets can be tender and
Speaker 1: can be painful to the point that if a cat
Speaker 1: sits on your lap, you don't like it. If a
Speaker 1: dog runs into your legs, you hate it. And if
Speaker 1: you actually have someone tap your shoulder and say come
Speaker 1: beg let's go and have a drink ouch, it hurts you.
Speaker 1: So these are really tender spots.
Speaker 2: So this condition really impacts women's lives significantly.
Speaker 1: Yes it does.
Speaker 2: So is there research happening in this area.
Speaker 1: There's a lot of research happening in this area, and
Speaker 1: Australia is actually one of the pioneering research places. And
Speaker 1: Dr Romin Scheine, who's a plastic surgeon in Melbourne, is
Speaker 1: pioneering a lot of original genetic research because Romen along
Speaker 1: with this wife Tartt, is run an adipose biology laboratory
Speaker 1: and you can't get more specific for lipitma than having
Speaker 1: an adipose lab. And they have got a global research
Speaker 1: group of people who know multiple countries in Europe and
Speaker 1: US of course. And there's an American organization called the
Speaker 1: Lepidiema Foundation LF and they fund lepadema focused research in
Speaker 1: across the world. So I think there is lipidima research happening,
Speaker 1: but is it happening quick enough? The answer is we
Speaker 1: don't know, but it is surely showing evidence that this
Speaker 1: is a genetic based disease because they're isolating genes now
Speaker 1: little by little, so hopefully there will be some sort
Speaker 1: of groundbreaking treatment in the future. But even what we're
Speaker 1: practicing today compared to what was being practiced twenty years
Speaker 1: ago is significantly different. So research of today will defind
Speaker 1: the medicine of tomorrow.
Speaker 2: Yeah, gotta love that, don't you. Why are gps not
Speaker 2: informed about lipaedema?
Speaker 1: It's I think back to the education and in medical school,
Speaker 1: this is not even recognized as a condition. And because
Speaker 1: it the appearance of lipedema fits into our understanding of
Speaker 1: fat and we're very easily kind of or very quick
Speaker 1: to say, oh that's only fat, God out an exercise.
Speaker 1: So every single passion of mind, we ask what's been
Speaker 1: your experience with a GP. Does a GPE noble epidema?
Speaker 1: Because what is very important is if you have a
Speaker 1: GP who understands slipidema and will be willing to look
Speaker 1: after you and you care for you. If your GP
Speaker 1: does not understand lipidima, does not make any attempt to
Speaker 1: learn about lipidema, then you run the risk of being gaslighter,
Speaker 1: which is not a good therapeutic place to be. Okay,
Speaker 1: So my recommendation I tell patients like, if you've you,
Speaker 1: it is very critical for your success that every single
Speaker 1: practitioner is treating you has to be not only lepedema aware,
Speaker 1: but it has to be lipidma empathetic. It starts from
Speaker 1: your personal trainer as well. You can't have your personal
Speaker 1: trainer say why are you not losing weight? Everyone else
Speaker 1: is losing weight, And that's not a nice thing to
Speaker 1: say because that shows a fundamental lack of understanding of
Speaker 1: the fundamental pathology of your patient.
Speaker 2: I would imagine women that have suffered this condition have
Speaker 2: been gas a little lot.
Speaker 1: Absolutely, Absolutely, I've suffer in silence. There's silence, silence terrible.
Speaker 2: It makes me feel sick.
Speaker 1: Actually, at least now in twenty twenty four, twenty five,
Speaker 1: you have information and thanks to social media and Instagram,
Speaker 1: when people start posting pictures, people look at the legs
Speaker 1: and say like, oh, this looks like my friend's legs,
Speaker 1: or they themselves look at the legs and say like,
Speaker 1: oh my god, they looks like mine, and then they
Speaker 1: start and Instagram is such a wonderful platform that we
Speaker 1: spend more than two seconds on one post, it'll start
Speaker 1: feeding you relative stuff. So in some ways that has
Speaker 1: been very helpful to patients who could bypass the traditional
Speaker 1: channels of seeking knowledge and advice.
Speaker 2: And what does the procedure usually do on patients?
Speaker 1: Okay with lida, so Lepidima has got technically three stages,
Speaker 1: stage one, two, and three, and we never see a
Speaker 1: stage one at the age of fifty, and we never
Speaker 1: see a stage three at the age of twenty, implying
Speaker 1: that the longer you leave it, the worse it becomes.
Speaker 1: And if you look at the internet and look at
Speaker 1: stage one, two, and three, it's a progression in the
Speaker 1: size at a macroscopic photographic level, but at a microscopic
Speaker 1: level underneath the tissues, what happens is the fat cells
Speaker 1: become bigger. Like if you say the fat cell is
Speaker 1: one by one in stage one, it'll be two by
Speaker 1: two in stage two, and three by three instat three. Right,
Speaker 1: I'm just picking numbers to illustrate the point. But in
Speaker 1: addition to that, there's additional College information as you incrementally
Speaker 1: go open the stages and as a consequence that you've
Speaker 1: got fibrosis. Right, so your outcomes are going to be
Speaker 1: proportional to the tissues you're going to handle. Okay, So
Speaker 1: the targeted procedure to treat lip patients is accommodation of
Speaker 1: non surgical conservative treatment first followed by liposuction to get
Speaker 1: rid of the fat, followed by maintenance conservative treatment for life. Right,
Speaker 1: So if you haven't optimized your conservative treatment before the surgery,
Speaker 1: you will fail, and that operation will fail because the
Speaker 1: outcomes are not going to be as good as you
Speaker 1: expect it to be. So I am a very strong
Speaker 1: believer in preparing, and I sometimes I use an actet
Speaker 1: of you know, if you want to run an Olympic marathon,
Speaker 1: you're not going to run the marathon the first day.
Speaker 1: If you have to prepare for a year. This is
Speaker 1: not different, right, so you but you can. It is
Speaker 1: complex when you look at it, but when you incorporate
Speaker 1: them one way one, it becomes almost a seamless process
Speaker 1: in your day to day life and lifestyle. And and
Speaker 1: people are done it very well and managed to keep
Speaker 1: it at bay. Right. It's a combination of many things
Speaker 1: that will go through that in a second. And the
Speaker 1: aim of lip persuction is to take out as much
Speaker 1: pathological fat as possible, as much as possible.
Speaker 2: How do you tell the difference between.
Speaker 1: Normal and leipadima fat? Yes, look, that's that's a good
Speaker 1: question because that's commonly get asked. There is no way
Speaker 1: of finding out right, Okay, So what we what I
Speaker 1: believe is based on my experience, is the fat you
Speaker 1: see in a lipid patient between your knee and your
Speaker 1: ankle is all lepidima fat. Okay, okay, The fat in
Speaker 1: your thigh between your knee and your hip is sixty forty, right,
Speaker 1: but you want to debulk it as much as possible. Now,
Speaker 1: the reason you want to get rid of your normal
Speaker 1: adipose tissue or a normal fat in a lipiduma patient
Speaker 1: is what triggers lipodema growth formation. Nobody knows it is
Speaker 1: a genetic process that gets amplified bass something. But both
Speaker 1: your normal adipos tissue and your lipidima fat cell secrete
Speaker 1: hormones and mediators in the same level of which a
Speaker 1: higher concentration comes out of lipidma cells. Right, So if
Speaker 1: you have more adipose tissue, you'll have a worse of lipoedema.
Speaker 1: So it is not in your interest to have lots
Speaker 1: of adipose tissue, normal adipos tissue or lipidima tissue, so
Speaker 1: you need to debulk all of them. So diet exercises
Speaker 1: an essential part of controlling lepidema, not directly, but indirectly.
Speaker 1: Liposuction is the only way you can get rid of
Speaker 1: lipedema tissue. Say, for example, if a patient goes and
Speaker 1: has surgical weight loss procedures and loses eighty kilos. Right,
Speaker 1: they will lose fat everywhere except your leg. Just need
Speaker 1: to ankle. It will not change.
Speaker 2: Is that right?
Speaker 1: It will not change. I've never seen that change. Right,
Speaker 1: And your thigh will come down in size, but you'll
Speaker 1: still have residual epidema.
Speaker 2: Facts YEP, which then has potential.
Speaker 1: To beget more epidema fat. Yes, so it's a positive reinforcement,
Speaker 1: so I think. So the best best outcomes in summary
Speaker 1: is if you can get early. In other words, when
Speaker 1: patients on early stage one is early twenties because you've
Speaker 1: had a fat deposit for three, four, five, six, seven,
Speaker 1: eight years, because you haven't been heavy at that point,
Speaker 1: your tendency to put on normal atipost issues low, so
Speaker 1: your amplification of your lipidema fat cells is less. So
Speaker 1: you can be quite aggressive and aggressive in the sense
Speaker 1: like it's a you know, take out as much lipidoma
Speaker 1: fat as possible, set them back on a healthy die,
Speaker 1: to exercise other non surgical modalities, which is plenty of them,
Speaker 1: and then they can lead a very very good, comfortable
Speaker 1: life for quite some time. The fat production of lipedima
Speaker 1: does not stop, never stops. It'll come back, but you
Speaker 1: can slow down the rate of production. It's a bit
Speaker 1: like if you had a leaking tap, your aim is
Speaker 1: to control the rate of dripping or leaking, as opposed
Speaker 1: to shutting off the tap. Shutting off the tap is
Speaker 1: currently not an option because shutting implies cure.
Speaker 2: It's a it's a really profound disorder for someone to have. Yes,
Speaker 2: it is because they must feel heavy and boggy and exhausted.
Speaker 2: This I'm kind of blun away with particularly these questions,
Speaker 2: but your answers, how is it that someone who is
Speaker 2: not a surgeon can perform live per suction in Australia?
Speaker 1: Now, this is this is a very important question and
Speaker 1: according to the national law, if you're a registered medical
Speaker 1: practitioner can pretty much do whatever you think you're capable
Speaker 1: of doing, provided you are appropriately and adequately trained. So
Speaker 1: that is exactly the words that has been used. It's
Speaker 1: not been defined. It's not been defined. So what the
Speaker 1: government has done is says they do not regulate scope
Speaker 1: of practice. In other words, if a newer surgeon tomorrow
Speaker 1: wants to do like persuction, the government can't say you
Speaker 1: can't do this, okay, right, If a cartithorised exigeon wants
Speaker 1: to lip persuction tomorrow. If a CRTI ex surgeon wants
Speaker 1: to brest augmentation tomorrow, the government is not going to
Speaker 1: say you can't do it, provided he's had adequate training. Right, So,
Speaker 1: every single medical practitioner is, according to the law, is
Speaker 1: capable of performing any procedure as long as they feel
Speaker 1: they adequately trained and support it. Okay, So that's why
Speaker 1: we saw this with the cosmetic surgery regulations and the
Speaker 1: Four Corners episode and Cosmetic Cowboys. A lot of this
Speaker 1: page doctors were basic medical practitioners who are doing performing
Speaker 1: cosmetic surgery. So that has not been taken away. They
Speaker 1: can still perform cosmetic surgery, but now they cannot use
Speaker 1: the title cosmetic surgeon.
Speaker 2: What about visitation rights? So what if something goes wrong
Speaker 2: at one of the practices that you are having bypersuction
Speaker 2: done that's by someone who isn't a surgeon or a
Speaker 2: plastic surgeon, and they don't have visitation rights and something
Speaker 2: goes significantly wrong, what happens? Who takes over the care
Speaker 2: of that patient and what happens? Then?
Speaker 1: Okay, let's answer the question two points. Now. The first
Speaker 1: thing is all Professional Plastic Surgery Society is the Solution.
Speaker 1: Society of Esthetic Plastic Surgeons and ASPS Society of Plastic
Speaker 1: Surgeons believe that they are five pillars of safety surgery
Speaker 1: by surgeons and its theasy binis that is surgery to
Speaker 1: be performed in accredited, licensed facility, the surgeon to be
Speaker 1: available to provide after k in the post operative phase,
Speaker 1: and the surgeon to have the expertise to esclate care
Speaker 1: should they need a rise. In other words, if you
Speaker 1: need to be admitted to a hospital to provide care
Speaker 1: due to excessive bleeding or excessive infection, you should have
Speaker 1: the ability not rely on the emergency department. So what
Speaker 1: happens is no hospital will give you admitting rights in
Speaker 1: surgery if you're not a registered surgeon. So in some
Speaker 1: ways this patients should choose a non surgeon for a
Speaker 1: surgical procedure have an inherent disadvantage because in the event
Speaker 1: of an emergency, you'll be at the mercy of the
Speaker 1: emergency department and the personal provides care in the hospital
Speaker 1: someone totally different. And this is what used to happen
Speaker 1: when I work in a public hospital in city and
Speaker 1: pre cosmic surgery reviews. We used to see a lot
Speaker 1: of patients being sent to emergency department following complications of
Speaker 1: cosmetic surgery because the primary proceduralists or the doctor who
Speaker 1: performed the cosmetic surgery did not have admitting rights in
Speaker 1: a hospital. Okay, then you come into the emergency department,
Speaker 1: then the department of plastic Surgery will look after you,
Speaker 1: but it is not the kind of care that you'd
Speaker 1: expect because you've gone through a surgeon or a person
Speaker 1: cosmetic surgery.
Speaker 2: So that is something I think is important to stress
Speaker 2: for the people that are listening to this that that
Speaker 2: is a really important question to whoever it is that
Speaker 2: you're going to have your treatment with, is that you
Speaker 2: need to ask them if they're a plastic surgeon, if
Speaker 2: they have visitation rights at a hospital, what happens if
Speaker 2: there is an emergency? What procedures do they have in place?
Speaker 2: But I think by asking the first two questions, you'll
Speaker 2: answer all the others.
Speaker 1: That's correct. You can ask a question, are you a
Speaker 1: registered surgeon?
Speaker 2: Yeah?
Speaker 1: Then and if the answer is no, then you have
Speaker 1: to ask the next question to yourself, why am I
Speaker 1: going for a surgical operation by a person who's not
Speaker 1: a registered surgeon. It's a passion choice, but I think
Speaker 1: it has to be informed choice, and I think the honest,
Speaker 1: unfortunately is on the patient to know that information before
Speaker 1: the patient makes a choice.
Speaker 2: Just having done some research and that sort of thing,
Speaker 2: what I have noticed is the disparity of cost as well,
Speaker 2: between what these people are are charging compared to what
Speaker 2: a plastic surgeon charges. And I just want to say
Speaker 2: that plastic surgeons are far more realistic with their pricing
Speaker 2: than what these other clinics are that are offering life
Speaker 2: a suction. It sometimes makes me feel like they're really
Speaker 2: targeting a very vulnerable group without you saying the wrong thing.
Speaker 2: Is that a fair assumption.
Speaker 1: Look, we don't know, we're not prival to what people
Speaker 1: charge and how people charge, and individual businesses can choose
Speaker 1: to price things accordingly. But for someone to see value
Speaker 1: in a service provided a potentially consumable see value at
Speaker 1: multiple levels, value of the expertise, value of the cost,
Speaker 1: value of what information has been provided, sometimes unrealistic. And
Speaker 1: most of the time people get told a very very
Speaker 1: rosy picture of the post operative recovery so that they
Speaker 1: can kind of be convinced to have search. I'm not
Speaker 1: saying that happens everywhere, but being accurate, especially when you
Speaker 1: understand something as complex as to our procedure three opposition
Speaker 1: and your downtime is going to be quite significant. How
Speaker 1: does that material impact? Your school can drop off? You're
Speaker 1: ability to drive the car, you're getting out of a car,
Speaker 1: how fast can you prepare lunches for your two kids
Speaker 1: at home? All those things make a huge difference that
Speaker 1: they will materially impact you on These things have to
Speaker 1: be explicitly mentioned to patients before the operation, so that
Speaker 1: that's when we talk about informed choice. So I think
Speaker 1: to as plastic surgeons, we spend a lot of time
Speaker 1: trying to tell patients the right information so that they
Speaker 1: can make the right choice. It is not my job
Speaker 1: for them to go through the procedure, but it is
Speaker 1: my job an obligation to provide you the right information
Speaker 1: for you to make the choice.
Speaker 2: Yeah, that's very well said. Okay, what are the common
Speaker 2: comorbidities associated with lipidema?
Speaker 1: This is a difficult question. There's no set answer, but
Speaker 1: let me let me start off by saying that there's
Speaker 1: a concept called metabolic health, and metabolic health is your
Speaker 1: basic cellular health, and the metabolic health markers are things
Speaker 1: like your blood pressure, your heart rate, your cholesterol, your
Speaker 1: tritless rights, your blood sugar and HP and AC and
Speaker 1: all those things. And these are the things that ultimately
Speaker 1: impact your cellular health and ultimately decide if you are
Speaker 1: going to have a healthy life or not a healthy life.
Speaker 1: There are multiple drivers for metabolic health the abnormalities, and
Speaker 1: some of them are endocrine and the words hormonal health.
Speaker 1: Sometimes it's weight which is kind of a excessive weight,
Speaker 1: and obesity and so on and so forth, And unfortunately
Speaker 1: with labandin patients, a lot of these things go exist
Speaker 1: and it is important to peel them. And we have
Speaker 1: a bias that if you've got the ideal body weight,
Speaker 1: you should be healthy. But research has shown that even
Speaker 1: people who are the perfect body weight for their height
Speaker 1: and the age, thirty percent of people are metabolically unwell right,
Speaker 1: and that number goes up when you are at the
Speaker 1: OH weight category on BMI, obesity Cat one, obesity category two,
Speaker 1: and morbid obs. So if you're heavier, your metabolic health
Speaker 1: is kind of not suboptimal. Other issues like thirore issues,
Speaker 1: hormone issues, some people may have type of diabetes, no
Speaker 1: different other population, but migraines are sent to be more
Speaker 1: common in laban in patients and some patients may have
Speaker 1: disordered eating sleep apnea based on urbesity and joints would
Speaker 1: be yeah, join pain, joint pain, and because the knee
Speaker 1: joint in particular is the most vulnerable joint in my opinion,
Speaker 1: because knee joint relies on collagen ligaments, a good quality
Speaker 1: collagen in your ligaments to be strong, and lipid human
Speaker 1: does affect collagen. And the reason lipidimen does affect collagen
Speaker 1: is it's evident if you look at your skin of
Speaker 1: your thigh compared to the skin of your tummy, the
Speaker 1: skin of your thigh looks different. It doesn't have the
Speaker 1: normal uniform tone of your tummy skin. And that is
Speaker 1: because the collagen content, the lymphatic content, and the blood
Speaker 1: vessel content is all different. Patients when they're going to
Speaker 1: have a hot bath or a hot shower, come out
Speaker 1: of the shower, but the legs are red because the
Speaker 1: density of blood vessels and capitalis is significantly higher than
Speaker 1: the tummy or abdomen. Right. So that is why if
Speaker 1: you feel the temperature of your tummy and temperature of
Speaker 1: your thigh, one is warm, tummy is warm, and thigh
Speaker 1: is always cold always interesting.
Speaker 2: Is it better to wait until after you've had your
Speaker 2: children before considering surgery? But you sort of answer that
Speaker 2: before that, if you know early on, you're better off
Speaker 2: doing something about.
Speaker 1: It, that's right. So the best analogy is to think
Speaker 1: of lipodima as a dripping tap that is dripping water
Speaker 1: into a bucket. So the question is if you let
Speaker 1: the bucket overflow, that's when things go wrong. So your
Speaker 1: aim is to try to get the bucket under control
Speaker 1: by lipersuction and the tap to slow down by all
Speaker 1: the non surgical stuff.
Speaker 2: What are the proven conservative measures to help keep fat
Speaker 2: from progressing?
Speaker 1: There's no answer. You question blood tests. There's no scan
Speaker 1: or a blood test to diagnose lipidema. That's what confuses
Speaker 1: people now now because every single disease or pathology has
Speaker 1: a scan or a blood test to diagnose that. But
Speaker 1: just take back, go back one hundred years when there
Speaker 1: was no scan, no blood tests, no nothing. The doctor
Speaker 1: or the physician had to rely on history and physical
Speaker 1: examination to come up with a diagnosis. Right, So this
Speaker 1: is exactly what it is. There will be a time
Speaker 1: when you can get some smart diagnostic kits like energenetic
Speaker 1: markers and so on and so forth. But I think
Speaker 1: that that's coming, but as of today, there's nothing, okay, right,
Speaker 1: The conservative managements are very simply to understand what you
Speaker 1: need to do to control the triggers of lipedima. So,
Speaker 1: lipidima is a bit like juggling more than two balls.
Speaker 1: The first two balls, every single human being the planet
Speaker 1: deals with. Increasing weight corresponds to decrease mobility, and decrease
Speaker 1: mobility influences increasing weight. That's a vicious cycle that feeds
Speaker 1: off each other. When you have lipidema, you have the
Speaker 1: third ball coming in where you increase your weight. Lipidima
Speaker 1: gets worse, Lipidima gets worse, you move less, you move less,
Speaker 1: your weight gets worse. It's a vicious cycle. They feed
Speaker 1: of each other. Yeah, okay, weight is not the primary
Speaker 1: trigger for lepidema. So I want you to visualize the
Speaker 1: fourth ball now, it is your hormones. Okay, Hormones feed
Speaker 1: of lepidima. Hormones make you develop more adipose tissue and
Speaker 1: expand adipos tissue, and the vicious cycle is amplified now.
Speaker 1: So all of a sudden, you've gone from two balls
Speaker 1: to three balls to four balls. Lipoedima characteristic is you've
Speaker 1: got fluid in your leg, your lymphatic circulation is sluggish,
Speaker 1: so your time for the fluid to clear up frame
Speaker 1: legs is slower than normal. So that's why libidum patients
Speaker 1: when they go on a long haul flight more than
Speaker 1: four US legs well quicker than the best trinsity next
Speaker 1: to them. It takes them three weeks for the swelling
Speaker 1: to come down after they reached London from Brisbane compared
Speaker 1: to the friend who takes about twenty four hours. Right,
Speaker 1: So that's circulation is sluggish, so that fluid build up
Speaker 1: is there, so they have to look after the fluid management.
Speaker 1: The way you do the fluid management is two for
Speaker 1: one is passive, in other words, a compression stocking of
Speaker 1: appropriate pressure class two MLD therapy by lymphatic therapists. And
Speaker 1: also you can use artificial pumps like the lymphopress and
Speaker 1: other vas so come home with the even you can
Speaker 1: put the pump, it will help you to give lymphatic missige.
Speaker 1: These are passive. You can read a book, listen to
Speaker 1: music while that's being done. And the active method is
Speaker 1: to be active. So walking is the best. Walking underwater
Speaker 1: is even better yoga is great, pilatus is excellent, Muscle
Speaker 1: turning is Running is not good because impact on your
Speaker 1: knee joint will take its toll. Yeah, So the combination
Speaker 1: of these five things as a critical element is a
Speaker 1: basic front line. And then if you have other issues
Speaker 1: like metabolic health, other medical issues, and psychological issues, you
Speaker 1: need to optimize those balls. All of a sudden, you
Speaker 1: could have a scenario where the minimum number of balls
Speaker 1: juggling is five and it can go up to eight.
Speaker 1: And now you can see why your day becomes crowded
Speaker 1: and why it's become complex. All along you've been trying
Speaker 1: to lose weight, diet and exercise and not seeing any change.
Speaker 1: It's time to expand with thought process and increase the
Speaker 1: multidisipary interactions.
Speaker 2: That is such good. Look, that's good advice for all
Speaker 2: of us, but it's imperative for these women that have
Speaker 2: It's critical for absolutely. Okay, is a PFO bubble test
Speaker 2: really necessary pre surgery?
Speaker 1: Look, this is a very difficult question because I get
Speaker 1: asked this question all the time. Now. PFO is an
Speaker 1: underlying condition which is technically a hole in the heart,
Speaker 1: which is present when you're when you're feet in but
Speaker 1: as soon as you're born it shuts off. There are
Speaker 1: small persons of people that does not shut off. Sometimes
Speaker 1: have symptomatic It can be symptomatic, and sometimes it doesn't
Speaker 1: be symptomatic. It doesn't reremin some dramatic But if you
Speaker 1: talk to a cardiologist, who are the people who deal
Speaker 1: with all in the heart, they usually say it is
Speaker 1: in the incidence of but one or less than one percent.
Speaker 1: That's about it for in the general population, and that
Speaker 1: don't recommend as a routine screening test for PFOS. And
Speaker 1: for the time I've been a surgeon surgical training surge
Speaker 1: in the last many many many years, seeing thousands of
Speaker 1: surgical patients having different types of surgery. Not everyone gets
Speaker 1: tested for PER four as a routine. You may have
Speaker 1: a hemoglobin test as a routine, but not a peer
Speaker 1: for test as a routine. But having said that, if
Speaker 1: the patient has concerned, I usually refer them to cardiologists
Speaker 1: and said, look, it's not my air of expertise to
Speaker 1: you and a bubble test and you go and see
Speaker 1: a cardiologist and they can take it from there. And look,
Speaker 1: it's a fair call to say, if you're concerned, get
Speaker 1: it checked out. What I do, though, is I extensively
Speaker 1: check your blood plotting screening thing, and I do all
Speaker 1: the tests, and you suddenly find because live belting patients,
Speaker 1: because of the nature of the surgery, the duration of
Speaker 1: the surgery, the discomfort post surgery, the lack of mobility,
Speaker 1: higher risk for clouding issues.
Speaker 2: I was going to say, is is DBT's an issue.
Speaker 1: It is a big issue. Yeah, it's not that more prevalent.
Speaker 1: But if you have an underlying respect factory five flight
Speaker 1: or any of those clouding factors issues, then you don't
Speaker 1: want to be missing that. So all my patients get
Speaker 1: extensively tested, and if there's any abnormality in either the
Speaker 1: bleeding factors or the clouding factors, that get an official
Speaker 1: heematology consultation and some measures get taken in Right. So
Speaker 1: now we're equally scared of bleeding because you're creating a
Speaker 1: massive dead space, and we're equally scared of clotting because
Speaker 1: people don't move much. So I've had to treat patients
Speaker 1: who had a von Villebrand's disease once on a Jehovah's
Speaker 1: witness patient. Right, Ah, So if you picked that up
Speaker 1: early on, you had enough protocols to go through the
Speaker 1: procedure very well, and you discovered it the wrong way,
Speaker 1: You're in strife.
Speaker 2: Big strife. Yeah, surgery takes a different level of care
Speaker 2: when once you know.
Speaker 1: Yeah, and especially lypidema liposuction, because your caplaries are quite fragile.
Speaker 1: Because the college is you've got technically grandmother's collagen and
Speaker 1: in your blood vessels, right, and the trauma that causes
Speaker 1: those blood vessels will enough to pop them. At the
Speaker 1: lightest trauma, very little trauma, computer, non patient, You're creating
Speaker 1: a massive dead space. You're creating a massive trauma. Your
Speaker 1: vessels are fragile, and the last thing you want to
Speaker 1: add to complicate the pictures that are beating disorder.
Speaker 2: So wrapping all of this up, big take home I'm
Speaker 2: getting from you is, if your mom has it, or
Speaker 2: if you're a mom and you've got a daughter, get
Speaker 2: onto it early. Really healthy diet, start good exercise practices
Speaker 2: as a family, good diet as a family. If you
Speaker 2: are finding that your legs are starting to get that bulkiness,
Speaker 2: that fat, go and see a plastic surgeon that's that
Speaker 2: specializes in Yeah.
Speaker 1: But I think the more important part is to I
Speaker 1: would recommend you see a lymphatic massage therapist or lipedema
Speaker 1: therapist or emphanema therapists. Yea. These are specialized people who
Speaker 1: are who treat patients who have got limp edema which
Speaker 1: is cancer rather worse, yes, and lipidima as well. So
Speaker 1: they're very they're content experts, they're knowledgeable in this process,
Speaker 1: they know exactly they'll give you the right advice, and
Speaker 1: they're far more accessible than trying to find a plastic
Speaker 1: surgeon because lymphi dema therapists are all over the country. Okay, right,
Speaker 1: So go and see a lymphatic therapist first, and they
Speaker 1: can start initiating you with the conservative treatment, understanding you
Speaker 1: the right measurements of the garments, the right type of guns, right,
Speaker 1: and then you can then they will have a trusted
Speaker 1: network of who's who's a good person to start to
Speaker 1: can do. But that's a physio, it's a doctor, it's
Speaker 1: a plastic surgeon. And then that's that's when you tap
Speaker 1: into the ecosystem.
Speaker 2: Okay. And then the other big take home I've got
Speaker 2: from chatting with you is that I can't stress this enough.
Speaker 2: In my clinic as an as practitioner, I only refer
Speaker 2: to plastic surgeons, dermatologists, specialists that you whoever you are
Speaker 2: going to see or choose to see, you ask the questions,
Speaker 2: are you a plastic surgeon? Are you a surgeon? Legally?
Speaker 2: Are you a surgeon? Do you have hospital rights? Just
Speaker 2: protect yourself because as we both know, things do happen
Speaker 2: that are unexpected and things can go wrong. That is great,
Speaker 2: and you mitigate those risks by making sure you cover
Speaker 2: all your bases and asking the right questions.
Speaker 1: Look, I think if you just look at a very
Speaker 1: basic metric, it's surgery by surgeons.
Speaker 2: There you go, surgery by surgeons.
Speaker 1: That's what it is.
Speaker 2: That's the name of my podcast, that's what it is
Speaker 2: meant to be.
Speaker 1: And I think if you if you perform a surgical procedure,
Speaker 1: does not make you a surgeon.
Speaker 2: No, it doesn't. Thank you so much for taking time
Speaker 2: out of the conference to coming and chat with me.
Speaker 2: So I have learned so much today chatting with you,
Speaker 2: and I know my missing followers on tenantus for Nurses
Speaker 2: will absolutely love this chat. But thank you. I know
Speaker 2: how busy you are with these conferences and everyone wants
Speaker 2: to have a chat with you, So I feel a
Speaker 2: bit privileged that you took the time. Actually, you just
Speaker 2: probably wanted to sneak away, didn't you.
Speaker 1: Thank you so bread day and Brisbane. Nice to get
Speaker 1: some warm weather.
Speaker 2: I know it's beautiful today.
Speaker 1: So thank you very much, Thank you, Thank you Beck,
Speaker 1: thanks for having me mine do We look forward to
Speaker 1: seeing you again at the NSS next year, twenty twenty
Speaker 1: five on the Gold Coast and on all your listeners too.