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Lipedema and lymphedema in the gynecological practice The best medicine: lymphatic drainage, compression and swimming

Issue 02/2019

Tension and tenderness in the arms and legs, differences in circumference in the extremities – in her gynecological practice with an oncology specialization, Dr. med. Birgit Ruhmland regularly sees patients with lipedema and lymphedema. In these cases, she needs to listen, educate and motivate those affected to participate in compression therapy.

“Lipedema is generally still given too little consideration. We should be more attentive here as physicians.”

Dr. med. Birgit Ruhmland

What is the proportion of patients with lymphedema in your practice on Elsterwerdaer Platz in Berlin-Hellersdorf, Germany? This question is not at all easy for Dr. Birgit Ruhmland to answer. “If, for example, you assume a lymphedema caused by breast cancer and the classic definition of a difference in circumference of at least two centimeters, then the numbers are relatively low. But if you include patients with clinical symptoms such as abnormal sensation, pain and mild congestion, then I would increase the proportion in the first two years after surgery to around 40 percent ,” explains the specialist for gynecology and obstetrics, who also performs operations herself. A great deal has happened in the area of lymphedema after breast surgery over the past few decades, however. “There used to be significantly more lymphedema, often with massive fibrosis, because surgery was simply performed very differently. Through sentinel lymph node dissection alone, we now have far less arm lymphedema,” Dr. Ruhmland emphasizes. Lymphedema in the legs as a result of gynecological carcinoma are much more common in her gynecological practice with oncology specialization. “Surgery is more extensive there generally. We often deal with very large and highly burdensome lymphedema, some of which massively impairs the affected person’s ability to move.”

For Dr. med. Birgit Ruhmland, early therapy consisting of lymphatic drainage and compression stockings is paramount in the treatment of lymphedema.
For Dr. med. Birgit Ruhmland, early therapy consisting of lymphatic drainage and compression stockings is paramount in the treatment of lymphedema.

Early treatment is crucial

Most edema patients report sensations of pressure, tension, sometimes pain and restricted movement. Many oncology patients are also simply afraid that a tumor is the cause of the symptoms again. “Although I can usually already see at a glance that it is ‘only’ lymphedema, we then carry out a thorough diagnosis to ensure that nothing is overlooked and to reassure the patient – and then generally follow this up with lymphatic drainage and appropriate compression stockings,” Dr. Ruhmland explains. The condition then improves quite fast , and then patients are relieved. In patients with lymphedema, in particular, it is paramount to begin appropriate therapy as early as possible, to prevent the condition from progressing.

Lipedema: still an overly
neglected condition

In addition to predominantly secondary lymphedema, the specialist also sees a small number of patients with lipedema in her practice. In the case of lipedema, Dr. Ruhmland particularly recommends postoperative compression after liposuction. “We could certainly achieve more if liposuction were carried out more often in young women – but that’s a political problem,” the specialist says regretfully. Lipedema is not only a significant burden for the person affected, but can also become lipo-lymphedema if left untreated. “Lipedema is generally still given too little consideration. Especially young women with lipedema are often simply dismissed as being a bit overweight. We should be more attentive here as physicians and ensure that we take the time to speak about constitution, family predispositions and symptoms,” she demands.

Wear compression clothing consistently

Discussions with edema patients are particularly important. The women primarily require a great deal of attention, Dr. Ruhmland describes. “Additionally, the importance of compression therapy also has to be explained repeatedly. In the case of lymphedema, compression is of the utmost importance, often for a lifetime.” For most edema patients, the level of suffering is so high that they wear the stockings out of self-interest because they notice considerable relief. “But if someone doesn’t want this treatment and doesn’t wear the compression stockings, then lymphatic drainage makes no sense. I make that very clear to my patients,” Dr. Ruhmland says.
Overall , compliance has improved noticeably over the years, not least because the medical compression stockings have also improved with regard to the wearing comfort. “And it is really cool what colors are now available! Nevertheless, patient compliance is still a problem sometimes. The patients notice, of course, that their complaints increase, that it is painful or that it is more difficult to put their shoes on if they don’t wear the stockings. All the same, not everyone is consistent ,” Dr. Ruhmland says regretfully. At this point , she therefore also appeals to the therapists to not let their patients leave the office without stockings after lymphatic drainage.

Expertise at the medical retailer

With regard to customized treatment using compression stockings, good communication with the medical supply retailers is particularly important to her, the specialist emphasizes. “I also have a look at what has been supplied. If I notice that something doesn’t fit right , I send the patients back to the medical supply retailer. But that is generally not necessary, as the specialized employees at the medical supply retailers are usually very competent and experienced in that regard.”
And what other advice does she give her patients to support treatment? “Movement. Swimming, in particular. Swimming is the best medicine. When they move in the water, that acts almost like lymphatic drainage,” the gynecologist recommends. “Compression and movement are simply the foundation in the treatment of lipedema and lymphedema.”

 

Images: Anika Büssemeier


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