Issue link: https://www.massageandbodyworkdigital.com/i/1315831
40 m a s s a g e & b o d y wo r k j a n u a r y/ fe b r u a r y 2 0 2 1 extend into the hands, so the wrists may appear to be cuffed. This condition also has a characteristic texture: it begins as tiny palpable subcutaneous nodules, like grit or grains of sand. These fatty deposits then grow to be pea-sized, and eventually much larger. The development of thick, dense connective tissue around and between the fatty growths contribute to the pebbly appearance. The nodules bruise easily, they often have spider veins, and they hurt—with palpation and without it. The accumulation of abnormal, painful fat deposits in the limbs is just one aspect of lipedema. Swelling is common, although pitting edema is not. Hot weather and exercise exacerbate swelling, which is persistent even when the legs are elevated. Enlarged legs can cause problems with knee arthritis, overpronation and foot pain, gait changes, and ultimately the loss of ambulation. People with lipedema are prone to eating disorders that can become dangerous and even life threatening. Advanced lipedema may complicate into lymphedema (now called lipo-lymphedema) and its accompanying risks of skin damage and infection. But beyond that, consider the whole- person consequences of having ever- enlarging fat deposits that don't change, no matter what you do. Difficulties with movement and sedentariness slow metabolism even further, compounding the overlap between obesity and lipedema. It may become impossible to travel on public transit, sit in public settings, or use public toilets. Problems with mobility, finding comfortable clothing, and fear of judgment can keep people isolated, which is likewise detrimental to overall health. Self-care becomes increasingly challenging, as the logistics of bathing, dressing, and getting around the house can be overwhelming. Depression and anxiety contribute to the vicious cycle of self-loathing and fear of going out. Without good care and a strong support system, lipedema can be a debilitating, life-shortening disease. TREATMENT The treatment goals for lipedema are consistent across disciplines: reduce or eliminate inflammation, swelling, and pain; improve lymphatic function; and expand the patient's overall quality of life with physical, mental, and emotional support. Interventions may be noninvasive or highly invasive, depending on the stage at which treatment begins and the needs of the patient. Noninvasive interventions begin with gentle exercise to use leg muscles to pump lymph and improve venous flow. Many patients find that swimming and other water-based exercise is pleasurable and pain free. A low-carbohydrate eating plan is recommended to keep obesity from developing or becoming worse. Skin care is important to manage infection risk, especially if lymphedema has developed. And decongestive therapy is emphasized, with compression garments, pneumatic compression pumps, manual lymphatic drainage, and wrapping. Specialists also recommend skilled psychological care to address some of the many emotional issues that lipedema can cause and reinforce. If these interventions are not adequate, then lipedema patients may pursue surgical interventions: liposuction and/or lipectomy. The liposuction techniques used for lipedema are different than those used for cosmetic surgery. In addition to removing fat (although it is impossible to separate normal fat from lipedema fat), it uses low concentrations of analgesic that can offer symptomatic relief. These procedures involve multiple surgeries, and skillful massage is often recommended during recovery. The purpose of liposuction for these patients is not to sculpt the legs into a more "normal" appearance, but to improve function to restore or maintain mobility. If liposuction is not adequate, then lipectomy—the surgical removal of some fat deposits—may be recommended. Again, this is not to improve physical appearance; it's to help manage the disease so that the person may be able to restore some quality of life. The ABMP Podcast Episode 32: Lipedema— "I Have a Client Who . . ." Pathology Conversations with Ruth Werner I had been aware of lipedema as a concept before undertaking this article, but a conversation with a massage therapist led me to make this podcast (abmp. com/podcasts/ep-32-lipedema- i-have-client-who-pathology- conversations-ruth-werner), which introduced me to a whole new way of understanding this complex, confounding condition. I would like to offer my thanks to three people who helped immensely with this article, and who also provided the quotations: the client who is described in the podcast; Megan Belanger, a massage therapist in Massachusetts who shared some of her experiences with me; and Kathleen Lisson, an expert on this topic, who pointed me to many excellent resources, including her own book on the topic. Many thanks to you all, ladies; I hope many will be enriched by your generosity. THE ABMP PODCAST SPEAKING WITH THE MASSAGE & BODYWORK PROFESSION