Lipedema & Lymphedema

What is Lipedema?

 

Lipedema is a chronic and painful lipid metabolism disorder that results in bilateral symmetrical impairment of fatty tissue distribution and storage combined with proliferation of individual fat cells.  It occurs almost exclusively in women and is genetic.

 

It is usually diagnosed based on a patient’s clinical history and a physical examination that confirms specific characteristic features of the disorder.

 

These characteristic features include:

1.     Symmetrical edema in the legs that stops abruptly at the ankles, leaving the feet of normal size.  The feet and ankles do not swell with fluid until later in the dysfunction when the lymphatics begin to fail.

2.     Stemmer’s sign is negative (meaning that you can gently pinch and lift the fold of skin at the base of the second toe) and there is minimal pitting edema (meaning if you press into the inflamed area it does not leave a very deep indentation).

3.     The shins and inner calves are particularly painful to the touch and ache unrelentingly, more in the afternoons and evenings and much more after strenuous high impact exercise or activity.   This is NOT a muscle ache.  It is caused by pressure upon nerves by excess accumulation of tissue fluid and by fibrosis of adipose tissue. 

4.     Swelling of the shins and calves worsens when standing for long periods, especially in high heat and humidity.

5.     In the early stages there are very distinct cyst like formations of fat that are attached to connective tissue (like the hamstrings tendons).  As the dysfunction progresses, if no measures are taken to keep lipedema in check, these nodes get bigger and become unevenly distributed and cause the skin to have an orange-peel-like appearance.  In the third stage of lipedema subcutaneous fat tissue projects in large pouches at the inner knees and outer thighs, hindering mobility.

6.     Very noticeable low temperature of the skin around the areas of fat deposits.

7.     Persistent enlargement of the fat deposits even after weight loss … the fat deposits will not be significantly reduced even with extreme calorie restriction. Therefore the person trying to lose weight develops an appearance of their hips and legs being several sizes larger then their upper body … this is an exaggeration of the ‘pear shape.’ It is also the reason why it is so very, very important for people with lipedema to watch their weight carefully and NOT GAIN WEIGHT.

8.     Small, dilated blood vessels are visible near the surface of the skin around the areas of the fatty deposits. 

9. The areas affected by lipedema are prone to bruising.

 

 

In lipedema, the body produces fat cells that have over abundant amounts of watery fluid in them.  The increased fluid is caused by an abnormality in the interstitial transport and exchange of fluid, this results in the disruption of fats and accumulation of fluid due to increased hydrostatic pressure.  This means that fluid enters fat cells at a faster rate and leaves fat cells at a slower rate.

 

People with lipedema have abnormalities with their blood vessels and problems with their lymph vessels.

 

In the early stages of lipedema the lymph system has normal flow, but the fat cells do not have normal fluid exchange.  So the lymph, which transports lipids and interstitial fluids, continues to provide the fat cells with a normal amount of fluid, the fat cells get engorged absorbing more fluid than they release.  The engorged fat cells then press on the lymph vessels inhibiting the ability of the lymph to move back to the heart. Interstitial fluids begin to collect in the lower limbs.

 

The capillaries just under the surface of the skin widen and become fibrotic, they appear as little red marks just under the skin.  This fibrosis damages the blood vessels causing them to leak their contents into fat tissue.

 

Eventually (after decades of slowly and silently occurring lipedema) this causes smaller lymphatic vessels to begin to stretch out and leak fluid into surrounding tissues … causing lipolymphedema.

 

The disorder occurs in three stages:

 

Stage I:

Thickening and softening of the subcutaneous tissue with small nodules; skin is smooth.

 

Stage II:

Thickening and softening of the subcutaneous tissue with larger nodules; skin texture is uneven.

 

Stage III:

Thickening and hardening of the subcutaneous tissue with large nodules, disfiguring lobules of fat on the inner thighs and inner aspects of the knees

 

 



Treatment:

 

1.     Follow a strict anti-inflammatory diet to minimize inflammation throughout the body and help modulate the immune system.  Eliminate all food allergies/sensitivities.

2.     To help the body clear up cellular debris and spilled proteins, take loading doses of proteolytic enzymes like Biotics Intenzyme Forte, 10 tablets 3-4 times a day, 45 minutes before meals, always on an empty stomach.

3.     Support detoxification reactions in the body daily with Apex ClearVite and copious bioflavonoids and antioxidants like Apex Nourish Greens and Biotics BioProtect that contain N-acetyl cysteine and super oxide dismutase. 

4.     Take an anti-inflammatory daily vitamin like Biotics VasculoSirt that contains quercetin and selenium.

5.     Receive frequent and regular manual lymph drainage and myofascial massage.

 

As a body therapist, I specialize in manual lymph drainage.  I also recommend Holly Hoffmann for those of you in the Charleston, WV metro area (http://massagetherapywv.com).  I receive manual lymph drainage therapy from her, and her skills really help to keep my pain manageable.

 

You can also visit: http://www.vodderschool.com/ to find a therapist in your area.

 

6.     Exercise regularly … but avoid high impact exercise … cycling, stationary bikes, elliptical machines, trampoline routines, weight lifting, yoga, tai chi, pilates, etc.  It is imperative that you move the body in order to move the lymph … and also to avoid gaining weight.

 

When I was first recovering, to be comfortable I needed exercise twice a day 5-6 days a week.   Now, in maintenance phase, I exercise faithfully every other day. That may seem like a lot, but it is what suits my body best.  When I was recovering from Erythema Nodosum after pneumonia I had persistent swelling in my legs that would not dissipate due to lipedema. In order to recover I used this regimen: first thing in the morning I got up and took 10 Biotics Intenzyme Forte and 4 Biotics Gammanol Forte.  I exercised for 1-hour following the beachbody P90X or Insanity programs.  Immediately after exercising I took another 10 Biotics Intenzyme Forte and 4 Biotics Gammanol Forte and showered.  After showering I drank an Apex ClearVite shake with Apex Nourish Greens and took my daily supplements including Biotics BioProtect.  Before dinner I again took 10 Biotics Intenzyme Forte and 4 Biotics Gammanol Forte and exercised for 1 hour, followed by a 30-minute infrared sauna session. It took about 4 months on that regimen to get to a place where the swelling diminished and I did not feel the tell tale lipedema nerve pain in my lower legs. Now, exercising once a day, every other day, keeps me pain free.

 

7.     Wear compression garments, especially when exercising.  I use 2XU UnderArmor during exercise and recovery compression tights at other times.  Other sources of compression garments, like fashion leggings and pantyhose include Jobst and Juzo.  Compression Class 2 (30-40 mm Hg) is recommended for lipedema.  Have your manual lymph drainage therapist assist you in measuring for custom sized garments.

8.     Maintain excellent skin health … have professional facials and body “facials" regularly. 

a.    Apex Oxicell glutathione cream applied on the shins and areas of greatest swelling helps to reduce inflammation.

b.    Use essential oils that contain linalool and linalyl acetate and other anti-inflammatory chemicals to reduce inflammation and pain in the lower legs … my favorite is frankincense but many other oils work very well, like: ginger, clove, black pepper, rosewood, basil, coriander, lavender, lavandin, oregano, jasmine, ylang ylang, orange, clary sage, osmanthus, bergamot, neroli, cinnamon, helichrysum, nutmeg, wintergreen, spearmint, etc

c.     I find that Akhassa Rituals Professional Spa Series Sake Detox body masque is fantastic for helping to reduce fibrosis in the thighs.

9.     Though hot tubs, steam baths and regular saunas are contraindicated for lipedema because they cause excess blood flow to the limbs and therefore excess spilling and leaking of fluid into the tissue, infrared saunas are an excellent way to increase detoxification and mobilization of fat tissue without increasing swelling in the limbs … the infrared rays heat up the body from the inside out (rather than the outside in) and this has a totally different effect on body tissues, helping to alleviate the appearance of cellulite. To read more about scientific research on the many benefits of infrared therapy from the treatment of cardiovascular disease, cancer, fibromyalgia, and rheumatoid arthritis to weight loss go to the National Institutes of Health PubMed.gov and search infrared sauna.

 

ONLINE LIPEDEMA RESOURCES:

http://www.hanse-klinik.com/englisch/Lipoedema.pdf

http://biglegwoman.blogspot.com/2006_10_01_archive.html

http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm

http://www.lymphedemapeople.com/thesite/lymphedema_lipodema.htm

http://www.curelipedema.org/

http://www.lipomadoc.org/lipedema.html

http://www.scribd.com/doc/54036724/Stefan-Rapprich

http://www.scribd.com/doc/54036944/Lipedema-an-Inherited-Condition-2010

 

 

 

So … what’s the difference between Lipedema and Lymphedema?

 

Lymphedema is a condition that can be caused by Lipedema AND by other issues.

 

Lymphedema occurs when proteins and tissue fluid remain in the interstitial spaces between cells rather than being transported back to the heart through the lymph and blood vessels.  The resulting swelling of tissues caused by accumulation of these proteins and tissue fluids is called lymphedema.

 

There are two main causes of lymphedema:

 

1.     Primary Lymphedema: the lymphatic system is abnormal from birth due to a congenital defect … like the absence of lymph capillaries, or too few lymph vessels, or too narrow lymph vessels.  In any case, the lymph transport capacity is insufficient.

2.     Secondary lymphedema: anything that injures a healthy lymphatic system resulting in permanent damage. Cancer or cancer treatment including radiation and surgery, viral/bacterial infection, accident/injury and lipedema can all compromise the performance of the lymphatic system leading to quick onset or slow onset lymphedema.

 

There are 4 stages of lymphedema:

 

1.     Latent: the lymphatic system is functioning inadequately, but it is still coping with the lymph that is produced by means of compensatory mechanisms.   No edema is present.

2.     Reversible: the lymphatic system is overburdened; a protein-rich soft swelling develops in the affected area.  It can be indented by apply pressure.  When the affect limb is raised, the swelling reduces on its own.

3.     Spontaneously Irreversible: the swollen areas develop excess connective tissue; fibrosis and sclerosis have developed.  Indentations can only be produced by applying strong, deliberate pressure and raising the limb no longer reduces the swelling.

3.     Elephantiasis: the swelling is extreme; the skin is hardened and shows wart-like growths.  Sometimes large bulges are present.  The risk of bacterial and fungal infection to the skin is very high and the skin is vulnerable to the development of deep, poorly healing wounds.

 

Management of lymphedema is achieved through reduction of the edema and maintenance.  The process is often referred to as Complex Decongestive Physiotherapy and consists of:

 

1.     Excellent Skin Care: this is very important to help prevent bacteria from penetrating into the compromised tissue.

2.     Manual Lymph Drainage: performed by trained therapists to stimulate the pulsation of the lymph vessel walls and accelerate drainage of the lymph in the lymph vessels that are still functioning.

The Dr. Vodder method of Manual Lymph Drainage (MLD) is a unique method developed in France in the 1930s.  It is used by therapists to enhance fluid movement in the skin. It also has a very powerful relaxing and calming effect on the nervous system. The gentle, rhythmic, pumping, massage movements follow the direction of lymph flow and produce rapid results. 

This is a gentle, non-invasive manual technique that has a powerful effect on the body.  Research in Australia, Europe and North America has proven its efficacy as a stand-alone treatment and in combination with other therapies.


Contanct me at vhendley@nessiji.com to schedule your Manual Lymph Drainage today.  Or contact Holly Hoffmann at: http://massagetherapywv.com


3.     Compression Therapy: manual lymph draining increases the flow of lymph in the still functioning lymph vessels, allowing more of the accumulated fluid to be carried away by the lymph capillaries … compression greatly enhances this process and helps to keep the fluid from quickly re-pooling in the affected areas.

4.     Exercise (while wearing compression garments for the affect limbs): exercise allows the compression to exert its greatest affect and helps to drain fluid from the tissue.  Lymph fluid is moved by peristalsis, deep breathing, arterial pumping and muscular movement; exercise employs 3 of these systems all at once: deep breathing, arterial pumping and muscular movement.

© Remède Physique