Transcript – Movement for Lipoedema

Note – all transcripts are automatically generated by Zoom, please allow for some spelling/grammar issues, as well as some words being improperly transcribed by the software

 

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And then we’ll do questions at the end. So any questions that come up as they come through just pop them in the box, and just to give a little welcome for us tonight, is

 

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Dr. Chris Lekich, so I’ll let. I’ll let Chris say, Hi, now!

 

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Thank you very much, Emily, and always the hard work you do.

 

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I’m glad you back from from Spain and you with us in Australia in our timeframe and and big.

 

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Thank you for telling us for joining us so name came up quite a few times last week when I was in Sydney with the patience there, and as many of you might know she’s in Canberra, but does see patients are out and about beyond camera and thank you for your good work I just like to

 

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say just how important movement is, and I saw a lady in 2,017.

 

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She was 33. She’s a big campaigner in.

 

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She had previous 3 live sections with someone.

 

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Else over a couple of years, and and unfortunately fat continued to grow.

 

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And it’s grow and grew and grew, and at some point she discovered more good conservative management.

 

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That started getting under control, and then , and at one stage we even discovered a large hole in the heart that got closed, and for the first time this girl, who was probably going to be 5 or 6 surgeries because she had somewhere around 40 litres of lipoedema fat in the

 

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legs just as we were giving a gearing up for sa surgery, she was involved in a motor vehicle.

 

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Accident, that’s a minor injuries and could not walk anymore along with that.

 

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The we had to manage. And this like this, this young lady who legs became so enlarged in this seem to be consuming her, and I was very sad that 3 months ago she was in intensive care on her fortieth birthday, and unfortunately this girl might be just past

 

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surgery now horrible! The diseases! That’s how horrible immobility for this condition is as the and lipoedema gets more inflamed.

 

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It puts more pressure on the lymphatic underlying Venus disease just causes this crescendo effect, which at some times are irreversible.

 

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So the moment for the conservative management is just so important to throw everything at it and and I really do applaud Liz and everyone else’s contribution to our webinars.

 

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So get the most out of the therapies.

 

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It’s for free the information. It’ll be recorded, and I appreciate both your time, Emily, and especially in this tonight.

 

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Thank you very much.

 

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Thank you. Dr. Lekich!

 

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Alright all yours!

 

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Right? Well, hi, everyone. So yeah, I’m with Charlton.

 

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I am a director and principal video. Oh, yeah, positive motion rehabilitation, which is our sort of overarching. You know, company.

 

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If you like, for a couple of businesses that have that have ended up merging together.

 

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So the lymphedema part of this business is actually called positive motion, physiotherapy and allied health services, because we I do have a lovely ot that works with us, and a couple of massage therapists as well so we moved beyond the physiotherapy and move towards the allied health services name on that

 

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one. So we I suppose I have been running this business by myself initially, in 2,007.

 

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And so it’s been a pretty long journey, and now, as you can see on the first slide, as well as doing the lymphedema lipoedema management.

 

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We also distribute some compression garments on the website Lymph Adonna’s, which sells from the parent company in the Us.

 

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Called link for divas. So that’s just something else that our business is involved with.

 

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And the other part of our overarching kind of business is Kingston Physio, which offers general musculos the legal physio services, as well.

 

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So, yeah, I think what I first emailed this presentation to Emily said, don’t forget to talk about how you got to hear.

 

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And you know, get more about yourself as well, so I’ll just introduce, I guess my journey to Lymphedema and lymphedema management.

 

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Briefly before we get started, so I suppose I did all of my study.

 

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I grew up in Brisbane, and did my study at University of Queensland, and I think that Lymphoedema is one of my loves, as because, before, I did physiotherapy.

 

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I actually did a majoring in microbiology parallel with a Bachelor of Arts, with a double major in music.

 

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So I suppose I always wanted to be a scientist who could also do music.

 

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And so when I finished that degree, I sort of looked around for some practical applications of some of those skills.

 

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I suppose, and so that’s what LED me to physiotherapy, and you know I think most of us live for Denver and lipoedema therapists, you know.

 

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We may double in some general physiotherapy, which I certainly did for a number of years, but I think we’re all the sort of breed that likes to, I guess nourish and and see the deeper side of treatment, and maybe a holistic side of management that is is not always quite

 

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the same in some general physio areas. So that’s sort of how I made it to here.

 

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And I, as a student in Brisbane. I was lucky enough to do a placement at the Royal Brisbane and Women’s Hospital, where I had Dr.

 

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Robin Box and Hildegard, her colleague.

 

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Both do some training with me, and a few of the students there, and during a placement, and that was my first introduction to Lymphedema, and we did do some bones management there as well.

 

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I’ve been when I graduated and worked for a little bit of time.

 

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I had some friends talk me into looking around for jobs in Canberra because they had taken some graduate jobs there.

 

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And so I ended up starting work and deciding to move down to Calgary Hospital.

 

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Here in Canberra and as some of you, or many of you might know, that is quite a significant lymphedema service there, as well.

 

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So I was very fortunate to add that service to my lymphedema training up at Mount Wilga Hospital, where they used to do the training under Brenda Lee, and then I was mentored by Jemma and Julie for those of you who know

 

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therapists at the Calgary Service for a couple of years, and after that I did decide to pursue a little bit more.

 

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General Physio outside of the hospital system, but as I did that my video colleagues kept saying this, you’d like this link stuff, you know, because I would always be the lady that those Dvt patients would go to will be those sort of cancer patients would be sent to because I have that area of knowledge and

 

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so that was how I manage to start up my own business as a one day a week business at the University of Canberra, where they had opened a little health clinic.

 

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So I guess long story short, I ended up one day a week person built into a couple of days a week, which ended up being a full-time job, and then thankfully lovely message therapist, Donna Lambie came on to help me out the service, and in the lovely Gemma

 

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our it also having her own breast cancer. Experience came on to work with us.

 

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So I am very lucky now to have moved from the Uc.

 

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Service to a practice at Philip, and now we’ve established our time down at Kingston in Canberra, and so this is our team here, and I’m happy to introduce my business partner, Fleur, on the left next to me, and then the lovely Gemma the Ot who

 

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thankfully stayed on for an extra week, so I could be here in Oakland for the so she is heavily pregnant right now, and filling in for me while I’m away.

 

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We have lovely Genevieve. Next to Gemma, who has, is our newest therapist, but has an experience also pediatrics, and Burns.

 

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We’ve got Mount the Ep. And then our 2 accredited lymphedema massage therapist, Laura and Donna.

 

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So we’ve got quite a team now, and it’s kind of exciting that to actually have a team of people.

 

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So you can be a little redundant and step away and come to conferences from time to time, which is really lovely.

 

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And the even better thing about being a team is that I think really having become a lymphedema therapist, you know, I think what I always wanted to be able to offer was a bit of a one-stop shop, you know, because it can be a really difficult journey for both oncology

 

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patients, lipoedema patients and everyone in between, you know, because you often do need a really holistic approach to your management.

 

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So I feel like now we’re able to offer, you know.

 

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Really a one stop shop for management treatment, you know. Garments.

 

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And so there he, we also can do compression, bandaging and complex physical therapy.

 

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We now offer home visits, and you know, we’re really yeah.

 

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I’m really proud that we can do that, and we, you know, gathered some equipment along the way, including a low, level laser, and we also have a sodo device and a limb for touch at our clinic as well, so yeah, I really, think the one stop shop concept with something that

 

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I was always really passionate about doing, because I always find it difficult as a person myself to have to go from place to place, to place, to get all the things that you need.

 

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So, yeah, even without limited online shop and another site that I’m setting up, we’re hoping to just be able to offer that to people.

 

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And you know, during Covid we we got pretty well acquainted with Zoom as well.

 

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So, so we’re able to get a service.

 

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Some patients, a little bit more distance away from Cambron these days, as well.

 

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If we can. So I’m really proud of our team.

 

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And I’m really proud of what we’ve created at Kingston.

 

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It’s a it’s a fun little place, and we try and do a best.

 

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That’s for sure. So let’s get on to the topic at hand.

 

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So you know, I don’t want to talk a lot about lymphedema diagnosis tonight, but I suppose only talking about movement for lymphedema.

 

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It’s just good to know what us as therapists are looking for when patients come into our clinic, and they say, Look, I, you know I think I have this condition, and I would really like to, you know, manage that with exercise or with therapy.

 

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Or can you offer me the range of options for me to manage my condition?

 

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So what do us therapists look for? And how do we do that?

 

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Because it is a very clinical diagnosis with so we have to be pretty sure of what we’re looking at.

 

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So this is basically a chart from it’s actually the lipoedema position statement in the Uk.

 

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And it was just a nice chart to pull out, and I’m using that in the next couple of slides, just so that you know anyone who’s logging in as a as a patient sort of a therapist, you know, who’s looking to diagnose lipoedema and give you

 

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that advice around exercise or management, what we’re actually looking for.

 

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So certainly when someone sits in a room and says, Look, I think I might have.

 

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lipoedema. How can you help me, or can you help me to figure out if that’s what I have?

 

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You know, we probably go through this type of checklist in our minds as we do both the subjective and an objective assessment.

 

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So we will. We will ask you, you know. When did that happen?

 

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When do you think you noticed it? Start, you know. Do you have any family history?

 

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So is a you know that, particularly as a female related condition, is there a grandma and a mother?

 

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You know someone in your family who had that your particular shape and size that has LED you to come to have this assessment.

 

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You know, and and we’re looking at whether you know one side is effective.

 

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But versus having both sides affected, whether it be arms or legs, or you know it’s certainly the report of weight loss, you know, being quite disproportionate in different areas is significant that we would ask a question like that.

 

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You know, if sometimes the effect of limb elevation on this chart is minimal, because there may or may not be the presence of fluid along with the itself, bruising easily can be quite a sign, you know, pain and hyper sensitivity to touch, very common you know these skin

 

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consistency again, you know, it would be different to someone with the condition of lymphedema.

 

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Certainly. And look, you know, unusual to have history of cellulitis, although again, it depends on the staging of the typing that you would have, which we’ll have a quick look at in the next couple of slides.

 

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And so, yeah, the presence of fluid isn’t necessarily something that’s there, particularly at the early stages, I should say, of so these are the sorts of things we, as therapists would be thinking through when someone’s coming to us asking for advice for a number of things.

 

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Including movement and exercise, so depending on which literature you want to read, or which you choose to follow.

 

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Basically, there’s a staging criteria and a typing criteria for life of David.

 

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So anyone you go to see for an assessment. She has qualifications or he can give you that advanced level assessment would be looking for these sorts of things.

 

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So stage one, you know often that we would just feel some small modules in the tissue, and certainly Dr. Lekich

 

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is obviously looking at these criteria as well as part of this assessment.

 

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For any of his patients. You know the stage 2 would be, I guess, more significant changes that porridge kind of look to the tissues, and some nodules that you know might be increased in size under the skin, you know.

 

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Then I guess by the time we get to Stage 2 we’ll and beyond to Stage 3 we’re looking at significant shape change.

 

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And then, by the time Stage 4 in this staging criteria, we’d be looking at the presence of fluid potentially by the Times classified as Stage 4.

 

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So then you know another set of criteria is typing, and that is because some patients that come to see us will have the libertarian tissue in particular places, and you know, so it’s not always affected through the whole length of the limb.

 

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But it can be in particular places, and so I guess the typing of lyme disease enables us therapists, or, as in medical professionals, as well, to look at what type of lipoedema you may have, and which areas may be affected.

 

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So you know, I think there’s still a bit of work to be done on the diagnostic criteria of life.

 

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Lipoedema being quite firmmed up, but at the moment, being such a clinical diagnosis, and they’re not being any particular clinical tests that we can use where actual medical testing should say that we can use further, we have to rely on a lot of our measurements and a lot of

 

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our observations and capations to help people to diagnose life.

 

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Lipoedema as a condition. But if we have established that lyme is what a patient is coming in with, and they are looking for some advice for us as therapists, I suppose.

 

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Where do we start? Well, the first thing which I can’t emphasize enough, and I think

 

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Dr. Lekich sort of alluded to as well is that the approach to Lipoedema must be a holistic one.

 

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So, you know again, there are some consensus documents that really clearly state that you know not one approach will work only to help to relieve the symptoms of lipoedema and to manage lymphedema as a condition.

 

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But you know I call it the toolkit so this is the toolkit that we have to look at in terms of helping people through to manage their symptoms and manage the condition that is so physical or movement.

 

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Therapy is only one of those pieces of one of those things in the toolkit.

 

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So you know, we have to be also looking at compression.

 

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Therapy, you know. Maybe psychosocial therapy depending on how people are going with that side of their of their lives and how they’re managing with their condition diagnosis. You know.

 

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Weight management certainly is still an issue, even though you know it’s difficult, you know, to lose life tissue, you know.

 

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If you look at some of the German documentation at early stages of Lyme.

 

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You know there are the position statement in Germany which states that actually general weight, loss of normal fatty.

 

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Tissue may well help to reverse to a degree some of those symptoms, and some of that, lipoedema progression.

 

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So certainly, you know this is not a talk about weight management, but in is just something to be considered as part of the toolkit.

 

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The live production procedures are certainly can be part of the toolkit as well as a number of self management strategies.

 

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So we’re picking out movements as a video movement or the video prescribed movement therapy as one of the pieces of the toolkit tonight.

 

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So you know, how do we? How do we exercise people?

 

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How do we decide as therapists? And how do we negotiate with you as patients?

 

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What what to do, and what sort of exercises appropriate.

 

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So there is actually this lovely again, looking at a holistic view to this, it’s a really nice picture to think that as therapist, we are going to develop a health profile and something that’s what we’d like to do at our clinic as well, so this health.

 

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Profile, you know, is kind of in this type of classification, of of functional ability to divides into what’s related to the health condition itself.

 

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And what’s related to the environmental factors and the personal factors.

 

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So I guess the the first. Yeah, the functional ability of a person is in part one in the top part is determined by their body functions and structure.

 

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So that means the shape of your body, the composition of your body, the composition of your connective tissues, and and how that impacts on your function and your movement.

 

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The activity levels are something that we need to consider as well.

 

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You know, in an assessment in a comprehensive assessment.

 

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Can you participate in everyday life activities as well?

 

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So those are the things that help us as therapists, to determine what the functional level is at this time of the assessment, and obviously the personal factors also play a part in, you know, beliefs.

 

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And in you know what other conditions are coexisting with the.

 

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lipoedema, for example, and the environmental factors of terms of you know what what your current environment is and what you’re able to do in terms of you know, home based versus, you know out and about type exercise and other factors that will determine your level of mobility and function

 

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so I suppose a long story short, a very good assessment is a really good place to start, and so the next couple of slides will go through what would constitute a good assessment for exercise prescription and goal setting.

 

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So a comprehensive history is something that we would always take the clinic, and anyone who is assessing you, I would always advise a comprehensive history-taking session.

 

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You know we don’t have a good look at the condition, so we’re going to determine the size of limbs.

 

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And look at that, maybe in a couple of different ways, whether it be electronic measuring as well as take measures and maybe determine the stage of the condition of lipoedema when you come in.

 

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What is the level of function? You know? What are your levels of pain at the moment, and how can we make change that?

 

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We’ll make sure that that doesn’t get any worse, and that’s pain in all areas.

 

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Not just the lymphedema areas as well.

 

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What’s the exercise participation history? What have you done in the past?

 

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What have you enjoyed? What haven’t you enjoyed?

 

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A clinical assessment. So, as I said, we do take a really thorough look at the person.

 

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You know the clinical assessment for us at the clinic.

 

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We do have a machine which measures both body, composition and fluid.

 

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So you know whether people want to know their body composition.

 

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Measurements is an interesting question, and that really depends on the goals that people have and their expectations for exercise as well.

 

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So we do take it at our clinic, just as part of the ratings that we do for fluid as well.

 

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But if people are not that goal orientated, we don’t necessarily have to share that with the patient spider.

 

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So physical, functional, physical outcome measures are really important for goal setting.

 

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So at our clinic alongside our exercise physiologist Matt, we have a 6 stand test, which is a standardized measure.

 

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We have grip strength testing. We do have a 6 min walk test for those that are keen and interested to look at their cardiovascular endurance as well.

 

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So, having a couple of functional outcome, measures as part of your goals.

 

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Setting process is really important and can be really helpful as well.

 

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So all of these things help us as therapists or as exercise physiologists, to develop that individual health, profile.

 

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So by the end of this lovely assessment we have figured out who you are as a person, what you want to do.

 

00:23:41.000 –> 00:24:02.000

Maybe what stage your condition is at. We’ve taken some measurements of your limbs with, you know, some or all depending again on the goal, and we’ve taken a pretty thorough assessment of you by this stage, I said Matt’s actually got several other indicators.

 

00:24:02.000 –> 00:24:08.000

That he would often take, including balance as well, and some other strength measurements as indicated.

 

00:24:08.000 –> 00:24:20.000

So by this stage I’ve got a pretty good idea of who you are, and maybe what what to advise you to do, or what sort of goals to set in cooperation with you around exercise.

 

00:24:20.000 –> 00:24:30.000

So then we can develop a more personalized treatment plan which would involve what kind of exercise and how much and what to do and what the outcome will be for that.

 

00:24:30.000 –> 00:24:36.000

So basically, you know for some patients that come to our clinic, they are not so goal orientated users.

 

00:24:36.000 –> 00:24:54.000

Therapists love some of these outcome measures. But honestly, you know, I think improving function and quality of life is huge as well, because some patients will tell us, you know, now, I can actually, you know, bend down to put my shoes on without pain, or you know I can actually walk through my house and out to the mailbox

 

00:24:54.000 –> 00:24:55.000

and back and I don’t. I feel comfortable to do that now.

 

00:24:55.000 –> 00:25:09.000

So really functional and quality of life outcomes or something that all of us therapists would also consider but I think for those who are seeking to start exercise and wanna have that motivation ongoing beyond just the you know, the function.

 

00:25:09.000 –> 00:25:22.000

And quality of life measurements certainly accomplish this. We can give you some really good goal setting measurements as well.

 

00:25:22.000 –> 00:25:23.000

So reevaluating those goals is the final step. Right?

 

00:25:23.000 –> 00:25:46.000

So again, if you’re being supported by an exercise physiologist or a therapist who’s experienced in exercise youth, it helps you to remain motivated. Then reevaluating those goals regularly is really helpful to keep that momentum up and to keep things going.

 

00:25:46.000 –> 00:25:47.000

So what do we know about Lyme and exercise past the assessment?

 

00:25:47.000 –> 00:26:08.000

Phase. Well, I have to say, probably not enough, and for those therapists out there who are interested in doing research around this area, I suspect there are many, many projects that could come out of a question like this, I would hope one day given the time and opportunity.

 

00:26:08.000 –> 00:26:28.000

I will hope to answer some of these questions, but at the moment I have just been digging through the information that I could find so far so documented in our literature, or on repeatable sites online, you know we know that the benefits of exercise prescribed correctly given a personalized

 

00:26:28.000 –> 00:26:33.000

program, you know, following a good assessment would be a reduction in pain.

 

00:26:33.000 –> 00:26:37.000

And again, is that pain in joints? Is that lipoedema pain?

 

00:26:37.000 –> 00:26:40.000

All the hope is that a good program would help address both of those on multiple sites of pain with appropriate access.

 

00:26:40.000 –> 00:27:01.000

Prescription, improvement shape. So you know again, with some strength exercises a lot of our patients do find that they can change their limb shape, and if they feel really happy with some of those results, look improving, mobility is a really great thing.

 

00:27:01.000 –> 00:27:04.000

In this space, you know, Dr. Like it to that at the beginning.

 

00:27:04.000 –> 00:27:08.000

How important for the lymphatic system it is just to move.

 

00:27:08.000 –> 00:27:16.000

So you know, by improving or maintaining mobility you can minimize the you know.

 

00:27:16.000 –> 00:27:26.000

Look, wait, and wait. Management. We’ve exercised, certainly, in conjunction with, you know, dietary management can be helpful for those that are seeking that as a goal.

 

00:27:26.000 –> 00:27:41.000

Look, we’ve exercise, you know, if we extrapolate all that we know as general physios, we absolutely know that exercise can help minimize secondary joint generation, even just due to general join upthritis and other conditions.

 

00:27:41.000 –> 00:27:48.000

Look again, optimizing, daily functioning, and of course, improving social.

 

00:27:48.000 –> 00:27:49.000

Well, being so, plenty of evidence, we can also look to find the release even endorphins with exercise for all of us.

 

00:27:49.000 –> 00:28:01.000

So yeah, that as a goal alone is also something to be considered which is just a fabulous outcome.

 

00:28:01.000 –> 00:28:08.000

Today just really good, well prescribed activity and exercise.

 

00:28:08.000 –> 00:28:09.000

So what are the goals? Well, look again. A lot of our patients are many and varied, you know.

 

00:28:09.000 –> 00:28:25.000

We send some younger patients with different goals. We have some other patients at further stages of what’s with different goals. We have some other patients at further stages of what I could do with different goals as well.

 

00:28:25.000 –> 00:28:35.000

But I would say, to make it all pleasant is something that we really strive to do, because nobody will exercise if it really fits them, or it’s not something comfortable.

 

00:28:35.000 –> 00:28:41.000

So our goal to exercise prescription at equipment would definitely be to try and make it pleasant.

 

00:28:41.000 –> 00:28:42.000

Juice, plane, and inflammation, of course. Protect joints, enhance self-care.

 

00:28:42.000 –> 00:28:50.000

As we said, psychosocial well-being, and we like to consider.

 

00:28:50.000 –> 00:28:59.000

And this is documented quite a number of places online. And looking at a way inclusive approach to directing efforts more towards health.

 

00:28:59.000 –> 00:29:04.000

Than towards weight stigma on any level.

 

00:29:04.000 –> 00:29:05.000

As I said, you gotta have outcomes related to goals. It helps us all.

 

00:29:05.000 –> 00:29:18.000

We all fade into this. You know, online exercise nowhere when we sometimes don’t have goals guiding us.

 

00:29:18.000 –> 00:29:28.000

So I believe that strongly that outcome measurements are super helpful to maintaining a good exercise program for us all.

 

00:29:28.000 –> 00:29:29.000

So yes, strength versus function versus well-being.

 

00:29:29.000 –> 00:29:40.000

So they are generally the 3 types of goals that we’re getting people through with the exercise prescription.

 

00:29:40.000 –> 00:29:43.000

So what else do we know? All right. Well, these are the options.

 

00:29:43.000 –> 00:29:46.000

That seem to come up consistently, both in research that I could find and also online.

 

00:29:46.000 –> 00:29:54.000

Sites. So hydro therapy comes up trumps quite a lot.

 

00:29:54.000 –> 00:29:57.000

And look, I suppose I would say almost the same for lymphsedema patients as well as lymphedema patients.

 

00:29:57.000 –> 00:30:18.000

What we do know about hydrootherapy is that the hydrostatic pressure of the water, especially at the deeper ends of the pool, the bottom of your limb can have, you know, quite some millimeters of mercury pressure on that area as well as to take the weight off your

 

00:30:18.000 –> 00:30:32.000

joints and look a lot of the wider demon, patients would say subjectively, subjective reports would say that they float very well, and that might be the one interesting kind of byproduct of Lyme.

 

00:30:32.000 –> 00:30:41.000

That. Yeah, maybe some activities and exercises create a really good buoyancy and make the exercise quite enjoyable for a lot of people.

 

00:30:41.000 –> 00:30:51.000

So Yoga also comes up a lot, you know, and when you think about exercise principles with the live system, which you know is a topic of a whole talk on its own.

 

00:30:51.000 –> 00:31:08.000

I suppose the deep breathing, or diaphragmatic breathing and movement of the diaphragm does help to pump the lymphatic fluid deep in our bodies from the bottom half to the top, half to recycle back up towards the heart so diaphragmatic

 

00:31:08.000 –> 00:31:24.000

breathing in Yoga, you know I don’t know who’s ever been to a class, but certainly when I have been to some I remember the instructor talking well about the benefits of deep breathing on the lymphatic system, so I think there is now some scientific basis to back that

 

00:31:24.000 –> 00:31:27.000

up that, you know, for our lymphodema patients.

 

00:31:27.000 –> 00:31:40.000

We also advise some diaphragmatic breathing and slow deliberate muscle movements, as per tai chi, or Yoga type speed, because we know that lymph travels very slowly through muscles.

 

00:31:40.000 –> 00:31:44.000

But about 40% is processed through those muscles.

 

00:31:44.000 –> 00:31:56.000

So by moving muscle slowly and deliberately inv by breathing with the diaphragm, we are enhancing the lymphatic flow as we, as potentially stretching and making joints really comfortable.

 

00:31:56.000 –> 00:32:00.000

So you know. Pick your yoga type, you know. There’s also an a number of Yoga’s out there these days that are much more intensive.

 

00:32:00.000 –> 00:32:07.000

But you know, depending on your preference, I would be looking for one.

 

00:32:07.000 –> 00:32:12.000

That’s a really nice, gentle move.

 

00:32:12.000 –> 00:32:16.000

Low impact exercise. You know there are. There are classes out there for all sorts of people that are in all sorts of conditions, both young and old, that have low impact style.

 

00:32:16.000 –> 00:32:29.000

Exercise, classes. And if you’re a class based person that can be really motivating and fun as well, dancing classes, you know.

 

00:32:29.000 –> 00:32:43.000

Look. I have a a little snippet of something at the end that might convince you all that dancing can be fun, but certainly dancing, even though it may not be a formal form of exercise.

 

00:32:43.000 –> 00:32:57.000

It can be great, and you know we’ll we may demonstrate that if you stay on with me right to the end, walking and walking, I mean walking makes sense just as a general activity, and the Nordic walking.

 

00:32:57.000 –> 00:33:13.000

I suppose you know officially is using the Nordic walking polls, and so certainly, for our lymphedema patients who have armed lymphedema, all those lymphedema patients who do feel they also have some fluids developing in their arms using polls to walk in

 

00:33:13.000 –> 00:33:33.000

the in the Nordic fashion. You know, that usually requires some training, you know, through some courses that are offered, it can both allow that nice muscle pump through the arm, but can also help to clear live because you know, when we walk normally, we have our arms hanging down by our sides

 

00:33:33.000 –> 00:33:37.000

and so we don’t. We have gravity acting downwards on those arms.

 

00:33:37.000 –> 00:33:39.000

So the Nordic walking can be great for movement and muscle pump, but it also takes.

 

00:33:39.000 –> 00:33:50.000

I think it’s up to maybe 20% of the load off the knees when you’re going down hill. Or certainly when you’re doing.

 

00:33:50.000 –> 00:34:03.000

You know mountain walking is. So yeah, the idea of walking is really lovely, and they have done some trial studies of Nordic walking and lymphozema in Sweden, and maybe now they’ve done a couple in other centers.

 

00:34:03.000 –> 00:34:09.000

But certainly the research started in Sweden around Nordic north.

 

00:34:09.000 –> 00:34:15.000

So weights training, you know, specific to need. You know, I think.

 

00:34:15.000 –> 00:34:22.000

I think you’ve had so butchers, you know, speak at one of these, and certainly had heard Clinic when she was back around the water area.

 

00:34:22.000 –> 00:34:40.000

She was running a weights glass for lipoedema patients, and she reported really good findings from that anecdotally, and I remember talking about that with her some time ago, and I think that I would agree that a lot of our patients to enjoy doing weights training do find that it can be a

 

00:34:40.000 –> 00:34:43.000

good form of exercise to be doing some strength, training I mean, that’s we.

 

00:34:43.000 –> 00:34:53.000

Body, weight will be white. Weights would be with bands, it could be with other pieces of equipment, but some some actual muscle building exercises.

 

00:34:53.000 –> 00:35:09.000

Do seem to come up quite well in the research as well, and all it’s that in terms of metabolic pathways, in so you know, the other options are now, you know, with the advent of Covid, we now know longer have excuses to not exercise.

 

00:35:09.000 –> 00:35:10.000

Because there are so many online options. It’s crazy.

 

00:35:10.000 –> 00:35:18.000

Actually, if you go looking so many online options. So you know, our clinic.

 

00:35:18.000 –> 00:35:26.000

Still. Now do real-time zoom classes as do I know of quite a number of Youoga studios down the south coast around us.

 

00:35:26.000 –> 00:35:29.000

So you may even find some real-time zin classes that you could attend, whether you live in the regions or you’re unable to kind of leave home for family kids, reasons.

 

00:35:29.000 –> 00:35:46.000

You may find, if you do, a little search or call some clinics in your area, they may still be offering zoom classes for some of their group, exercise sessions.

 

00:35:46.000 –> 00:35:52.000

Youtube is an amazing thing. Again, if you did not discover it before David, it is suddenly an exercise resource, like nothing else.

 

00:35:52.000 –> 00:36:08.000

So I mean, I’ve just found you know, a quick search on Youtube before I, you know, logged into this presentation, came up with a range of lipoedema specific Youtube clips.

 

00:36:08.000 –> 00:36:16.000

So I just pulled out a couple which, look, I won’t show you these, but I’m saving our energy till we end.

 

00:36:16.000 –> 00:36:17.000

But but you know, really, these were just 2 that I pulled out. There were.

 

00:36:17.000 –> 00:36:25.000

There were pages of them. So you know I couldn’t say whether all of those are entirely appropriate.

 

00:36:25.000 –> 00:36:30.000

But you know, for everyone but one of them was a seated strength exercise program, you know.

 

00:36:30.000 –> 00:36:35.000

The other was a standing exercise program for a leopard demon exercise class.

 

00:36:35.000 –> 00:36:39.000

And there were multiple options out there. So you know, if you really struggle to leave the home to get to some of these things, or all the expense of it even, is a bit much for you.

 

00:36:39.000 –> 00:37:00.000

It’s great to have so many online options. And I know even myself, so many patients actually ended up mentioning it to me that I started to look at the Yoga by Adrian, which I haven’t shared.

 

00:37:00.000 –> 00:37:01.000

But I can share through, and if you look up Yoga by Adrian, which I think is, I.

 

00:37:01.000 –> 00:37:10.000

E, n, E. On Youtube. She has an amazing array of clips.

 

00:37:10.000 –> 00:37:19.000

Everything from 12 min to an hour sessions, and they’re all Yoga moves that are designed for multiple injuries.

 

00:37:19.000 –> 00:37:21.000

Multiple conditions. So, yeah, I am constantly flabbergasted by the amount of free resources for exercise there are out there these days.

 

00:37:21.000 –> 00:37:27.000

So as a Physio. It’s hard to convince us that you can’t so have a look.

 

00:37:27.000 –> 00:37:45.000

See if any of them appeal to you, especially if you’re not exercising regularly.

 

00:37:45.000 –> 00:37:58.000

Okay, so having said, all those wonderful things about exercise, talk about lipoedema, and exercise cannot be had without discussing some of the barriers around it.

 

00:37:58.000 –> 00:37:59.000

So what are the barriers to people exercising?

 

00:37:59.000 –> 00:38:19.000

You know, I’m sure a number of people in this group can contribute to both the exercise options as well as the barriers to exercise here so absolutely, we know his therapists that those inflammatory frostes in lipoedema tissue can be painful and so whatever we

 

00:38:19.000 –> 00:38:37.000

do together, you know, whatever the prescription is, it has to be helpful to that pain, and when that may then, you know, warrant a discussion around some light compression to where, whether that be more of a sports style, compression or more formal style of compression that might help with some of the

 

00:38:37.000 –> 00:38:41.000

discomfort of that inflammatory pain, as well.

 

00:38:41.000 –> 00:38:52.000

Finding suitable clothing and footwear. You know we have a number of patients who feel really uncomfortable wearing sports where we may feel really uncomfortable getting into a pool.

 

00:38:52.000 –> 00:38:58.000

So you know, that is it. Recognize it as a barrier, and see, and we try very hard to be glass.

 

00:38:58.000 –> 00:38:59.000

Our full people to overcome these barriers and to make some suggestions.

 

00:38:59.000 –> 00:39:09.000

And certainly there’s some companies that do some great sports for all different shapes and sizes these days.

 

00:39:09.000 –> 00:39:25.000

The lack of understanding of the condition. So you know, some of our patients have really sadly said, you know, I used to go to a gym, but then I had some people come up to me and ask me why I was such a funny shave, but you know just making all sorts of really inconsiderate and

 

00:39:25.000 –> 00:39:26.000

uncry remarks, and so, you know, I think that is a real barrier.

 

00:39:26.000 –> 00:39:38.000

Again to be recognized, and that might guide you in terms of your goals and your options for exercise for yourself as well.

 

00:39:38.000 –> 00:39:44.000

I can’t lose the fact. Yes, I look. It is an understandable problem that you know.

 

00:39:44.000 –> 00:39:46.000

lipoedema at certain stages is a very stubborn fat, and we must, as therapists, recognize the setting of realistic expectations.

 

00:39:46.000 –> 00:39:57.000

But remember a couple of slides back we were talking about the goals being quality of life, and you know, minimizing kind of issues into the future.

 

00:39:57.000 –> 00:40:11.000

So I think sitting expectations for yourself and helping in your therapist, helping you to set those realistic expectations is really important.

 

00:40:11.000 –> 00:40:20.000

So, you know, if you can’t lose the fat. Well, there is still some normal fatty tissue within your body that will respond to exercise and lifestyle, modification.

 

00:40:20.000 –> 00:40:22.000

So it’s just really important to understand. You know what it is you’re trying to achieve.

 

00:40:22.000 –> 00:40:35.000

By the exercise that you’re doing, and you know, understanding the nature of lipoedema, it’s going to be a tricky journey, potentially to set goals around.

 

00:40:35.000 –> 00:40:41.000

You know the fat loss of the lymphedema as well, but I still always come back to Patience.

 

00:40:41.000 –> 00:40:57.000

To those positions. Statement in Germany that says, Look, you know, if you do start a really effective set of lifestyle modification, you know projects, then it is possible for you to be able to reduce significantly the burden of lymphedema.

 

00:40:57.000 –> 00:40:59.000

So so do still consider it a useful thing, even if your ultimate goal is to lose the fat.

 

00:40:59.000 –> 00:41:09.000

You know, we’re actually trying to improve on function and condition as well.

 

00:41:09.000 –> 00:41:20.000

There was one study I found, which I did not put in the reference list, so I might have to pass that onto Emily that was actually looking at that studied.

 

00:41:20.000 –> 00:41:22.000

It was a very small pilot study, so it is very hard to extrapolate a lot of information from that.

 

00:41:22.000 –> 00:41:32.000

But they actually took 2 groups of people and studied them.

 

00:41:32.000 –> 00:41:50.000

Actually without an exercise intervention involved. It was a group with lipoedema, who were clinically diagnosed with Lyme and a group that were just in the obesity category, and they tried to match them for age and Bmi as appropriately as they could and they

 

00:41:50.000 –> 00:42:09.000

did actually find in this study, which was replicating one other study that I could find, that they may actually on those functional tests that we were talking about, have have a decreased muscle, strength and decreased exercise endurance capacity that was measured with the six-minute walk

 

00:42:09.000 –> 00:42:14.000

test. Then those who had been diagnosed with obesity.

 

00:42:14.000 –> 00:42:26.000

So that was just a very interesting paper for me, which is something I’ve not really considered that the condition of lipoedema itself, perhaps because of the coexistence of connective tissue disorders.

 

00:42:26.000 –> 00:42:30.000

In some patients, or for some other reason, they might actually based on physical barriers to exercise for some, like the demon patients.

 

00:42:30.000 –> 00:42:39.000

So don’t again. Don’t create a barrier for yourself out of that.

 

00:42:39.000 –> 00:42:44.000

It but I’m going to keep looking at what comes out around that, because, yeah, it may help us to put together clinical diagnosis criteria with.

 

00:42:44.000 –> 00:42:57.000

With exercise added into that. If there is some significant difference between a population with and without, lipoedema, who are matched well to other control, you know, patients.

 

00:42:57.000 –> 00:43:10.000

So anyway, that’s just some food for everyone. If anyone has a burning research project out there, that would be another one to answer.

 

00:43:10.000 –> 00:43:17.000

I recommend. So again, you know, we were looking at all the exercise options in previous slides.

 

00:43:17.000 –> 00:43:27.000

And look, I would say the reason. You know there are often some barriers to doing higher intensity.

 

00:43:27.000 –> 00:43:32.000

Exercise is because it can trigger. In some patients some inflammatory pain.

 

00:43:32.000 –> 00:43:36.000

And that’s true for lipoedema and non lymphoedema patients alike.

 

00:43:36.000 –> 00:43:53.000

So I thought I would just present to you some of my sides brain in why, we would recommend to work in general at a moderate range of activity, which is kind of that tool or that whistle test kind of level rather than a high intensive activity.

 

00:43:53.000 –> 00:44:08.000

Level, you know, for most patients that we would see with, you know, because we do have metabolic pathways in our bodies, that are triggered by particular exercises or a particular exercise strategies.

 

00:44:08.000 –> 00:44:16.000

So there are 3 metabolic pathways, or 3 main metabolic pathways in our body or ways that we burn energy.

 

00:44:16.000 –> 00:44:22.000

So there is the sprint pathway, the phosphorus pathway, which essentially is our absolute quick.

 

00:44:22.000 –> 00:44:32.000

Just a few seconds with the energy pathway when we have to sprint to that bus, or you know the flight front load kicks in, and we’ve got to get away from that tiger.

 

00:44:32.000 –> 00:44:34.000

You know this is your creatine, phosphate pathway.

 

00:44:34.000 –> 00:44:41.000

Very fast acting, and it bones show up. Really, sugar related particles in our body.

 

00:44:41.000 –> 00:44:51.000

Then you have them middle pathway, which is kind of the moderate pathway which also has a feel of glycogen, which is more of a long story.

 

00:44:51.000 –> 00:44:57.000

You know sugar, reserves, I suppose. So. That’s when we kind of walking to the bus in a reasonable case.

 

00:44:57.000 –> 00:45:05.000

But we’re not sprinting to catch it, and then we have our slow burn pathways, which by and large burn fat.

 

00:45:05.000 –> 00:45:19.000

So you know, I feel like there were many classes in the eighties and nineties that that were called the Fat Burner classes, and I suppose they were all aimed at this kind of sustained level of exercise for longer periods of time.

 

00:45:19.000 –> 00:45:20.000

So you know things like your pump classes that go for 60 min.

 

00:45:20.000 –> 00:45:33.000

You know a lot of the moderate exercise programs that you know, that involve strength training with more likely to burn this pathway.

 

00:45:33.000 –> 00:45:34.000

So my take home message as to how hard the average live.

 

00:45:34.000 –> 00:45:51.000

lipoedema patient should be working, I mean, usually as a physio depending on age group depending on the assessment I would recommend recommend motor level on the rating of perceived exertion.

 

00:45:51.000 –> 00:45:55.000

Scale, which is, instead of the 12 quarter whistle test during exercise.

 

00:45:55.000 –> 00:46:17.000

And you know perhaps there again, I can’t point to a research study at this point, but extrapolating what generally works for patients who want to exercise with Lyme and putting together our metabolic pathways, awesome possibly those more sustained moderate forms, of exercise may be less painful

 

00:46:17.000 –> 00:46:27.000

and more effective in reaching goals than perhaps the more intensive spread pathways that some people may, you know, have tried in the past.

 

00:46:27.000 –> 00:46:28.000

So you know, that’s just probably me as a therapist trying to extrapolate that information.

 

00:46:28.000 –> 00:46:37.000

To make sense of it, to to the lipoedema patients that we see as well.

 

00:46:37.000 –> 00:46:49.000

So having said that everyone’s different. So you know, moderate exercise comes up, trumps in every single exercise category where the you are exercising post cancer treatment, whether you are, you know, exercising for health according to the national guidelines.

 

00:46:49.000 –> 00:47:10.000

Then moderate exercises. What is recommended? Okay, even in our population, for cancer recurrence, moderate exercise is actually there seems no additional benefit to intense exercise in terms of cancer recovery, according to all articles that have come out.

 

00:47:10.000 –> 00:47:23.000

If over the last 5 years, so so me as a therapist, you know me personally, but me as a therapist.

 

00:47:23.000 –> 00:47:39.000

I also think that the moderate exercise approach means that you will be less likely to cause injury, and you may well activate in yourself more of this slogan pathway which will be more effective for you in the long term.

 

00:47:39.000 –> 00:47:51.000

So in summary, you need to exercise according to individual needs, and I would say not many lipoedema patients that come through outdoor are the same.

 

00:47:51.000 –> 00:48:02.000

So I think if you are inspired by tonight’s talk, or you have been thinking about engaging in some exercise, and you are concerned as a lipoedema, you know.

 

00:48:02.000 –> 00:48:14.000

I guess, person yourself. I think, seek an exercise professional who has some experience on, who is open to learning in this area, because, I said, Look, Matt, who’s with us getting joined us last year, and he has done so much learning with us around this condition and around.

 

00:48:14.000 –> 00:48:16.000

Lymphedema management as well. So I think you know.

 

00:48:16.000 –> 00:48:32.000

Do seek an exercise professional to set your goal, whether that be an experience video, whether that be an accredited exercise physiologist or just somebody who really knows this stuff because I think everybody has to set their own goals, individually and figure out.

 

00:48:32.000 –> 00:48:45.000

A way phone from there. As I said, yeah, the cardio versus wakes discussion.

 

00:48:45.000 –> 00:49:01.000

Because look, you know, in all athletes, yeah, we had just discussed with a video colleague just recently that there are studies happening around, you know, chemicals in your body that are produced with intense cardiovascular activity.

 

00:49:01.000 –> 00:49:06.000

And they’re trying to figure out whether you know those those chemicals from metabolism that are released can actually, you know, cause inflammation even in entirely.

 

00:49:06.000 –> 00:49:13.000

You know professional athletes. So you know. Is there a reason for live? Adema?

 

00:49:13.000 –> 00:49:23.000

Patients who may have some inflammatory pain to do intents cardiovascular exercise.

 

00:49:23.000 –> 00:49:28.000

Well, if that’s what floats you boat, then do what is comfortable and what you feel is really satisfying to you.

 

00:49:28.000 –> 00:49:39.000

But if it is not what you are comfortable to do, you know, take comfort in the fact that moderate activity, and not necessarily intense activity, will be absolutely fine for you, and you know, bear in mind that some strength, training.

 

00:49:39.000 –> 00:49:53.000

I call it weight training here, but essentially any kind of strength training, using even bans, body weight, or weights traditionally, is considered a burning approach to exercise.

 

00:49:53.000 –> 00:50:12.000

So maybe consider putting that into your exercise program somewhere. They are probably benefits of both cardiovascular exercise is good, for your heart what your metabolism, you know, good for release of endorphins versus the strength training which is which is good for strengthening joints

 

00:50:12.000 –> 00:50:18.000

and a good, you know, functional outcomes as well.

 

00:50:18.000 –> 00:50:34.000

So, as I said, you know the one of the goals that you can set at a clinic where they do have a body composition device is that you can track some of the body composition measurements a dietician that used to work with us is not that keen on that on tracking the specifics.

 

00:50:34.000 –> 00:50:54.000

Of fully composition in a number of patients, but certainly that is another outcome measure, either looking at circumference of limbs or looking at the Uhlenex readings for fluid or body composition of fat masks, the little muscle mass bmi weight all of those so that is another outcome measure that can

 

00:50:54.000 –> 00:50:59.000

be used as well.

 

00:50:59.000 –> 00:51:08.000

So I have talked for a while, and I did promise Emily, that I would actually make everyone exercise a little bit.

 

00:51:08.000 –> 00:51:16.000

So the lovely Gemma. Here in the picture she even hated me putting this picture up because she said, what happened to my body?

 

00:51:16.000 –> 00:51:23.000

So she is our ode, and if anyone is engaged with an it, I feel like it’s our absolute quality of life.

 

00:51:23.000 –> 00:51:32.000

Individuals, and so the lovely Gemma. She is on record on a zoom presentation, saying how much she hates exercise.

 

00:51:32.000 –> 00:51:52.000

Yet Gemma herself has done some of the training in the past, and so during lockdown, when we opened our lovely gym space in 2020, she managed to use lovely Zoomba warmups as part of our exercise classes, we were offering online for our

 

00:51:52.000 –> 00:52:05.000

oncology, patients doing it, a number of our classes and other patients logging into zoom for exercise classes as well so I’m going to try very hard now to line this up.

 

00:52:05.000 –> 00:52:17.000

She is standing, I would highly recommend standing, and the best thing about this video is that you don’t have to watch me do it, although I have been known to do a lot of the moves in the chair myself.

 

00:52:17.000 –> 00:52:24.000

So if you prefer to sit most of what Gemma is gonna do in this present in this video is going to be doable in a chair.

 

00:52:24.000 –> 00:52:31.000

But if you’re feeling particularly inspired, I can’t see anybody, and I would love it if you stood up and had a bit of a go and having fun with you.

 

00:52:31.000 –> 00:52:42.000

So I’m gonna stop sharing your screen, and I will see if I could pull up this video and make it work beautifully.

 

00:52:42.000 –> 00:52:58.000

Just give me one sec.

 

00:52:58.000 –> 00:53:01.000

I’m so excited for this!

 

00:53:01.000 –> 00:53:03.000

Look, I think I’ve built it up a lot.

 

00:53:03.000 –> 00:53:07.000

So I you know it is. She’s she’s just great.

 

00:53:07.000 –> 00:53:08.000

I can’t wait.

 

00:53:08.000 –> 00:53:19.000

So, hopefully.

 

00:53:19.000 –> 00:53:36.000

It is just going to be if I can share sound with you also, hopefully.

 

00:53:36.000 –> 00:53:47.000

But hopefully, Emily, if you can hear it, then everyone else came here, and if you can’t get a music you’re just gonna have to you know, have a think about the excellent music in the background.

 

00:53:47.000 –> 00:53:52.000

And stick to the page I feel like even my next is happy.

 

00:53:52.000 –> 00:53:57.000

Hmm, yeah. I can’t hear the music, unfortunately, but it’s already started.

 

00:53:57.000 –> 00:54:00.000

So let’s just keep going.

 

00:54:00.000 –> 00:54:10.000

That is okay. Yeah, I couldn’t share the sound. Unfortunately.

 

00:54:10.000 –> 00:54:14.000

But I think it’s basically expressions kind of sell. It.

 

00:54:14.000 –> 00:54:15.000

So that’s okay.

 

00:54:15.000 –> 00:54:21.000

Yeah, definitely.

 

00:54:21.000 –> 00:54:49.000

And the idea is here that you know you can really exercise doing anything. And if you stand up and do this, these little things that you certainly will get a couple of. And Gemma laughs because when she watches this, she realizes that she’s actually.

 

00:54:49.000 –> 00:54:50.000

The music. Yeah, the music does add to it. But yeah, I can’t share my sound.

 

00:54:50.000 –> 00:54:56.000

Maybe on this one. So next time.

 

00:54:56.000 –> 00:55:26.000

Oh, such a shame! Next time we’ll see if we can reshare on Instagram.

 

00:56:48.000 –> 00:56:51.000

So it’s always let’s move in here.

 

00:56:51.000 –> 00:56:56.000

I’m gonna talk through the talk through the movements, you know, almost jiggling.

 

00:56:56.000 –> 00:56:59.000

If it feels good, it’s quite nice to move all that tissue around.

 

00:56:59.000 –> 00:57:05.000

And she loves that, she insisted, splitting it up for you.

 

00:57:05.000 –> 00:57:11.000

And so then we’ve been through. We got a couple of minutes ago. I might.

 

00:57:11.000 –> 00:57:40.000

I’ll finish it up with you to be said. The idea that he could post the the last couple of days, and then that might inspire you to.

 

00:57:40.000 –> 00:57:43.000

Alright! So that’s the lovely Gemma, anyway.

 

00:57:43.000 –> 00:57:44.000

Doing some zoom. So yeah, the sound sharing was not quite working for me.

 

00:57:44.000 –> 00:58:09.000

There, I might have right just a fail on the technology, but otherwise, look, you know, I think the only thing I had on the final part of the slide here was just the final page to say, yeah, look at if anyone’s got questions, or if you know anyone wants so contact us, at the

 

00:58:09.000 –> 00:58:17.000

clinic. Then, you know these are our details. But obviously, you know, you can get that from the others as well.

 

00:58:17.000 –> 00:58:22.000

So, just.

 

00:58:22.000 –> 00:58:30.000

With that final slide so, yeah, this is just a at in Canberra.

 

00:58:30.000 –> 00:58:34.000

So yeah, we’re located in Cambridge, you know.

 

00:58:34.000 –> 00:58:39.000

We’re always up for a bit of a chat, and we’ve got our website there as well.

 

00:58:39.000 –> 00:58:53.000

So. Thank you. If how many questions? Yeah, feel free to fire them up, and hopefully, you will enjoyed my perspective on a movement for life.

 

00:58:53.000 –> 00:58:57.000

Thank you so much, Liz.

 

00:58:57.000 –> 00:59:04.000

No worries. No, I’ve had a question come through.

 

00:59:04.000 –> 00:59:07.000

Can I ask a question?

 

00:59:07.000 –> 00:59:08.000

Of course.

 

00:59:08.000 –> 00:59:09.000

Sure!

 

00:59:09.000 –> 00:59:14.000

Yeah, just with the third Mentalist, and thank you very much for your presentation.

 

00:59:14.000 –> 00:59:23.000

Often patients are asking me, the facilitated movement through compression.

 

00:59:23.000 –> 00:59:30.000

What are your what? What are your thoughts about those?

 

00:59:30.000 –> 00:59:41.000

How do you use them in your practice? Do you integrate that as part of your protocols for patients to keep the movement flowing?

 

00:59:41.000 –> 00:59:42.000

Yeah, look, I think, yeah, I think impression pumps can be very valuable.

 

00:59:42.000 –> 00:59:56.000

And again. You know, I think this is where, in an area of lymphedema and lymphedema, you know, I think we gotta put the knowledge base together right?

 

00:59:56.000 –> 01:00:02.000

Because in sports therapy they’ve been using compression pumps for recovery for quite some time as well.

 

01:00:02.000 –> 01:00:03.000

So, yeah, I think that using compression pumps, you know.

 

01:00:03.000 –> 01:00:15.000

It facilitates the muscle pump in the arms and the legs, you know, and it, you know, it helps to facilitate the moving on the skin to the muscles.

 

01:00:15.000 –> 01:00:16.000

So yeah, I think we we actually do have a couple of pumps at the clinic that we use both in session.

 

01:00:16.000 –> 01:00:27.000

But for a lot of the time we use to demonstrate, so that others can can perhaps rent them themselves as part of their treatment.

 

01:00:27.000 –> 01:00:30.000

So, yeah, I think, particularly those people that can’t move in terms of, you know, a structured exercise program.

 

01:00:30.000 –> 01:00:41.000

If really they are quite unable to move a bit like the patient that you were talking about.

 

01:00:41.000 –> 01:00:47.000

You know the particularly compression pumps become something that’s important to a patient like that.

 

01:00:47.000 –> 01:00:54.000

To facilitate some movement of the skin to the muscle. Yeah.

 

01:00:54.000 –> 01:01:02.000

Are you? Particularly when I’m asked about compression?

 

01:01:02.000 –> 01:01:09.000

Pumps. Obviously, we’re access isn’t an issue for patients to get the therapist.

 

01:01:09.000 –> 01:01:31.000

That can be very useful in remote areas. I also then asked patients when they asked me, Do engage with your because I think they’re gonna get the settings. Is that something you’re comfortable with sitting down with the patient and talking about that particular pump of the settings.

 

01:01:31.000 –> 01:01:42.000

I have. I mean, I can tell patients that post surgery very happy for you to stop the pump.

 

01:01:42.000 –> 01:01:49.000

Clearance 4 or 5 wait for that at least, and then get on with it.

 

01:01:49.000 –> 01:01:57.000

Thereafter as you’re comfortable with. Are you engaged with the clients in the same way with their settings?

 

01:01:57.000 –> 01:02:09.000

Yeah, definitely, I mean, we really do like to line people up with their pumps before the surgery, because I think you know, it’s much easier to get used to the precious and things that you’re comfortable with.

 

01:02:09.000 –> 01:02:13.000

And I think with those sort of compression pumps, I mean, certainly with the main company that we rent the punch out of Sydney.

 

01:02:13.000 –> 01:02:22.000

You remember that those pumps are used for sports purposes as well, and some of those pressures can go up to a 150 millimetres of mercury. You know.

 

01:02:22.000 –> 01:02:39.000

So. And I think what patients need to just remember is that, yeah, the bigger is not better when it comes to compression, pumps, settings, and that when we’re aiming for the lymphatic system and pumping and movement, we actually want to use the lower levels of

 

01:02:39.000 –> 01:02:48.000

compression and you know, if they’re going to sort of maximum 30 of mercury, then you know, the compression pumps maybe need to be a little higher than that.

 

01:02:48.000 –> 01:02:52.000

But yes, certainly any patients that would go, you know, over a 100 millimetres of mercury.

 

01:02:52.000 –> 01:02:58.000

That would be, yeah. An unacceptably high level because it’s more of a swish.

 

01:02:58.000 –> 01:03:00.000

The recovery of sports, type conditions than it would be for lymphatic condition.

 

01:03:00.000 –> 01:03:07.000

So, yeah, absolutely. I think it’s important to have the right settings.

 

01:03:07.000 –> 01:03:11.000

Thank you very much.

 

01:03:11.000 –> 01:03:16.000

I’ve had a couple of questions. Look at. Yeah, I actually had a question around.

 

01:03:16.000 –> 01:03:21.000

Yeah. Dr. Z in Arizona. And unfortunately, I will type an answer.

 

01:03:21.000 –> 01:03:27.000

But I don’t have Canadians personally to any surgeons in the Us.

 

01:03:27.000 –> 01:03:39.000

But I know there is. They’re really interesting couple of Facebook groups that exist. And one of them is called global lifetime journey.

 

01:03:39.000 –> 01:03:41.000

You know, and I think there’s one or 2 other Facebook groups where there’s a lot of patient traffic about people.

 

01:03:41.000 –> 01:03:50.000

You know, having surgeries in different countries and their outcomes and things.

 

01:03:50.000 –> 01:03:53.000

So yeah, I think that can be really an interesting world.

 

01:03:53.000 –> 01:03:54.000

Now that we’re all connected to try. Get some reports back from those kind of groups.

 

01:03:54.000 –> 01:04:00.000

Yeah.

 

01:04:00.000 –> 01:04:06.000

Also just to let you know, Liz, we do. Dr.

 

01:04:06.000 –> 01:04:07.000

Yeah, okay.

 

01:04:07.000 –> 01:04:08.000

Lkkage does accept patients from outside Australia. So we’re just starting to have some patients come through now from the Uk.

 

01:04:08.000 –> 01:04:15.000

And the Us. So if you’re interested, they.

 

01:04:15.000 –> 01:04:21.000

We, we have 2 New Zealanders in overnight tonight, and New Zealanders.

 

01:04:21.000 –> 01:04:24.000

We have on a regular basis. And you’re right.

 

01:04:24.000 –> 01:04:39.000

Patience! Yes, sir, inquiring from Europe, from the States, from Singapore, and and that’s certainly it’s it is a smaller world.

 

01:04:39.000 –> 01:04:57.000

It’s become very global. The lipoedema and and engaging with these patients with particularly with our protocol, got a great team with them, and and our information.

 

01:04:57.000 –> 01:05:03.000

And always over the last 7 years. And basically a protocol.

 

01:05:03.000 –> 01:05:11.000

It’s lovely to be able to share and engage with these patients as well.

 

01:05:11.000 –> 01:05:12.000

Yeah, definitely.

 

01:05:12.000 –> 01:05:22.000

Yes, that is interesting. Such a yeah. Wide audience. Then look, I do have another question here about, you know.

 

01:05:22.000 –> 01:05:32.000

I guess, live with patients who are sort of on the younger side, you know, in their twenties thirties make an interesting population, and whether or not you should be doing a high intensity exercise. You know.

 

01:05:32.000 –> 01:05:44.000

Look, it’s a really tough one, and I think I’m going to default myself back to the previous slides of saying, it really depends on the assessment.

 

01:05:44.000 –> 01:06:01.000

You know, a good assessment is really valuable for you, because, to be honest, if if patients like intensive exercise for their lifestyle, for their endorphins, for their mental health, you know I feel like as a therapist, I can’t across the board say you shouldn’t

 

01:06:01.000 –> 01:06:09.000

do a high intensity exercise, because we know that, you know, if you enjoy it, and it’s healthy for your body, and it doesn’t create pain for you personally, that it’s not something you should absolutely avoid as a complete contraindication.

 

01:06:09.000 –> 01:06:32.000

So I think you know a good exercise person who can, you know, give you an assessment and guide you through that, and perhaps some goals that you can set yourself around pain and and even cardiac function.

 

01:06:32.000 –> 01:06:38.000

You know some of those functional tests that walk tests or run tests and things can just guide where you’re at.

 

01:06:38.000 –> 01:06:48.000

Because, you know, if you’re doing intense exercise for the right reasons for your body, and it doesn’t hurt you, then I’m really averse to say, don’t do it.

 

01:06:48.000 –> 01:06:57.000

So it is confusing, because we know that some patients can get and not just lipoedema patients, but athletes of all types.

 

01:06:57.000 –> 01:07:12.000

Can actually get inflammatory responses in their body from intense exercise, you know where there’s not adequate rest and a good rest to work ratio so inflammatory responses can happen with intense exercise.

 

01:07:12.000 –> 01:07:16.000

But if it’s balanced out with rest and good holistic, you know, choices with diet as well, and maybe you know you guide yourself.

 

01:07:16.000 –> 01:07:28.000

I feel that it’s still worth following what is comfortable and good for you as an exercise routine.

 

01:07:28.000 –> 01:07:49.000

And I agree with you. Lisa needs to be comfortable, but they realize that along with their live demo, a lot of them have a lot of Stan loss type of mobility, and if they’re doing it to beat the disease and reduce and remove the fat, it’s not going to

 

01:07:49.000 –> 01:08:13.000

work. The concerns are, if they heard themselves in the process, and end up from even a minor industry with a and then they develop a blood clot that goes to their lungs and and I’ll see that why, too, many times so it’s very important to realize oh, you’re not gonna

 

01:08:13.000 –> 01:08:24.000

beat it, but stay healthy. And nice, and fit, and develop those muscles and those patients who had surgery get to see those muscles eventually.

 

01:08:24.000 –> 01:08:32.000

Once the Feds gone. But be careful. You have some cobbinities along the way.

 

01:08:32.000 –> 01:08:35.000

You can really really hurt yourself if you overdo it.

 

01:08:35.000 –> 01:08:44.000

Yeah, and that’s yeah. The thing that you know high intensity exercise is, you know, it’s high risk, high rewards stuff, right?

 

01:08:44.000 –> 01:08:50.000

So you know you do. People feel great endorphins are gonna be really reinforced. But it is.

 

01:08:50.000 –> 01:08:59.000

It’s high risk in that. It can cause injuries really easily, you know, jump on a box, or you’re doing, you know, absolute, Max, lifting crossfit sort of stuff.

 

01:08:59.000 –> 01:09:02.000

So you just gotta balance that out and I don’t know.

 

01:09:02.000 –> 01:09:20.000

I think working with oncology patients has probably taught me the lesson as well to say, Look, don’t create an environment where you are able to well, you know, when you feel that your life has been impacted negatively from your condition, you know.

 

01:09:20.000 –> 01:09:21.000

So you. It’s all about managing with your condition, not avoiding things because of.

 

01:09:21.000 –> 01:09:34.000

And I think that’s that’s where I come from as a therapist to try and facilitate what people wanna do in the best way that it can encourage that.

 

01:09:34.000 –> 01:09:42.000

Because, yeah, you don’t want to sell because I have lipoedema. I’ve never. I’m no longer able to do all these lovely things that I enjoy because you don’t.

 

01:09:42.000 –> 01:09:48.000

You don’t want to meet your end. Feeling that this condition has actually not limited you that much from the things that you enjoy.

 

01:09:48.000 –> 01:10:04.000

So where you’re able to balance well the things that you enjoy with the condition that you have, I think that’s a great place to be in a really healthy head space to get into it. We can yeah.

 

01:10:04.000 –> 01:10:09.000

Yeah, definitely.

 

01:10:09.000 –> 01:10:16.000

Another question. So we have quite a few accounts coming through about recommendations for services.

 

01:10:16.000 –> 01:10:22.000

Obviously Liz is in Canberra, and with her details there.

 

01:10:22.000 –> 01:10:26.000

So please pop in and go and see Liz and her team, and then I’m going to you.

 

01:10:26.000 –> 01:10:40.000

Put an answer on the previous one Liz, and I’m just linking to our support register as well, which is all our website lipoedema surgical solution.

 

01:10:40.000 –> 01:10:52.000

Dot com forward, slash, get support, I will link it, and that if you just pop in your state and location that has a list of webinar, friendly practitioners and resources. Liz is on there. Obviously.

 

01:10:52.000 –> 01:10:58.000

Yeah, and look at, you know, I’ve got a couple of colleagues up there, but it’s actually a bit hard to keep track.

 

01:10:58.000 –> 01:11:02.000

Sometimes I think, yeah, that register. So yeah, the register, these guys have this really good.

 

01:11:02.000 –> 01:11:13.000

You know there is a you know. I think most. It’s interesting that even when I did, my lymphedema training course back in, you know, 2,005 or something, you know.

 

01:11:13.000 –> 01:11:24.000

I think that lymphedema is something that lymphedema therapists even though we’re not called a therapist called lymphedema therapists, which kind of encompasses all the adeemas and I think

 

01:11:24.000 –> 01:11:35.000

we always learn to about Lodma ourselves. And so I think a really good, qualified, well trained, lymphoid therapist is going to have come across lipoedema. But there’s just a few of us.

 

01:11:35.000 –> 01:11:49.000

I guess, who followed a bit more of the journey of lipoedema, because, you know, it’s been a big proportion of what we’ve seen, and so I think we’ve sought at conferences and talks, and you know, and other areas more information because we’ve been seeing so much of it

 

01:11:49.000 –> 01:11:52.000

that we wanted to give ourselves an arm ourselves with some more information, as well.

 

01:11:52.000 –> 01:11:53.000

So. So I think you know you still want to connect with the therapist.

 

01:11:53.000 –> 01:12:03.000

So you’ve got to find a therapist is just going to go through the journey with you, and that can like everything.

 

01:12:03.000 –> 01:12:11.000

Take a couple of goes. So you know, if you see one therapist who’s not very understanding, or you know, maybe isn’t really able to see you or not.

 

01:12:11.000 –> 01:12:19.000

That interested. Then I’m sure that another therapist, you see, Will, because it’s just it’s a bit of a subcategory within what we trained to do.

 

01:12:19.000 –> 01:12:32.000

So it’s tricky, and I mean we. We have one specialist here in Canberra who can be very blunt with our lipoedema patients, and he’s been a goto for a lot of the lymphedema patients for a long time.

 

01:12:32.000 –> 01:12:44.000

And sometimes we do have to counsel them when they come back to say, it’s okay, like, actually, there are doctors who really do care about Lyme and and you know, we’ll maybe be more sensitive to you.

 

01:12:44.000 –> 01:12:46.000

So like anything you’ve got to connect to your medical professional or your therapist to make sure they’re able to give you what you need.

 

01:12:46.000 –> 01:12:57.000

And you know, help you with the questions that you have. Yeah.

 

01:12:57.000 –> 01:13:03.000

Can I just ask a very quick question, and I haven’t bought it until so are you happy, Emily?

 

01:13:03.000 –> 01:13:06.000

Yes, sorry. I talked a bit too much.

 

01:13:06.000 –> 01:13:18.000

Not at all. There seems to be a big movement out of Germany now with the doctors who hmm!

 

01:13:18.000 –> 01:13:26.000

With a, in fact, they’ve gone out on 11 created this whole European movement.

 

01:13:26.000 –> 01:13:31.000

Where they say that lipoedema doesn’t exist there, finalizing the press women.

 

01:13:31.000 –> 01:13:41.000

And what the guy taking the charge is a a wide loss surgeon, and says that in fact, you know it’s obesity.

 

01:13:41.000 –> 01:13:52.000

And the women do well with weight, loss. Surgeries of A B city-related activities which in my world it’s further from them.

 

01:13:52.000 –> 01:14:06.000

Truth, because even as they’re trying to challenge themselves to lose all of that fat and end up in hospital, still have this disproportionate reality with Betty.

 

01:14:06.000 –> 01:14:13.000

Okay, no matter what they do. However, the thing that is interesting as part of that controversy.

 

01:14:13.000 –> 01:14:25.000

Excuse me. The controversy is also that that there’s no such thing as the swelling the demons you talked about lymphedema.

 

01:14:25.000 –> 01:14:32.000

In fact, there’s no such thing as a swelling of.

 

01:14:32.000 –> 01:14:51.000

Why we using MLD therapists? Because there’s no swelling so here I am telling all my patients go in and see great email, the therapist cause you make yourself more comfortable and when you’re ready for surgery, you’ll be a lot softer and i’m starting

 

01:14:51.000 –> 01:15:01.000

to now very occasionally, patients coming back and saying this doesn’t believe I’ve got it swelling whatsoever which I find very fascinating as well.

 

01:15:01.000 –> 01:15:06.000

Clinically. That’s not my experience. What are your thoughts on that list?

 

01:15:06.000 –> 01:15:09.000

Yeah, look, I, actually a colleague in Canberra who used to look at Calvary. She’s actually moved on from there now.

 

01:15:09.000 –> 01:15:29.000

She look? I actually got Covid, and could not go to the conference last year, and I was particularly depressed about it, because the guy is leading the charge on this in the European kind of model is to bias Burch right?

 

01:15:29.000 –> 01:15:33.000

And he he came to the conference last year, and Sd.

 

01:15:33.000 –> 01:15:45.000

Held a kind of a big round table with him, which myself and his colleague were supposed to go to, and that was actually the thing I wanted to go through the most last year, and I I couldn’t go.

 

01:15:45.000 –> 01:15:48.000

It’s like over the day before I got so so annoying.

 

01:15:48.000 –> 01:15:53.000

So she talked me through it a bit, and look, I think it wasn’t that the roundtable wasn’t as significant as I thought it would be.

 

01:15:53.000 –> 01:16:08.000

I thought that was sort of sitting around and having a discussion on it, but the concerning thing is a little bit that I mean, like every health care practice, you know, when you’re looking at different conditions.

 

01:16:08.000 –> 01:16:15.000

It’s always frustrating when people like deviate, and rather than discussing how to treat things optimally.

 

01:16:15.000 –> 01:16:21.000

You then get into this like paradigm, shift, model blah blah! You know.

 

01:16:21.000 –> 01:16:23.000

And I think what’s kind of happened, it seems, is that the European model, you know, spearheaded by Bias Burch.

 

01:16:23.000 –> 01:16:34.000

They put out this big position statement which literally I think, is titled The Paradigm Shift, as if there’s some shift that has to happen.

 

01:16:34.000 –> 01:16:43.000

You know, and in the Us. Model is much more traditional, and I think Australia, we’re just stuck in the middle.

 

01:16:43.000 –> 01:16:49.000

And so this round table was supposed to be a bit of a discussion that Anthony was hosting around.

 

01:16:49.000 –> 01:16:50.000

You know, looking at Australia’s position statement and trying to figure out where we sit in that.

 

01:16:50.000 –> 01:17:02.000

And which way we go on it. And honestly, when I read both things because I was home with Covid really annoyed, I wasn’t there.

 

01:17:02.000 –> 01:17:06.000

So I actually read every single thing I could find about it, that I’d been sent by by Sd.

 

01:17:06.000 –> 01:17:09.000

Reps, and by my colleague, and I just feel like it’s just splitting hairs on the topic.

 

01:17:09.000 –> 01:17:26.000

Right. I mean, you know every patient that comes in with epidemic is different, and some of them are really swollen, and some of them are really not, and some of them are in horrendous amounts of pain.

 

01:17:26.000 –> 01:17:35.000

With what you would think is minimal lipoedema tissue, and some patients are stage 3 to 4 with very minimal pain and managing reasonably well.

 

01:17:35.000 –> 01:17:38.000

So I think, yeah, what the Europeans are trying to say.

 

01:17:38.000 –> 01:17:50.000

Is that it? It’s a fat condition, not a swelling condition, and that’s the, you know fat, painful, depressed women argument that basically.

 

01:17:50.000 –> 01:18:01.000

Yeah, that you doesn’t necessarily cause swelling, and so swelling should not be included in the diagnostic criteria at all.

 

01:18:01.000 –> 01:18:19.000

But I feel like, even if you just use your brain physiology on that one, that if you have space occupying tissue, that is fatty tissue, it is going to be impacting on the Hillary circulation, it is going to be impacting on circulation, in that and I don’t know how

 

01:18:19.000 –> 01:18:25.000

it’s possible that you can be growing fatty tissue and not affecting your circulation.

 

01:18:25.000 –> 01:18:33.000

Once it gets to that stage like I don’t even know how. That’s a debate to be had, because there is physiology behind that right?

 

01:18:33.000 –> 01:18:39.000

If if he ever wants some personal thoughts, and I discuss these with Doctor, hey?

 

01:18:39.000 –> 01:18:53.000

Greatly, and all the individuals involved reach out to me personally, I won’t go on the record to say what our thoughts are about practitioners that don’t see lipoedema every day of the world.

 

01:18:53.000 –> 01:19:00.000

Thank you very much for your contribution. Thank you, Emily.

 

01:19:00.000 –> 01:19:01.000

Hey? Looks like it.

 

01:19:01.000 –> 01:19:07.000

Good no worries. Thanks for that. Yeah, it’s it’s good for people to be aware of that discussion, because we are starting to have questions about it at the clinic as well.

 

01:19:07.000 –> 01:19:21.000

So hopefully. Australia takes a moderate approach and just looks at people individually, according to conditions and criteria.

 

01:19:21.000 –> 01:19:24.000

Yeah, absolutely.

 

01:19:24.000 –> 01:19:25.000

Okay. Well, I think we can wrap it up. There is.

 

01:19:25.000 –> 01:19:32.000

I think, yeah, worries.

 

01:19:32.000 –> 01:19:36.000

Thank you so much for joining us tonight. This has been so enlightening.

 

01:19:36.000 –> 01:19:38.000

You must learn a lot as well.

 

01:19:38.000 –> 01:19:39.000

I do. I learn a lot. It’s great, especially if someone I didn’t come from a clinical background.

 

01:19:39.000 –> 01:19:45.000

It’s really yeah. But it’s really inspiring.

 

01:19:45.000 –> 01:19:51.000

It’s great. So thank you.

 

01:19:51.000 –> 01:19:52.000

Thanks for not agreeing.

 

01:19:52.000 –> 01:19:53.000

Hi! Lynn, a lot today I learned a lot of you guys, too.

 

01:19:53.000 –> 01:19:54.000

Thank you very much.

 

01:19:54.000 –> 01:19:56.000

Alright! Thanks for inviting me!

 

01:19:56.000 –> 01:19:58.000

Thanks like it.

 

01:19:58.000 –> 01:20:00.000

Thank you. Bye.

 

01:20:00.000 –> 01:20:01.000

Bye!

 

01:20:01.000 –> 01:20:06.000

So Liz has her details up there for everyone in Canberra.

 

01:20:06.000 –> 01:20:18.000

Her email website. And I just wanted to let everyone know as well that in case anyone not away yet next month is lap, dim awareness, month.

 

01:20:18.000 –> 01:20:27.000

Yeah. So please go go on. Socials. Go online, we have a whole host of things coming up.

 

01:20:27.000 –> 01:20:30.000

That we’ll be posting on our website and our social media pages.

 

01:20:30.000 –> 01:20:38.000

And yet we encourage you to get involved. Listen to as much info as you can.

 

01:20:38.000 –> 01:20:41.000

And yeah.

 

01:20:41.000 –> 01:20:42.000

Yes.

 

01:20:42.000 –> 01:20:43.000

And lobby, and tell your adopted about it, and you know, lovely any politician that will listen as well.

 

01:20:43.000 –> 01:20:49.000

Yeah. And well, yeah, thanks for helping us raise awareness.

 

01:20:49.000 –> 01:20:50.000

No worries.

 

01:20:50.000 –> 01:20:53.000

Thank you. Enjoy the rest of your night.

 

01:20:53.000 –> 01:20:55.000

But thanks so much. I’ll talk to you another time.

 

01:20:55.000 –> 01:20:59.000

Thank you.Bye.