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

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

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

4. 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

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

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

8. Photo Comparison
2009
2019

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

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

11. Questions