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Obesity and Lymphedema

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.

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Obesity and Lymphedema

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  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 • 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

  6. Treatment History • 2015-2016 • 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

  7. Photo Comparison 2009 2019

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

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

  10. Questions

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