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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As they’ve worked with in the Telly House.
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And now in theater, and Nick.
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Hey? When they hmm, hey? Remember to help us progress.
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Our patients, journeys for lipoedema, both in the in the clinic Conservative management and the surgery space.
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So I’m very excited to have Nick with us, and tonight we’re going to be talking.
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Emily, I guess Nick and I, chatting.
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What is it that we, as doctors expect? Your journey is gonna look like, and what surgery is?
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And of course most of you who are contemplating surgery really want to know what it looks like from our perspective.
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And there’s a lot of information that we give you.
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The clinic and a lot of information that we in part.
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But what’s really exciting is the next time we do this event we’re going to flip it.
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We’re actually going to have patience from past, present, and even future.
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Pretty much leaving the conversation with us, actually observing, and and perhaps being able to try me.
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And already today talking to our post-OP ladies this morning, you know, they were all of us thinking great.
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There’s great pills, I mean, we can provide, and we will actually find it very informative.
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As well, so it’ll be a nice collected. There’s a lot of buddy systems that are already forming with patients that come in and have surgeries together.
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They seem to book surgeries together as well. So we think that format will be very exciting.
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So I’d like to just hand over to Nick now and give him an opportunity to talk about what it looks like from our perspective.
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Thank you, Dr. Thank you for the wonderful introduction. I feel really lucky to be part of the team here for the past 3 years.
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I wanted to take you along. The patient’s initial journey from the very beginning.
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All the way, leading up to surgery. And this is what we do to work you up to a surgery and get you through it.
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So, so your as a patient or journey would typically begin finding out about Mit and wanting to look into a group zoom session with one of us, just to see, find out more about what it is, what we can do about it.
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What our actual clinic is all about, and what we can offer, following which we’ll get a one on one session.
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We’ll book in a telehealth with myself where I will go through your patient questionnaire.
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If patient history, search of clinical photographs, and give you a form of diagnosis of life, what is a document?
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The typical starting point for a lot of our patients is to begin your lipoedema journey, and that’s usually following conservative management recommendations, and that would encompass the lipoedema family diets.
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Compression. Therapy, usually flattened compression.
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And now manual lymphatic drainage, nature, which is a specialized form of such therapy, and all of these are important to optimize patients for their actual surgery.
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When we assess patients to determine if they are ready for surgery as part of our surgical protocol, to make sure that patients are occupied and patients have the best possible surgical outcome, we do a clinical assessment inflammation is all the way down and
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with whether you’re actually ready for surgery. We also do a vein scan with the ultra sound scan that is to assess what the possibility of darkness space that not only with worsening inflammation is slowing, but also could increase the blending risk so
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as specialist in swollen legs.
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We want to determine if there was any potential contributors that could make your life even worse and address it prior to your actual surgery.
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The last thing that we do to optimize from a certical safety point of view is this bubble study, or, as we call it in, and we call it, the transcriing of documents so that’s a simple study that we do to exclude the possibility of the pfo or hole in the heart to essentially
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remove the risk of a paradoxical ambulance associated with Serger.
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So once you’ve been through all of that. Then if your links are soft and ready, then able to begin planning for surgery, and with that planning and booking for surgery, you’d be given one of these which is a pre-help pre and
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post Operative instructions for the actual survey that this would be coming.
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Your guide and Bible leading up to this earlier with the actual surgical booking and process, we do get patience to guess some pre-operative blood tests and an Ecg usually around top of 4 week mark priority extra services this is to make sure that
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we we can plan with your server. Make sure that you get through service safely.
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On the day of surgery itself, we will do a very specialized markup, and surgical planning so we mark up the extra areas for the surgery.
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The extra service you are, you’ll be the assist who will be administering the for you and the goal of is to keep you comfortable for the service that you don’t have any pain or discomfort, and you get your server really quickly with the actual surgery
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itself. We employ a very specialized protocol that Dr.
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Has done extensive training in Germany, and he’s not doing me in.
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It’s a very specialized water assistant.
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With the goal of the moving all of the life to be not tissue.
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And then the Fedex starring. So, Nick, so Nick had to stump up full surgery for assisting and being part of the surgical process, and and had to complete 100 directly supervised surgeries.
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Now, folks just so, I can tell you, in a straight itself is a mystery to most general.
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Most specialist GPS and medical specialists, and and that includes general surgeons, plastic surgeons, cosmetic surgeons, and in Germany, where I train with Doctor felt in 2,017 Dr.
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Falk was an orthopedic surgeon, is fifth, is the next busiest in the life. Atlantic. In Germany.
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Is a gynecologist, and he has a team of plastic surgeons.
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And now also vascular surgeon, so to make it very crystal clear.
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In Australia, the expertise in Lyme is limited.
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There is no formal training in Australia, and Nick, as, apart from what we have in the library, doing surgical solutions. And Miami private hospital, we have a straight training protocol that along the way Nick has had to hit all the high points, and this is building on the.
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Oh, they don’t do cosmetic surgery.
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We don’t do the plastic surgery and the way it approach it by removing the plastic surgery in the way of approaching it by removing skin and fat.
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It is a protocol that’s been absolutely tested, and improvement and effective in Germany.
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Remove the fat, so it doesn’t. So it doesn’t come back.
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So in terms of the protocol, it’s actually now being distributed to major site holders, medicare medical defense organizations, health funds, and all of that is advocacy to actually make the surgery more acceptable and to make it more affordable over time and having
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Nick, join the team. Just means we’re getting more and more momentum.
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We have 8 overnight beds now, and that is filling up and we’re working with more doctors in terms of the training as expert in swollen legs, as Nick said, there is an advanced training for the discipline of in some parts of the
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world that has its own special details. Category in Australia.
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It is a an extension. It’s part of the Australian College of Topology that has been lead is in in the field of choiceing venous and lymphatic, and being aware of what we’re doing is actually extending the formal
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Training that’s what we’re doing is actually extending the formal training.
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Now for Australia. So look, we’ve done a lot of talking.
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Is there anything more that you wanted to outline? He sits here, having.
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Yeah, achieve so much in that space so dedicated in such a a welcome member of the team.
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And certainly, if at any time you want to, the qualify any of that that’s a formal training.
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By all means do so. Is there any other mention of the surgery in our perspective that you think you need to highlight before we ended it over to Emily and the audience?
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I just wanted to touch on the the unit points of our protocol and the lymphatic, sparing approach.
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That is a key part of the technique. Special techniques that we use that perform this.
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Oh, and that’s why the email. But it’s been very important for lipoedema.
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Because in like that email, we often see second, note that email as well. And it’s quite crucial to make sure that you preserve those important statics that are really being damaged by the ongoing information.
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Now, Emily, do you wanna open it up to the audience?
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And the specific questions that we can ask answer in terms of where, how to, and what we do here at Miami Hospital.
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Yeah, definitely, okay, so we have quite a few questions come through.
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And I’ll just try to combine them and read them out to you.
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So we have the first question, do you require a Gp referral for surgery?
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So a gp Referral or lipoedema is it’s not a condition that exists here in Australia.
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It’s certainly not recognized by Medicare as being a condition, and we actually find that we are most about patients.
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So that come by referrals from GPS that are learning about the disease.
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We certainly do a lot of Cpd training in that space as well as our team.
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But we’re getting plastic surgeons and cosmetic surgeons referring patients, and certainly is a significant amount of word of mouth.
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It is always our preference that we get license referred in way of correspondence, because it gives us an opportunity to write back to your team.
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But what we found even before Covid, but more so during Covid to get to see a Gp.
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Seems to be a major barrier and and please don’t let that be.
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A barrier will rot to your team, and we’ll ask for every single.
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Person who’s been there, not understanding, like the demon we did, a survey there’s an average 6 visits to doctors and specialists before the penny drops of is a diagnosis with lipoedema so along the way collect all the names, and we’ll help educate them with
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their yeah, absolutely.
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Sounds good, and just before we go to the further questions from Zoom, I just wanted to answer a couple of questions from social media that we had.
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So our question is, how do you facilitate surgery for international patients?
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Specifically airplane travel. If I’ve been told by my doctor I shouldn’t travel overseas.
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Nick, why don’t you kick that off with the work that we’ve done as a team collective?
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In Aesthetic. The haematologists. We covered all of those grounds.
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Yeah, so first, I like to say that we do get quite a few patients internationally, and at least from the initial zoom and initial appointments that could be quick conducted at the distance from the certified optimization.
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Points of view. We could look at the each and individual circumstances.
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Look at getting these investigations that locally, and that would be the main scan.
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The of study, and if we can, we can always find a metal drainage. Therapist will also be able to work locally with you.
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But for locations. Who are travelling internationally to come.
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Yet the search. Survey. We’ve got the first purpose still.
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Private hospital, in Australia. It’s specifically the whole Academy.
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We’ve got a whole team here that’s going to be able to look after you. We’ve got it.
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The doctor here. Monday to Friday. After that issue, and myself.
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It’s always on call and doesn’t mean that you don’t have access to, as you always have mobile numbers, you’re always being able to contact us, and we will always be able to respond to you.
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So from that perspective, I think that we are able to provide quite a lot of support in the event or international so, in terms of the managing swallow and legs, both Dr. Teo.
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I had extensive experience with probably what is people’s biggest concern.
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The bains and blood clots. So this is our base, and then we have the expertise in the lipoedema and the lymphoedema Space to actually combine all of that knowledge base and have a significant team behind us with himatologists if we need them.
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With an insensus to deal with in theater and to absent doctors.
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We’re not cosmetic. We have a mind for medical conditions, and the biggest concerns being plots.
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We regularly manage patients that have what we call from the failure or tendency towards blood clots, and I’ve now performed about a 1,000 surgeries.
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I’ve consulted over about 5,000 patients, and out of those 1,000 surgeries we are yet to have a deep mind from us, because we’ve got a very strict protocol in terms of the plus operative state, and every patient is walking straight away after the
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surgery flying is, we have a protocol that since the 2 weeks arrival to the Gold Coast it gives us time to be out, and we actually have a lot of communication before patients survive. As Dr. Teo
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said. Patients will get worked up prior to arriving.
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So you won’t just turn up the surgery.
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There’ll be so many test points with probably team of 20 clinic staff.
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And then after that another 20 to 30 medical hospital team that are there to look after so we’re very fortunate that we have a very comprehensive review process.
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Host of process, you’ll be sick of us. We’ll just absolutely smother you with honey and we’ll be able to do everything that we need to, both through sound to to exclude any big bank from buses will have a protocol of compression and travel for patients that are outside of Australia that
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sits within international guidelines. And it’s front and center of what we do.
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So it’s very safe. I worked in Germany, where places travel from all over the world, and as a I was interested in not only the lieutenant, but how that look for international travel and let’s face it.
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Okay? Great. So that touches on this question, do we have to have continual visits to Miami private hospital before surgery?
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We’re in the most beautiful part of Australia. Everyone wants to be on the Gold Coast, and we love to share it for both our Interstate and before surgery.
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Yes, in the lead, up!
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Yeah, very quickly. Say, as doctor mentioned, for overseas patients, we can actually work with your team.
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And we know, and we can guide exactly what needs to be done with the 10 health.
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It’s very important for the diagnosis. And then the conservative management.
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And then, if there’s requirements for investigations, we can guide that.
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But that’s true. For into state patients and patients that don’t have access to us, many a patient arrived in the first time we see them face to face, he’s at the theater the morning of the markup all the day or so before surgery, but many many many touch points are
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occurring with this process that the Admin team has, and we get good feedback using your other experts that we get involved.
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Yeah, wonderful. So that clarifies. We have a couple of questions.
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Coming through. If we do. If you perform surgery in other locations.
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But it’s yeah. Just in Miami private hospital.
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So we do like getting involved so we do like getting involved other disciplines from work you live. If you’re not in Brisbane Gold Coast, Sydney, Melbourne, or even oh, trust me, second such a low long time to go to Germany assemble an amazing team here
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and and give me time. And give me time. I don’t want to say too much, because some of my colleagues may not like the sound of that, but we have huge requests for work and getting a team together to
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be able to facilitate this. But in Germany, in Mohai that’s the center of the world there, and we’ve got it in the center here.
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Okay, so how long would someone have to book accommodation for when coming from interstate or overseas?
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When having surgery, and what is the recovery? Time after surgery?
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So ideally, ideally, your licenses stay close to up for these 7 days after this surgery before they are but flying with driving back home.
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I think it’s there that’s get longer.
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That would be, that’s it, but ideally, they’re like 7 days.
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And that’s because we want the ability to look after you.
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After the survey. We want to have that close contact, the ability to do anything that we absolutely need, whether that’s reviewing you in terms of.
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Checking your vitals, checking your email global checking for any servers that might be drainage, or even just be a fine question being able to look after you is it gives us the ability to touch trivial.
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Or throw that points of care right off the surgery. Yeah.
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So what we need to understand that in Australia I went. Doctor.
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He traveled here in 2,017, he said.
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Doctor like I’m in a time. Walk back in Germany 20 years ago.
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Look at all that stage 3 and Stage 4 live. So the years of advocacy and awareness, and we look forward to seeing that here in Australia and we’re seeing much younger patients present now for earlier surgery, so that I’m progress and need more extensive surgery and with
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that comes more age and more. Co-orbidity.
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So, even for the most extreme patients, we’re often operating on patients that need a number of surgeries.
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3 to of beyond 3 surgeries, and these patients will have beyond 30 to 40 litres of facts.
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So we do a stage surgery, and we can actually give album and mit patients.
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Well, we can actually talk them up with a unit of blood.
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We have a hospital here. It’s not a day surgery, and we can keep patients if we need to.
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But 99.9% of patients with this photograph go home. The next morning.
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They come back with some touch points, and then, if you’re international, we let you go.
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You can go up through your 7 days, and you can have some exploring.
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The goal coast is wonderful. But if you want to go to Sydney or Melbourne, or North Queensland, by all means go there.
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But we’re here, and and we’re well connect with colleagues that even in your travels we could assist, if needing.
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Yeah.
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Does that answer that?
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Yes, I think so. I agree. The Gold Coast is very beautiful.
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So, a couple of questions coming through on suitability for surgery, and how?
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That’s assessed, so I’ll try.
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And keep those ones together would stage 4 more.
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But obesity qualify. Sorry for surgery.
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So with Stage 4 of the city, the test assessment that 50 would be done would be doing the initial one to one.
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Tell you how we actually go through your medical history. We look at the clinical photographs, and if we need to, we can actually reach out to your Jp.
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Or any medical specialist that could be involved in your care.
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Just to get in, get an overview, get an opinion and clear things by your existing specialist.
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Stage, full mobility is not necessarily a contraindication, but there will be considerations on the surgical points of view that we will need to optimize prior to surgery, and what we actually have is a team of an assist behind us.
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And we also have the ability to get patients through. If I need to make sure that everything’s optimized and save progressing to surgery and what’s interesting, Nick is often we see patients that get toll over and over and over again, you’re obese the
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more bad days, and yet I have tiny wise that have big legs.
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So that’s part of the misunderstanding in the medical community.
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So, as doctor said, having a that, tell me how that initial Tony have, and usually in that telehealth we can give you with your history and your photographs.
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We can give you pretty clear stage, and talk of.
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We can actually even tell you we think you do have some sense of secondary obesity, and we think with the conservative management, you should lose weight, and how long that might take with that experience.
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You see so many patients. So we generally get a a good idea what the journey might look like if you’ve got secondary visits.
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So I have a patient from Melbourne. He lost 65 kilos in in 12 months, and 55.
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That was in the first 9 months, and she had horrible stage.
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4 legs. So you know, I really one of the worst that I’ve seen, and she got so soft after that journey, with all that information came out, and she’s getting to a point where she was going to get a surgery ready.
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So it’s important that we have an opportunity to work with you so it’s important that we have an opportunity to work with you and to spell a lot of meet.
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Unfortunately, a lot of patients come in with a lot of this, but if you’ve been given a stage for diagnosis, you do not need cuts from the ankle to the groin, and these are minimally basic procedures.
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So we get all the fact out, so it does not return.
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That is the AIM of the surgery, and we are very particular about that approach.
00:29:11.000 –> 00:29:18.000
Es, to Germany.
00:29:18.000 –> 00:29:25.000
Okay. Great. Thank you. And then what about other promote such as we have?
00:29:25.000 –> 00:29:34.000
One question. I have fibromyalgia, and on differentiated connective tissue disorder and Vaughn will brands.
00:29:34.000 –> 00:29:36.000
Am I able to have surgery?
00:29:36.000 –> 00:29:58.000
So lots of our library. Our patients actually have Co mobilities or previous diagnoses, such as hydrogen and Connecticut, and for a lot of our patients getting the information down, getting reluctant, even tissue out actually helps significantly with their paying.
00:29:58.000 –> 00:30:01.000
And it’s really improves the quality of life.
00:30:01.000 –> 00:30:12.000
So we are. We are quite able to risk assess patients with surgery, and we have taken a lot of these patient through to surgery.
00:30:12.000 –> 00:30:22.000
Quite successfully. I have a talk that I do when I speak to doctors and conferences, that it’s called.
00:30:22.000 –> 00:30:30.000
Look beyond the and when you look beyond it, you see patients that aren’t at least that lazy in the press.
00:30:30.000 –> 00:30:35.000
But beyond the is usually a list of about 10 to 15 coorbidities.
00:30:35.000 –> 00:30:50.000
So we do. It is all the time, it’s doctors that are medically focused and the quick, the surgical technique we we can manage those patients along the way as well.
00:30:50.000 –> 00:31:02.000
And we like to bring in a team of experts. If you’ve got your own specialist, we work with them very, very closely.
00:31:02.000 –> 00:31:08.000
Okay. Great. Thank you.
00:31:08.000 –> 00:31:18.000
No, that’s great. That’s a little bit. So I’m just trying to go through all of the questions and keep them group the ones together that are similar.
00:31:18.000 –> 00:31:40.000
So what is the wait list for surgery once conservative management is complete, and then that on the second part of that question, if a Pfo is found or a hole in the heart, how long does it take before an appointment can be made to have it closed up?
00:31:40.000 –> 00:31:47.000
Why don’t you check that a lot?
00:31:47.000 –> 00:31:57.000
With regards to the Pfo project. So if we do need bubble suddenly and we diagnose you with a hole in the heart of the PFO.
00:31:57.000 –> 00:32:07.000
What we, what we would then have to do is to refer you for an MRI of the brain as well as you.
00:32:07.000 –> 00:32:15.000
After once the Cardinal just has actually seen you. And what do you up for?
00:32:15.000 –> 00:32:35.000
The actual procedures across the whole in the heart. It’s usually about 3 months before we get able to bring you forward for, lipoedema-extraction surgery, so that the and it’s not any old cardiologist in actual fact, most cardiologist GPS lost in this space.
00:32:35.000 –> 00:32:39.000
We’re not interested in tiny little holes that may be.
00:32:39.000 –> 00:32:47.000
Your patience might have we talking about big holes, and I refer to the harping the size of the face.
00:32:47.000 –> 00:32:57.000
Human face, and you had a vertical, muscular set then, dividing the left side of the heart, which is arterial, the right side, that is, Venus.
00:32:57.000 –> 00:33:21.000
So what we want to pick up is where there is a whole somewhere at times between 20 to 30 in size that directly connects the Venus side to the arterial side, and it’s so important to understand that we can virtually stop the risk of a stroke hey?
00:33:21.000 –> 00:33:24.000
Diagnose these very effectively, using our bubble studies.
00:33:24.000 –> 00:33:27.000
The cardiologists in all of the work that we’re doing in that space is when we refer a patient to.
00:33:27.000 –> 00:33:29.000
Then they usually have a whole, and it’s usually a big one.
00:33:29.000 –> 00:33:54.000
When if your brain fog exercise intolerance or migraine, it’s a good chance, he will have a whole, and but the scary thing is some of the biggest holes we’ve diagnosed have absolutely no symptoms, and the cardiologists say even blown away
00:33:54.000 –> 00:34:02.000
and the conversation happens around the lifetime of risk that can occur with tiny little strikes. So that’s why the Mr.
00:34:02.000 –> 00:34:05.000
Speaker strike even in yeah, little Mini strikes or microscope.
00:34:05.000 –> 00:34:16.000
In early age. Imagine what that looks like in terms of down the track, let alone the risk of a blood clock going to the brain.
00:34:16.000 –> 00:34:34.000
If you fact, if you had a moon moves on, or if you fracture a limb, and you have by marrow go up, or you have Lynn surgery and a baby in theotic fluid, and when we’re doing a fluid and when we’re doing our
00:34:34.000 –> 00:34:37.000
licensing, we don’t believe we’re risky.
00:34:37.000 –> 00:34:42.000
We’re actually very complete getting all of that fat. And we know that in that.
00:34:42.000 –> 00:34:47.000
And if you want to see, it will show you enough to say where all these blood vessels live.
00:34:47.000 –> 00:35:04.000
We don’t want that fat to percolate up, and then the minute is stand up off the table and you’d make a and if it goes up to the Brian and have people died from large suction and having a chat yesterday, with one of the underwriters from medical defense
00:35:04.000 –> 00:35:08.000
organizations, trying to make them understand that this lipoedema and lymphoedema work is not cosmetic.
00:35:08.000 –> 00:35:18.000
An outlining what we do for risk minimization.
00:35:18.000 –> 00:35:27.000
He was quite surprised, but was very quick to tell me of all the design that are occurring both in the cosmic and plastic space.
00:35:27.000 –> 00:35:33.000
When it comes to liposuction. So from our port of view we wanna mitigate that risk.
00:35:33.000 –> 00:35:38.000
We use very experienced cardiologists throughout Australia, and even New Zealand.
00:35:38.000 –> 00:35:39.000
And now we we’re finding the right people.
00:35:39.000 –> 00:35:46.000
But yes, 3 months it takes for that plug, which is a 15 min.
00:35:46.000 –> 00:35:53.000
Procedure it’s one of the most straightforward ones for the extra cardiologists in some parts of Australia.
00:35:53.000 –> 00:35:56.000
Even they go home the same day, and then we sleep well at night.
00:35:56.000 –> 00:36:00.000
Everyone does that you’re not gonna get a strike.
00:36:00.000 –> 00:36:22.000
But prior to surgery, when people have that done, it changes their lives even, and and what fascinates me is that there are some people in the space that don’t understand PFOs. And their response online is well, if you have a stroke, you’ll get in intensive.
00:36:22.000 –> 00:36:32.000
Care if that’s the way you want to going forward and have you hitting the same, then we’re not the right people for it.
00:36:32.000 –> 00:36:33.000
That’s right. Yes, just the white. The wait. Times. Yeah.
00:36:33.000 –> 00:36:40.000
Hey, Emily? I feel that question the one yes, you don’t have to wait till next year.
00:36:40.000 –> 00:37:02.000
Now we have a 8, day overnight board, and we have done to working and doing places and booking case, and yes, you have a minimum of 2 months of your conservative journey, and the whole idea of this whole program of a group zoom. A one-on-one telehealth
00:37:02.000 –> 00:37:03.000
is really to get you started with the journey, so you don’t have to wait 6 to 12 months to see us.
00:37:03.000 –> 00:37:15.000
And then start your journey, and then, obviously an appropriate time depending on your size, and where you’re at.
00:37:15.000 –> 00:37:23.000
And if you surgery that you want, you know, we’re hoping that we were not waiting more than 2 or 3 months.
00:37:23.000 –> 00:37:27.000
Okay. So the timeline, roughly, is a question here.
00:37:27.000 –> 00:37:31.000
2 to 3 months, from consult, from initial console to surgery.
00:37:31.000 –> 00:37:41.000
Yes, and very mind the most popular times in in winter, when no one was to compression.
00:37:41.000 –> 00:37:50.000
News for you. You need flat nets in summer, when it’s the worst effect of the weather on your legs.
00:37:50.000 –> 00:37:55.000
So it should be an all year round thing, and if your teachers in school holidays, then then you really have to hustle with the Admin team, because they’re very popular.
00:37:55.000 –> 00:38:07.000
But we’re busy all year round thankfully, and it’s a privilege to be out to do that.
00:38:07.000 –> 00:38:13.000
Absolutely busy, busy. So a couple of questions about lymphoedema as well.
00:38:13.000 –> 00:38:28.000
Can you perform the surgery when limbs are still presenting with lymphedema? Or does lymphoedema wanting need to be almost 0 before you undergo surgery?
00:38:28.000 –> 00:38:39.000
Yeah, so we need to do a setup as part of the goal of conservative management is to reduce the inflammation.
00:38:39.000 –> 00:39:04.000
Installing as far as possible but for patients, a lot of patients with secondary length, that email, we will not be realistic to actually get to 0 then for the. So we are going to work with you to get you optimize as best as possible for surgery.
00:39:04.000 –> 00:39:18.000
But certainly we can actually look at the survey once we’ve you know, yet as close as best as we possibly can.
00:39:18.000 –> 00:39:21.000
Sounds that and you can do your best as a prescription for life with MLD. Flat Meat.
00:39:21.000 –> 00:39:28.000
A liability of a friendly dive that doesn’t make the lipoedema go away.
00:39:28.000 –> 00:39:41.000
It usually progresses on the triggers of, and then the polls of children, etc., make it worse that you can try and maintain it.
00:39:41.000 –> 00:39:47.000
The next step is to actually remove all of that over a 6 to 12 month period.
00:39:47.000 –> 00:39:54.000
Sometimes a much earlier, quicker license will have that slowing reduce in the Linux.
00:39:54.000 –> 00:40:06.000
Do not have to deal with that that burnt, or in flying disease. Now, if you’ve had it for decades, this lipoedema and and you’ve got stage 4.
00:40:06.000 –> 00:40:16.000
You’ll have a significant reduction in paying it’ll increase in mobility, and your lymph, Fedex will be the best I can possibly be in the skin.
00:40:16.000 –> 00:40:32.000
They can possibly be by removing all of that fact. The bear in mind. The longer you leave this, the more impact it has on, and it can become irreversible.
00:40:32.000 –> 00:40:41.000
Okay, a couple of questions about the surgical protocol.
00:40:41.000 –> 00:40:47.000
Can can we talk about? How does your mythology, methodology?
00:40:47.000 –> 00:40:58.000
Sorry of lab removal, default, or compare to other specialists in Australia, and then just a couple of other questions, sort of on power with that.
00:40:58.000 –> 00:41:04.000
What is the maximum amount able to be removed in one surgery?
00:41:04.000 –> 00:41:12.000
Does it return? I’ll read them again. But does it return off the laptop section?
00:41:12.000 –> 00:41:40.000
And can you do both 4 legs at once? So just again, the first part of the question is, how does your surgical protocol differ from other specialists in Australia, and how much can you remove in one surgery?
00:41:40.000 –> 00:41:41.000
The protocol and the goal of the surgery.
00:41:41.000 –> 00:41:45.000
It’s very different to what’s available elsewhere.
00:41:45.000 –> 00:41:56.000
With the goal of this photocopy to remove all of the Microsoft teams issue so that a desktop grow back.
00:41:56.000 –> 00:42:10.000
That’s very different from some other approaches where they might look to scope, or because some of the the fatty tissue or Scott to create, which is completely not what we are about.
00:42:10.000 –> 00:42:14.000
Our approach is a very medical approach to remove it all.
00:42:14.000 –> 00:42:18.000
They having a background, invades and topology.
00:42:18.000 –> 00:42:33.000
We also have a very deep understanding of the website. The vessels that the block supply system of the lake and and part of utilizing that knowledge, we employ a very specific limited expiring approach that is very technical.
00:42:33.000 –> 00:42:46.000
And it’s very, particular in preventing any further damage.
00:42:46.000 –> 00:42:56.000
That’s not the location that has already top without stage for Michael, lipoedema, for how the ongoing information collected in my cost.
00:42:56.000 –> 00:43:21.000
So that cases can be well as possible and that makes sense that we do not damage we need to remove all of that fat as Doctor said, not a little bit.
00:43:21.000 –> 00:43:26.000
You’ve got normal skin and normal fat to remove all of the remaining facts.
00:43:26.000 –> 00:43:27.000
So it doesn’t keep growing back. Let’s see.
00:43:27.000 –> 00:43:33.000
I’m in the survey. So with that comes a stage approach.
00:43:33.000 –> 00:43:37.000
And in answer to the question, Can we remove the fact from all over?
00:43:37.000 –> 00:43:58.000
But all over the legs. The answer is, no, it wouldn’t be virtually rare. It’s when I’m doing revision surgeries for the patient.
00:43:58.000 –> 00:44:05.000
May be able to manage that, but it would be very rare for our overseas.
00:44:05.000 –> 00:44:10.000
People expression as rare as an instinct. It’s very unlikely that we could do it all in one hit.
00:44:10.000 –> 00:44:17.000
So even if you’ve got small amounts of light, it’s not so much the volume of the fact.
00:44:17.000 –> 00:44:19.000
That’s the limitation becomes a percentage body weight.
00:44:19.000 –> 00:44:22.000
Because we’re using anaesthetic fluid.
00:44:22.000 –> 00:44:27.000
And we were very closely with the nursing and the city team during surgery.
00:44:27.000 –> 00:44:28.000
Make sure that we go over those, and we keep it very safe.
00:44:28.000 –> 00:44:51.000
In fact, we’ve got a very conservative level that we have to make sure there’s no neurotoxicity or cardio toxicity, and where we have to cut a large area, we as a minimum, even if you have tiny amount of fact it’s 2 sages, low as if you’ve got
00:44:51.000 –> 00:44:58.000
more progression in the size. It might be 3 surges, so modern was, you know, a good decent case might be 4 to 5 litres. But it’s not what we’re looking for.
00:44:58.000 –> 00:45:09.000
The volume. It may, I mean in the.
00:45:09.000 –> 00:45:14.000
And and seeing some places that have had far more volume.
00:45:14.000 –> 00:45:25.000
Perhaps some of our previous social media. But that’s we’re we, we know we can do that based on percentage body weight, the bandaging the post operative course.
00:45:25.000 –> 00:45:26.000
And this is aligned with the protocol in Germany, with percentage, body weight and protocols with the solution.
00:45:26.000 –> 00:45:49.000
So, so it’s very carefully connected if we turn, you need 3 surgeries, and we’re pretty comfortable with that then it’ll be 3 surveys if you find a doctor who can spend 6 h do a little bit in on your legs in your tummy
00:45:49.000 –> 00:45:53.000
your arms. That’s what you prefer. One surgery, 6 h surgery!
00:45:53.000 –> 00:46:14.000
Go for it. It does not work, I’m telling you now that second opinions, if you want a large access skin removal, if that surgery, feeling that you need your access skin removed and some fat and then go for it. If that’s what you want in our experience that does not work.
00:46:14.000 –> 00:46:17.000
to arrest the lipoedema, because we keep seeing patients like this.
00:46:17.000 –> 00:46:27.000
We can perform surgery. We’ve had surgery before, and we very frequently do that with break here, plus these and 5 lifts, and sometimes more extensions.
00:46:27.000 –> 00:46:40.000
That’s the doctors protocol elsewhere. It’s not the one here, and it’s certainly not what we I’ve been trying to do formally in Germany.
00:46:40.000 –> 00:46:44.000
And then what we’ve been here. So every doctor that works with our protocol has got an eye for this condition.
00:46:44.000 –> 00:46:53.000
It’s not cosmetic approach and very strict protocol.
00:46:53.000 –> 00:46:58.000
Okay, great. Thank you. I just wanted to also remind everyone watching tonight that we don’t have too much longer left.
00:46:58.000 –> 00:47:12.000
Only 10 to 15 min, but if we don’t get to your question tonight, feel free to just pop it through on our Facebook or Instagram Page, and we’ll do our best to always get back to you.
00:47:12.000 –> 00:47:21.000
So the next question is, do you need to have general anesthetic, or can you be given a twilight for surgery?
00:47:21.000 –> 00:47:29.000
Sure. So the goal for our service is actually but keeping the patient very comfortable.
00:47:29.000 –> 00:47:34.000
And we can actually tweak the to make sure that.
00:47:34.000 –> 00:47:43.000
You’re, you know not going to feel like pain, you know, went to memories of the actual surgery.
00:47:43.000 –> 00:47:44.000
But for a lot of our surgeries the patients are actually talking so comfortable.
00:47:44.000 –> 00:47:53.000
Getting able to walk off the table and walk straight into the recovery room.
00:47:53.000 –> 00:48:01.000
So in answer to those patients who are absolutely mortify to be about being awake, you’d be asleep.
00:48:01.000 –> 00:48:18.000
And then at the end the drug will be turned off, and you walk out 99% of the time, because we want that early walking to avoid deepts, and then you’d be roaming around the world as you’re chatting to each other to keep those legs moving that’s the recovery
00:48:18.000 –> 00:48:25.000
that stuff instantly off the table for those patients who are mortified about going to sleep.
00:48:25.000 –> 00:48:41.000
Let me tell you, you can be polite for the whole procedure, and, in fact, one of the videos of the surgery for patients who undergo the the Admin information process leading up to a group.
00:48:41.000 –> 00:48:42.000
Zoom is the video where a patient you’re in operating theater with me.
00:48:42.000 –> 00:48:50.000
And you see a patient completely away. No pain comfortable today.
00:48:50.000 –> 00:48:52.000
I had out of my 4 patients, all 4 of them elected to be awake yesterday.
00:48:52.000 –> 00:49:02.000
All 5 of them for our surgeries. We did yesterday, Dr. Teo
00:49:02.000 –> 00:49:19.000
. I all elected to be away, and were amazed that they could be awake and enjoy all of those drugs that you’re not gonna find unless you go for a list of drug dealer, and it won’t be very safe and not recommended.
00:49:19.000 –> 00:49:24.000
But with the you can actually enjoy it drifting and out of sleep.
00:49:24.000 –> 00:49:33.000
That’s how we did it in Germany. But if you so worried about that in the city, call it a general anaesthetic, if you like, unless we do the arms.
00:49:33.000 –> 00:49:48.000
In most cases we might have what’s called a mass, where lemme where the working at the head in the uni status is that your foot end?
00:49:48.000 –> 00:49:58.000
And then they’d like to have all the controlled anesthetic equipment so they can trick you and not get in our way as as we’re working.
00:49:58.000 –> 00:49:59.000
But for the other cases, we don’t need to put.
00:49:59.000 –> 00:50:06.000
Tuesday, and it’s our typewriter. The recovery is very nice.
00:50:06.000 –> 00:50:10.000
Yup, okay. So we have a question, is recovery painful?
00:50:10.000 –> 00:50:17.000
And we’ll pain medication be required, and if so, for how long?
00:50:17.000 –> 00:50:22.000
So there will be a little bit of discount. That recovery.
00:50:22.000 –> 00:50:29.000
But most patients do recover very comfortably, but certainly in terms of paid medication.
00:50:29.000 –> 00:50:43.000
There will be in the overnight state that we access the pain medication, and certainly, when you’re distrusted with an update, there will be scripts provided for in medication estimated.
00:50:43.000 –> 00:50:55.000
Yeah, I’m smiling because I know the next time we do a group zoom, we’re gonna have all the collective wisdom of all of our past patients chiming in and answering that question.
00:50:55.000 –> 00:50:59.000
Look, there’s no difference. We’ve had decades of this disease.
00:50:59.000 –> 00:51:02.000
We wanted all that consistently. Patients go to recovery.
00:51:02.000 –> 00:51:08.000
They’re given drugs in recovery by about 6 Pm.
00:51:08.000 –> 00:51:18.000
That night. Those drugs are no more, and really what they go beyond 100’clock patients go home with Panadol and Europe, and that’s what we tell them to do.
00:51:18.000 –> 00:51:24.000
We don’t want to constip it on heavier drugs, and I’d say most of the time patients manage that.
00:51:24.000 –> 00:51:38.000
If you build a lot of information and a lot of disease, you’ve been lugging around and capturing, and you’ve got a lot of co-orbidity that are on mute, you may have more pain, and we can merch you.
00:51:38.000 –> 00:51:45.000
With that. And it’s not very common that license need to take the stronger plain with in their recovery.
00:51:45.000 –> 00:51:50.000
It’s more uncommon. But let me tell you, the lower legs are more uncomfortable.
00:51:50.000 –> 00:51:59.000
About 5 to 7 days, curiously, the size the politics add so much that every patient is so different.
00:51:59.000 –> 00:52:01.000
So if you get to reach out to one of the group chats and ask questions, you get answers very quickly.
00:52:01.000 –> 00:52:14.000
There’s been about a 1,000 patients before you, and and it would be very rare that the pain control is not there. Walking.
00:52:14.000 –> 00:52:19.000
Get out of the hospital the next morning. You walk everywhere. We encourage it. That’s good.
00:52:19.000 –> 00:52:30.000
Compression is good, and and facilities with the pain.
00:52:30.000 –> 00:52:31.000
Okay, so how long would it take until you could expect to return to physical activity? Post?
00:52:31.000 –> 00:52:41.000
Surgery, such as running or swimming.
00:52:41.000 –> 00:52:46.000
So let’s say, you know, with most patients, actually find that around the week 4 to week 5 is when they tend to feel like they’re back to normal.
00:52:46.000 –> 00:53:14.000
When they’ve recovered pretty much from the surgery, but with any heavy physical activity like running or in pack activity, we’re gonna ask you to take it easy enough for a so you’re gonna have a bit of a drop of your email for very young active people.
00:53:14.000 –> 00:53:24.000
That aren’t affected by lightheadedness. So a lot of the patients do have parts, and and you know, from the tech economy and they’re all things that make it easy.
00:53:24.000 –> 00:53:39.000
Most of you have a stenos syndrome as well. Your skin and Fedex and your microsoirculation is not quite normal.
00:53:39.000 –> 00:53:40.000
But most patients, we say that we you could AIM to get back to lighter work within 2 weeks.
00:53:40.000 –> 00:53:53.000
Now there’s a practical consideration. Do you feel sorry to drive at that point both from a comfort point of view?
00:53:53.000 –> 00:53:54.000
Your head space over about 4 weeks your blood will get back to normal.
00:53:54.000 –> 00:54:01.000
So it’s unlikely we need to give you a top of any blocks.
00:54:01.000 –> 00:54:02.000
It’s gonna be your own internal process that’ll enable you.
00:54:02.000 –> 00:54:07.000
Now every patient is different. I’ve had patients that I honestly don’t know why they do sometimes.
00:54:07.000 –> 00:54:18.000
What they do. I have one place in walk, 2 kilometers.
00:54:18.000 –> 00:54:27.000
3 days after a surgery, while the husband was driving up the esplanade of the Gold Coast, enjoying the view, she decided to walk to a Dvt.
00:54:27.000 –> 00:54:35.000
Check the names, Carrie. She’s been a case study, she’s had about 30 leaders removed, and that’s one extreme.
00:54:35.000 –> 00:54:39.000
I had a doctor’s wife who had surgery with us.
00:54:39.000 –> 00:54:45.000
One of our teams, doctors, wives, and she is a crazy Marathon runner.
00:54:45.000 –> 00:54:55.000
A day chain. She started running 10 kilometers a day, I don’t know why anyone would want to run to start with, let alone that quickly.
00:54:55.000 –> 00:55:02.000
That quickly after service. So all places!
00:55:02.000 –> 00:55:10.000
Yeah, absolutely, everyone’s different. So with patients need psychological support before or after surgery.
00:55:10.000 –> 00:55:15.000
You mind me? I’m answering this. The answer is, we always ask about psychological states.
00:55:15.000 –> 00:55:37.000
The counselors, the psychiatrist. They passed history of eating disorders, anxiety, depression is very, very common, and we really urge patients to get and connect with that member of the tribe.
00:55:37.000 –> 00:55:40.000
Now that they have a diagnosis of lipoedema really does help for those patients who have got some other serious psychological conditions.
00:55:40.000 –> 00:55:49.000
We’ve done surgeries for patients that have self harmed in the past.
00:55:49.000 –> 00:56:01.000
I have had some serious psychological and psychiatric conditions, and we’re closely with the psychiatrists regarding that.
00:56:01.000 –> 00:56:12.000
And we’ve had to today amazing results for these patients who have been so triggered about their disease at a very early age.
00:56:12.000 –> 00:56:18.000
We have, stepping all of that up, we got some really exciting stuff we’re doing at the moment in that space and it’s going to revolve around research as well.
00:56:18.000 –> 00:56:29.000
So keep keep posted there.
00:56:29.000 –> 00:56:33.000
Absolutely. Okay. So we just have time for a couple more questions this evening.
00:56:33.000 –> 00:56:40.000
And I lovely marketing manager. Sarah has just reminded me that if we don’t get to every question which we probably won’t, we’ll be able to post that on our website.
00:56:40.000 –> 00:56:56.000
Replay, so everyone will receive an email link as well as notification on Facebook that the recording is posted and your question is there answered in the FAQ.
00:56:56.000 –> 00:57:16.000
Section. Okay, so couple of questions around skin, what would your recommendation be if we do have a significant amount of access skin in addition to our lipoedema?
00:57:16.000 –> 00:57:25.000
So the plastic surge is that we work very closely with actually preferred to to work on a clean slate.
00:57:25.000 –> 00:57:44.000
Essentially, they want us to move all of the live events, issue, give the skin every chance to retract, and then, if the patients don’t need any skin reduction survey, that’s where they will come in in our experience, we we find that the low webex, the skin we tracks really nicely after so we’ve never had
00:57:44.000 –> 00:57:54.000
a patient any skin we don’t, Thomas, and the birthday region.
00:57:54.000 –> 00:58:07.000
You might have a bit of a skin, and unfortunately, one of the things that’s commonly associated with my lipoedema is a weaker collagen or elderly syndrome for 40 stations.
00:58:07.000 –> 00:58:18.000
If you go to the best strategy we can, we would recommend is actually getting the live giving a good 12 months.
00:58:18.000 –> 00:58:30.000
Given, the skin every transfer, your check and recover, and then, if you need a bit of skip, the skin works done, we do have really good plastic surgeons that we could have.
00:58:30.000 –> 00:58:39.000
Everybody wants. So, as Nick said below the knee cap down, it would be very unusual for you not to have something that looks like normal.
00:58:39.000 –> 00:58:43.000
Normally, above the kneecap. There may be a fold where you’ve already got underneath a bursa and fixed skin, and then we remove the fat.
00:58:43.000 –> 00:58:59.000
We’re very conscious to make sure that you can see your knee and and experience removal of all of that locked diva.
00:58:59.000 –> 00:59:03.000
So it doesn’t keep growing, and we sometimes blown away.
00:59:03.000 –> 00:59:04.000
Just how much older patients shrink their skin, or maybe just a little bit of tight.
00:59:04.000 –> 00:59:11.000
They have, patience, says doctor said we would go through the journey.
00:59:11.000 –> 00:59:17.000
Would do the legs. We do the arms. Sometimes it’s stuck.
00:59:17.000 –> 00:59:28.000
In the afternoon. We do. We’re asked to remove that as well by the cosmetic and plastic surgeons in the techniques that we use a lot of doctors use.
00:59:28.000 –> 00:59:48.000
Wall, by the way, throughout the world, thousands of them. But the technique of how we use it to remove all of that from the ankle all the way to the to the from the waste all the way to the ankles from the all the way down to the arms with minimally invited techniques and then
00:59:48.000 –> 00:59:57.000
let the scheme and the lymphatic fields the best as they can, and there are times patients will need skin work, and we’ve got very good doctors that work closely with us.
00:59:57.000 –> 01:00:06.000
To remove the scheme, but that we’d like to get through that and around the 9 12 month.
01:00:06.000 –> 01:00:25.000
Just see how strings check with scans. Make sure there’s nothing untoward with any bodies, and then be able to put a very nice straight forward, live deeper, free approach for the surgeons who want to.
01:00:25.000 –> 01:00:27.000
Okay.
01:00:27.000 –> 01:00:37.000
Okay, great. So we’ll just end with one final question, a 2 part question about post surgery.
01:00:37.000 –> 01:00:42.000
Again is conservative management and compression still required.
01:00:42.000 –> 01:00:55.000
Post-surgery, and then second part of the question, if I live by myself, will I need someone to stay with me after surgery?
01:00:55.000 –> 01:01:01.000
So after surgery, it says, part of this booklet that you’d be given.
01:01:01.000 –> 01:01:03.000
The contraction will be required to help with reducing inflammation and solving, and just helping you.
01:01:03.000 –> 01:01:11.000
In fact, actually recover with regards to the actual pool surgical process.
01:01:11.000 –> 01:01:32.000
Yes, in the first week, particularly off the subject. We do recommend that you have someone here to help support you, so help look out for you just so that you have that little bit of extra backup.
01:01:32.000 –> 01:01:43.000
Actually, it’s more than a recommendation. If you do not have a camera with you when you get discharged, that’s against the Queensland Health licensing requirements.
01:01:43.000 –> 01:01:50.000
So!
01:01:50.000 –> 01:01:51.000
Organized. It makes a lot of sense. You’ll be able to walk.
01:01:51.000 –> 01:02:09.000
You’ll be able to have baby box. We recommend that, but you need to have a an adult over 80 staying with you to be able to obviously go home the next day and come back. Go to your MLD.
01:02:09.000 –> 01:02:17.000
Appointments. Go to your come back to to the hospital, and yes, we will need a compression.
01:02:17.000 –> 01:02:36.000
I tell patients usually 6 to 12 months expected your lymph, Fedex, if you’ve had lipoedema for a very long time, you won’t be required to wear your flat needs for the rest of your life, but you may need some compression time to time, if you really clap out.
01:02:36.000 –> 01:02:41.000
To lymph Fedex. You won’t have the plan.
01:02:41.000 –> 01:03:00.000
You have the ability. But for younger patients and those patients who get onto the journey earlier, the the ability to preserve, you know, been Fedex, by not having this lifetime of lipoedema
growing and getting worse is an opportunity to remove it.
01:03:00.000 –> 01:03:14.000
Go through the healing process, and then long term, and that freedom which also includes the freedom of having all that conservative management every single day.
01:03:14.000 –> 01:03:20.000
Yeah, absolutely. Okay. Well, thank you very much for your time tonight.
01:03:20.000 –> 01:03:31.000
Talk to, and doctors here, and just a reminder if we didn’t get to your question tonight that we will be posting the questions on our website recording.
01:03:31.000 –> 01:03:39.000
And we email everyone as well as pring to our social media pages when that’s live and ready, just take a couple of days for us to get through them.
01:03:39.000 –> 01:03:40.000
I’m sure. But yes, thank you very much to you both, and to everyone who joined us tonight.
01:03:40.000 –> 01:03:54.000
We’re on the goal coast, and especially to everyone who joined us from outside of Australia and from everywhere else within Australia.
01:03:54.000 –> 01:03:55.000
Thank you.
01:03:55.000 –> 01:04:02.000
Thank you very much, Emily, and thank you very much.
01:04:02.000 –> 01:04:13.000
Okay. So I haven’t she’s but yes, the popularity.
01:04:13.000 –> 01:04:20.000
She’s very, very much keeping a soundtrack by putting up signs and and steering. As far as you know.
01:04:20.000 –> 01:04:23.000
Thank you very much for the opportunity to share this time with you.
01:04:23.000 –> 01:04:35.000
I think our questions are getting really on point. It sounds like community is getting very educated, and, thanks to all the good work you team do as well to help our patients with the journey.
01:04:35.000 –> 01:04:36.000
Thank you. Thank you.
01:04:36.000 –> 01:04:41.000
Be awareness of growing. Thank you.