Linda-Anne Kahn CIDESCO HHP CLT-LANA NCTMB, CMT, CHNC is an Internationally trained Lymphedema Therapist, Clinical Aromatherapist, Integrative Health Coach and Board-Certified Massage Therapist with over 30 years of experience. She has specialized in the treatment of Dercum’s Disease and Lipedema for more than 25 years.
Good news – we now have a Standard of Care (SOC) for Lipedema, which will help lipedema patients receive proper diagnosis and treatment. Awareness of lipedema among physicians and practitioners is poor and often nonexistent. Patients often go most of their lives suffering, not knowing what is wrong with them and not receiving the appropriate therapy. These standards will help.
As background, a committee of expert lipedema specialists, including vascular surgeons, plastic surgeons, researchers and certified lymphedema therapists, gathered at the Fat Disorders Resource Society Annual Meeting in 2019 to review the literature and develop consensus SOC guidelines for lipedema. The consensus document details lipedema pathophysiology and medical, surgical, vascular, and other therapeutic recommendations, in addition to selfcare, compression and nutrition.
As a reminder, Lipedema is a fat disorder involving the loose connective tissue, appearing primarily in women (read more about the condition). Non-lipedema obesity, lymphedema, venous disease, and hypermobile joints are comorbidities. Medical professionals perform a clinical exam with diagnostic criteria to help guide the clinical diagnosis of the disease.
For purpose of this blog, we will focus on the findings for compression needs for lipedema patients, as part of the new SOC. Lipedema fat can be painful. Compression stockings for lipedema should provide comfort and reduce pain by supporting the tissues. Compression needs vary depending on patient presentation, pain and physical ability to don/doff garments or compression bandages.
Manufacturers, like Juzo offer “off the shelf” sized garments, as well as made-to-measure (or custom), which Juzo knits based on the patient’s specific measurements (view compression garment options). Patients can also wear athletic garments (such as bike shorts) and body shaper or shape wear products, in conjunction with compression stockings.
Per the new SOC, the therapist or fitter needs to carefully select the correct compression garments, depending on the lipedema stage and size of the patient. If there are many lobules or deep skin folds present, it may be necessary to combine types of compression therapy. The patient may need to be fitted for an adjustable short stretch compression wrap for the thighs or high waisted Capri-style shorts combined with a lower leg garment or knee high. It is important to check that the garment fits well and does not cut into tissues, especially at the ankles and knees.
Selection of compression styles, fabric and strength should be individualized for the patient. Fabrics range in containment, depending on the stage of the lipedema (learn more about compression garment types). Multilayer, short-stretch compression wraps may be used to contain fluid and may be helpful for painful limbs, as the level of pressure can be adjusted.
Finding the correct garment
A trained fitter or lymphedema therapist should measure for compression stockings and adjustable compression wraps. Care must be made to select the most appropriate type and strength of garment. Special attention should be made to see that the patient can don and doff the garments with ease and the patient needs to be instructed how take care of the garments.
The compression class level shall be chosen according to the lipedema stage and patient tolerance. Lipo-lymphedema patients will need a flat knit garment with a higher compression class for the strongest containment and will need to have compression on the feet.
If pain increases with compression, the compression class level may be decreased, or garments layered. Once the tissue has been decongested with lymph massage - compression garments will more easily be tolerated and will feel more comfortable. If there is increased pain, numbness or pins and needles, the garment may be too tight and may need to be adjusted.
It is important to have team work and communication between the fitter and the therapist for the best outcome for the patients.
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