lipodema/lipoedema

Lipodema                        Lipedema                Lipoedema It is written in many ways but it is: a generally thought to be an abnormal deposition of subcutaneous fat with anassociated oedema. It occurs spontaneously and is characterised by enlargement of both legsfrom below the waist to the ankles. Occasionally, it also affects the arms. Patients find the condition extremely distressing. Despite being identified in 1940, lipoedema continuesto be poorly understood and is often misdiagnosed. Little has been done clinically about treating this condition in the past.

Lipoedema – and what you ought to know about it                                                                                                                                                  Here you will find out everything that you ought to know about lipoedema: What is lipoedema? What can I do about it? How does it make its presence felt? What are the most frequent symptoms? What therapy methods are available? What should the affected patient be aware of?Frequent symptoms Lipoedema leads secondarily to a chronic lymph blockage. The fat lobules and fat cells are anchored in the connective tissue where they are surrounded by very small lymphatic and blood vessels. An increase in the fat cells gradually results in the finest lymphatic vessels being pressed shut. In addition, oestrogens (female sex hormones) cause an increase in the storage of fluid in the connective tissue and a loosening of this tissue. One side-effect of lipoedema is therefore a chronic lymph blockage in the dependent parts of the body and the storage of fluid in a very loose connective tissue. This explains the pains that regularly occur. Feeling of heaviness in the legs This is caused by the weight of the increased adipose tissue and the amount of accumulated tissue fluid. Swollen legs (orthostatic syndrome) It is mostly during long periods of standing and/or sitting that the accumulation of fluids in the legs increases. The result is a swelling, frequently accompanied by a tendency to swell in the (otherwise not affected) feet. People affected by this often say that they have trouble putting their shoes on in the afternoon. Orange skin phenomenon and cellulitis Caused by the special structure of the connective tissue and the loosening of this tissue. Increase in the occurrence of bruises (haematomas) in the affected parts of the body (even at the slightest inducement) The reasons for this are:- pressure on the blood-vessels by the fat cells; a lack of anchoring of the small capillaries in the connective tissue, which results in them tearing when affected by the pull of gravity. Considerable pain in the legs; painful sensitivity to touch The continued development (chronification) of the lymph blockage leads to a hardening of the tissue (induration), which can be extremely sensitive to touch and very painful. Early occurrence of degenerative changes in the joints and arthroses Especially in the knee (because of wrongly placed stress and excess weight). Function of arteries, veins, and lymphatic vessels red = arteries blue = veins yellow = lymphatic vessels Blood is pumped along the arteries right down to the big toe. 90% of the blood flows back to the heart through the veins. The remaining 10% is carried back along the second return flow system, the lymphatic vessels, to the main circulatory system. Lymphatic vessels Lymph fluid is absorbed from the lymphatic vessels by small pores and pumped upwards. Constriction of the lymphatic vessels Constriction of the lymphatic vessels by an increased fat deposit. The return flow of the lymphatic vessels is thus blocked.                                                              Classification of the lipoedema  (5 types) Type I Type Ia: without pain Type Ib: with pain Increase of the adipose tissue in the region of the pelvis and the backside (jodhpurs phenomenon) Type II Type IIa: without pain Type IIb: with pain The lipoedema goes as far down as the knees   Type III Type IIIa: without pain Type IIIb: with pain Marked clinical picture of a lipoedema from the hips down to the  ankle (Suaven trousers phenomenon) Type IV Type IVa: without pain Type IVb: with pain Special particularity: the arms are affected. Type V Type Va: without pain Type Vb: with pain Special particularity: restricted to the lower leg Combinations of the types are possible. Stages of lymphatic oedema Lymphatic oedema, which appears secondarily in lipoedema, i.e. as the consequence of the increase of adipose tissue, is frequently divided up into 4 degrees of severity in medical literature (see below): Stage I Can be depressed, and is spontaneously reversible. Is apparent after physical strain or at the end of the day, and has gone again after a night’s rest. Stage II Can be depressed, and is reversible after treatment. Complications such as eczema and erysipelas frequent. Without therapy is less severe in the morning, but is still detectable. Stage III Connective tissue hardened (fibrosclerosis), cannot be depressed. Can only be improved, but even after therapy damage to the connective tissue still present. Stage IV Irreversible oedema, elephantiasis; complications up to malignant degeneration. Presence of superficial varicose veins Of the blood that is pumped by the heart along the arteries to the legs right down to the big toe, 90 % is transported back to the heart in the veins. However, nothing can flow of its own accord against the pull of gravity, i.e. upwards. The blood must be pumped upwards actively. This is done with every movement of the legs, with every stride. That is why there are flaps in the big veins at short intervals. The venous flaps work in the same way as a valve and only allow the blood to flow upwards. These flaps frequently get damaged or even destroyed in the event of a thrombosis. In a genetic weakness of the connective tissue the veins frequently stretch in the course of years or decades to such an extent that the venous flaps can no longer close and the blood flows back into the leg again. This is helped by factors such as professions involving sitting or standing,  pregnancy, hormone treatment, extreme overweight, and heavy physical labour (especially in a hot environment).  The veins which expand because of this are called “varicose veins”. Damage to the deep-lying venous system It can however also affect the deep-lying venous system, which is as a whole much more important for the circulation and whose transport capacity is four times as great as that of the superficial system. Because of the pressure of the column of blood in the varicose veins or in the deep-lying veins, fluid and/or solid substances are passed into the tissue (“interstitial space”). This fluid is usually transported back to the heart along the lymphatic vessels. The remaining 10 % is filtered off in the system of the capillaries as an albumin-enriched clear liquid which is called lymph.Because of the increase in the weight of the lymphatic fluid an even greater strain is placed on the transport capacity of the lymphatic vessels, which are already being pressed shut, and they swell. For this reason a phlebological examination of the venous system must also be performed as a matter of course in patients with lipoedema, since varicose veins can be both avoided and also well treated. Great physical strain An increase in the weight of the lymphatic fluid can also occur as the result of too much physical activity. Here, of course, the limits vary according to the individual. With the increase in the demand for oxygen and energy by the muscular system of the legs during generally unusual physical exertion, the heart has to pump more blood into the leg per time unit, and the cardiac output rises.  10% of this accumulates in principle as lymphatic fluid; because of this the strain on the lymphatic system is increased. Some patients report an increase of the pains after stimulating drinks such as coffee, coke, tea, wine, or sparkling wine. Caffeine and alcohol stimulate the microcirculation in the capillaries, thus causing an increase in the demands on the lymphatic system. First complication Of all the possible complications, the ones to be named first and foremost are the diseases caused by wear and tear of the joints (preferably of the lumbar vertebrae and of the pelvic, knee, and foot joints). Second complication A second complication is the development of lymphatic oedemas. Especially in stage III of the lipoedema there is a disorder of the lymphatic flow which is due to the increasing stenosis of the lymphatic vessels by the sudden growth of the adipose tissue. At a more advanced stage of the disease large-sized lymphatic oedemas can occur in addition to lipoedema. In contrast to pure lymphatic oedemas, which usually bear different characteristics on both sides, the development of a lymphatic oedema in the course of a lipoedema disease is always symmetrical. Third complication Increase in weight! In particular – as stated at the beginning – psychically depressive factors can frequently cause an increase in weight in lipoedema.  Because of this the risk of additional complications, such as diseases caused by wear and tear of the joints or the development of a lymphatic oedema, is dramatically increased. Treatment possibilities are restricted 1. Diets and fasting Lipoedema is not caused by nutrition, and therefore can not be influenced by diets or fasting! Patients frequently suffer from a severe loss of their self-esteem. Only too often they are told that their disease is the result of the wrong nutrition. They hear this not only from their family and their private/professional sphere, but unfortunately also from inexpert paediatricians and general practitioners. Because of this massive external influence, many people genuinely believe in the end that the symptoms are the result of the wrong nutrition and start their first cutting-down diets.However, the weight reduction achieved by this has no influence at all on the leg circumference. Besides which, a diet makes the organism change over to low-flame, so that the subsequent “normal” eating habits, when resumed, lead to a sudden increase in weight (usually in the legs first of all!). Nutritional disorders are however frequently a side-effect of lipoedema. At the latest when the legs become sensitive to touch, and pain and haematomas occur on every touch, the sex-life is impaired to a very great extent. One result of this is that the affected people often look for a substitute satisfaction, frequently in an excessive food intake. In many instances this results in a nutritional disorder that needs to be treated. Here a stay in a hospital specialising in lymphatic disorders gives the patients the opportunity to get back to normal eating habits again. 2. Medicinal treatment Lipoedema cannot be influenced or healed with medicines (neither by pills nor by creams)! 3. Sports The ideal sport to go in for with lipoedema is swimming. Here the muscular activity takes place in a horizontal position, so that there is no danger of the threat of an oedema which occurs when the body is upright (orthostatical syndrome). Cycling is also good for you. Gymnastics, going for walks, and light jogging can also be recommended. 4. Cosmetic corrections Liposuction (suction of the fat) is a method of treatment that is frequently applied. It must be admitted that in the past no improvement was observed in a few instances. If the lymphatic vessels are damaged during the procedure the result can even be a deterioration. Before you decide to have liposuction you should get someone to tell you about all the side-effects, the expense it involves, and the long-term results of this method. PLEASE Consult several doctors! 5. Lymph drainage and compression treatment The only recognised and highly effective method of treatment is the combination of manual lymph drainage and compression treatment. Hereby the lymphatic vessels are opened by means of a special massage technique. In the course of one session  of e.g. 45 minutes approximately 500 ml of lymph and water are moved out of each leg in the all-round treatment. In order to make the effect last longer, both lymph and blood have to be pressed into the lower-lying larger veins or lymph collectors. In addition the provision with medical compression stockings or tights is absolutely essential. In lipoedema the legs are often beyond every standard size, so that made-to-measure stockings in high compression classes are necessary. Intermittent compression treatment with apparatus containing several chambers seems to have a favourable effect on lipoedema and is necessary as an additional therapy when the amount of manual lymph drainage (MLD) cannot be increased. Treatment as an out-patient or an in-patient? People with Stage I lipoedema are normally treated as out-patients. From Stage II onwards treatment in hospital must be taken into consideration at least as an initial measure. There are several reasons for this:1. The disease needs continuous treatment. If it is interrupted or discontinued the findings and the pains will deteriorate more or less quickly. The suffering is constitutional; there is therefore not one cause which can be resisted therapeutically. 2. The patients, who are very often young, have to be convinced of the necessity of wearing compression tights consistently. It is natural that this will be more likely to succeed when an effect is visible. Treatment as an out-patient certainly produces a clear reduction in the pains in many instances, but not, however, an appreciable reduction in the circumference of the legs. 3. In most instances the patients have a very disturbed feeling of self-esteem (the younger they are, the more frequently). It is often a help for them to be in a group with fellow-sufferers who are faced with the same problems and with whom they can exchange stories of their experiences. After having been to a hospital specialising in lymphatic disorders many women seem to be internally transformed and have a positive attitude to their lives again. 4. From Stage II onwards an effective de-blockage, which accompanies a measurable reduction of the circumference and volume (approx. 1 – 1.5 litres per leg or 5 – 12 cm less on the upper leg), can no longer be achieved in by a lymphatic therapist working outside a hospital because of the amount of time needed for this.    In-patient treatment in a hospital specialising in lymphatic disorders. Optimal treatment, such as can only be performed in a hospital specialising in lymphatic disorders, looks like this:1. Manual lymph drainage in the morning and in the evening as a total treatment for the duration of at least  45 mins., with simultaneous breathing exercises and anti-blockage exercise-movements. 2. Subsequent bandaging of the legs with special foam rubber, textile-elastic short stretch bandages. 3. If necessary intermittent compression for 30 – 60 minutes (if necessary twice a day). There are in addition supportive measures such as: – advice on nutrition – reduction and wholesome diets – pain therapy – bicycle ergometer training – long walks – psychological counsellingFemale patients are occupied with this therapy all day long. It is only through these intensive measures that appreciable reductions in the circumference can be achieved. During the first two weeks the success of the treatment is relatively small. In most cases the greatest progress is to be expected after approximately 4 weeks. In severe forms with the second stage of lymphatic oedema it may be necessary to carry on the treatment for longer. During the day – Do special anti-blockage gymnastic exercises in compression stockings – if prescribed by the doctor. During the night – If prescribed – put a bandage on the affected extremity after careful skin-care! – Put the affected arms or legs up! (If necessary raise the end of the bed). Holidays – Avoid tropical regions (heat, insects)! Take antibiotics with you in case of emergency. Your doctor will tell you the dosage). – On long journeys have breaks so that you can do gymnastic exercises (in the aeroplane, if possible, get up and walk about   again and again: do rocking movements with your feet). Physiotherapy/remedial gymnastics – No kneading massage! – No fango packs in the oedematous area! – No deep-heat-producing electrotherapy! – No overstretching remedial gymnastics! Doctor – Do not measure your blood-pressure on the affected arm. – Do not allow any phlebography or direct lymphography to be performed on the swollen limb! – Do not accept manual lymph drainage as an isolated therapy! (Compression treatment is absolutely essential!) In manual lymph drainage the affected quarter of the body or the entire body must always be lymph-drained. Go to a doctor immediately if … – pains occur and/or the muscle-power diminishes. – the swelling deteriorates in spite of adequate treatment. – inflammation of the legs occurs with pain, redness, marks, or shivering fits (erysipelas = erysipelas infection). Nutrition – Keep to your optimal weight or, if you are overweight, try and get back to it by dieting and exercise! – Make sure you have a balanced diet! Eat a lot of vitamins! Avoid sugar, sweets, and things made with white flour    (cake, biscuits, etc.) – Restrict the amount of salt you eat. Drink when you are thirsty; in other words, you may drink as much as you want   (at least two litres a day). Garden Avoid injuries (thorns, prickles, tools). Pets Avoid at all events being bitten, or scratched by a cat. Subsequent out-patient treatment After having provided the patient with compression stockings a consistent permanent continuation of this treatment must take place at home: Manual lymph drainage once to twice a week, the permanent wearing of compression tights, and, if these measures are not sufficient, the additional prescription of an apparatus for mechanical intermittent compression by the general practitioner in charge or a phlebologist. These measures serve to ensure the success of the treatment in the hospital specialising in lymphatic disorders. In many cases this may be sufficient. Frequently, however, the situation occurs where, in spite of good coordination with the patient and the raising of the weekly lymph drainage, extra hours in the “lymphomat”, and if necessary also a rise in the compression by means of stronger and/or additional compression stockings, an improvement is not achieved, but instead a continuous deterioration occurs. This can make itself manifest in the form of an insidious increase in the circumference and/or an increase in the blockage problems/pains.If this happens in spite of an open-minded and active cooperation in the therapy on the part of the patient, i.e. if there can be no question of compliance problems as the explanation for this, another in-patient stay in a hospital specialising in lymphatic disorders cannot be avoided. And over the course of the years additional in-patient treatment will have to be considered when the possibilities of out-patient treatment in that place have been exhausted. What the female patient should be aware of: at home and at work Avoid injuries, strain, extreme temperatures (heat and cold)! Clothing Skirts, trousers, and belts must not exert pressure – free breathing is important! Cosmetics and body-care – When caring for your nails do not cut into the nail wall! – Do not use cosmetics that irritate your skin! – Do not use alkaline soap; use a soap with an acid pH value – the acid protection layer of your skin must not be damaged. Your skin must not be dry or cracked. – Take care in the sauna! It can be harmful, but may not be. – Take care when sun-bathing! You must at all events protect your skin from sunburn! – Avoid kneading massage of your leg and the lower backside of the same side! Sports In general, going in for sports is advantageous. The de-blocking effect of sporting activities is increased even more if you wear compression stockings. – Get your doctor to fit you out with compression stockings from the range of the well-known Bavarian manufacturer Juzo. With the SkinProtect® procedure specially developed by Juzo the fine mesh becomes extraordinarily pervious to air and moisture and is therefore pleasant to wear. – No sudden movements of the swollen extremity (take care in sports such as tennis, squash, football etc.) – Do not get frostbite if you go in for winter sports! – Do not risk getting injured! (Choose cross-country skiing in preference to alpine; gentle swimming is one of the therapeutic methods).