Obesity and Lymphedema

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Presentation transcript:

Obesity and Lymphedema Case Study Jillian Caster DPT, CWS, CLT AHN Wound Conference

The Relationship BMI >30 increased risk of lymphedema following surgery BMI >50 increased risk of developing lymphedema independently Does reducing BMI reduce lymphedema??

Patient BC Demographics 53 year old African American female Married 10+ year Hx stage III uncontrolled abdominal and bilateral LE lymphedema R >L

Past Medical History PMH: Morbid obesity, DVT, HTN, PE, sleep apnea, kidney stones, cellulitis, thyroid disease, parathyroidectomy, anemia, abdominal abscesses with I&D, greenfield filter placement and removal, gastric bypass, cystoscopy, lymphedema Medication: Warfarin, albuterol sulfate, ferrous sulfate, furosemide, multivitamin, oxycodone-acetaminophen, omeprazole, vitamin B-12, Vitamin D3

Treatment History 2007-2008 2009-2015 Attempted admission for CDT Diuretics Weight: 516 BMI: 78.5 R LE volume 18745 cm3 2009-2015 Bariatric weight loss program Non-adherence Weight 605 BMI: 90.2 R LE volume 32029 cm3

Treatment History 2015-2016 2016-2019 Bariatric Weight loss program Gastric bypass surgery 2016 Weight 445 BMI: 67.7 R LE volume: Unknown 2016-2019 Bariatric weight loss program Walking Compression bandaging Weight 314 BMI: 47.7 R LE volume: 8606 cm3

Photo Comparison 2009 2019

Weight loss & CDT Weight loss CDT Reduced fluid volume Reduced compression of vessels Reduced inflammatory environment Manual mobilization of volume External compression Muscle pump

Recommendation Weight loss Referral to CLT Bariatric weight loss center Endocrinologist Referral to CLT Compression bandaging Manual lymphatic drainage Therapeutic exercise program Skin care

Questions