1 September 2020

Creating a treatment plan for Lipoedema

What comes first?

Listening. That's what comes first. So many women with Lipoedema have never been heard - by the medical fraternity, their families/partners or their friends.

Sometimes, being able to tell your story, the whole story, is the beginning of a slow process of healing and learning to love and accept yourself. Having your feelings acknowledged, efforts validated and questions answered is powerfully important. You have NOT imagined things, you DO have a medical condition.

How do I create a treatment plan for Lipoedema?

Compression

Once I've listened to your story and found out all the different things you've tried over the years, I start to make suggestions to feel out what will work and what won't. There's no point me suggesting you rush out and get Class 2, custom-made, flat-knit pantyhose if you've never worn compression before. That is just too overwhelming (and expensive). This is quite often what surgeons recommend in their first consult.

Instead, I suggest a more gentle approach to compression - because, guess what, compression is a very important part of the process. But let's start with low compression and work our way up to the good stuff.

There are a number of products on the market to try in the early stages of diagnosis. Personally, I'm a fan of Bioflects. Technically, they are lymph-stimulating stockings rather than graded medical compression. Here's a photo of me rocking mine in the middle of January when it was really hot and humid and my legs weren't coping ...

Rocking my Bioflects in the middle of summer

Another two good brands to try are CzSalus and 2XU. And if those are too much (compression or expense-wise) then you can always start with sports compression from places like Target, Big W or Aldi. Light compression is better than no compression at all.

If you've already dabbled in the compression world and are ready for stronger stuff then there are a few options. I send my clients to a couple of different places who deal just with compression - you go in, get measured and in 99% of cases, walk away with your stockings. In Sydney I send people to either Cosmac, who have a range of brands, or Garnet Medical who stock the full range of Sigvaris products. For custom-made stockings in Sydney I recommend OAPL

Compression pumps

These are hugely beneficial and give you a lot of control. They have come a long way since I trained and we were warned to stay away from them. Now they are designed brilliantly to help improve your lymphatic system as well as break down fibrosis.

There are two main brands I recommend. Firstly, the Medi-Rent pumps - for Lipoedema I use the Biopants. Initially Medi-Rent just had the LX9, which is also an excellent machine, but the newer Biopants include the abdomen and for Lipoedema this is very beneficial. There are cases where the LX9 is the better option and this is why speaking with a therapist is a good idea. The fab thing about Medi-Rent is their rent-to-buy programme - hire the pump for three months and if you don't like it, you can send it back. If you love it, you can purchase it and they take the three months' rental off the purchase price.

Here I am trying out the Biopants at a Medi-Rent workshop

The second option is the Lympha Pants from OAPL. Another excellent machine which includes the abdomen. Unfortunately, OAPL doesn't have the rent to buy option but you can ask them for a short trial to see if it works for you.

Exercise

Yes! Whatever floats your boat. There's no point me telling you to get into the water - the absolute best thing you can do for your Lipoedema by the way - if there's no way you're going to put swimmers on and be seen in public. If the reaction to that suggestion is horror then I move on.

Walking. Fab. Walking in water even better - oops, promise I won't mention the water again. Rebounding. Fab. That's jumping/moving/dancing on one of those mini-trampolines - as much as your joints/bladder can cope with, you don't have to go nuts. Stationary bikes; Zumba; dance; yoga; tai chi; pilates; cardio class at gym; running (if you don't have any pain associated). Seriously, any exercise you enjoy and will do regularly.

Diet ... or as I prefer to call it, way of eating

I try not to focus on this aspect to be honest. Usually by the time someone gets to me they've tried a million different ways of eating and either nothing works or they've found something they are happy to stick with. Keto is something that is recommended by some of the surgeons and lots of the lippy ladies out there. If Keto works for you, go for it. Like exercise, it's finding something that you will stick to. There's LCHF, HCLF, carnivore, the Mediterranean diet, anti-inflammatory diet - you name it. It's all out there.

My advice in this first appointment? Eat real food. Eat the rainbow. Avoid all processed food.

And if they want more help finding a way of eating which works for them I refer them on to a local clinical nutritionist who also has Lipoedema.

Treatment

There's not usually a lot of time left over for treatment in the first session but I always aim to get at least twenty minutes or so, so that new clients can experience what manual lymphatic drainage feels like. I may also use the LX9 on one leg while I work on the other, so that they can experience what the pump feels like before they order one.

Homework

Everyone, and I mean everyone, leaves with homework. Because the more you do for yourself the better. I have the homework in written, diagram and video format so that there is no excuse.

Homework - opening nodes, breathing, dry brushing

So. What questions do you. have? There's more I can say but in a first appointment this is about as much as a new client can digest.

What other topics would you like me to cover?

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