“All edema is lymphedema” is one of the new things I learned partnering with BC Cancer to present on lymphedema at the BC Cancer summit on November 20, 2025.  The topic was expanding access to lymphedema care with topics of:

• Lymphedema assessment and medical management

• Head and neck lymphedema treatment

• Upper and lower extremity lymphedema treatment

• Development of handouts for self-measuring arms and legs at risk of developing lymphedema. (This is available on our website here: 

• BCLA and BC Cancer goals for lymphedema care.

 Presenters from BC Cancer included:

Dr. Lauren Capozzi, MD, PhD, Cancer Physiatrist – Kelowna

Lisa Kuhn, Speech Language Pathologist (SLP) – Victoria

Stefanie Del Gobbo, Sarah Budding Smith – Physiotherapists – Vancouver

Both Christine Chandler and myself shared our patient stories and what BCLA offers.

We are currently in the planning stages for the May 8^th, 2026 Lymphedema Education Day for professionals where you can learn more about  what was presented at the BC Cancer Summit.

BC Cancer and BCLA share the same goals for improving lymphedema care in BC and it will be an exciting year ahead to see progress in the following areas:

• Provision of online tools and protocols for practitioners and lymphedema patients

• Standardized practitioner training in lymphedema

• Early diagnosis of lymphedema

• Pre-screening and measuring of both limbs prior to surgery and post treatment follow up

• Patient education for self-management once diagnosed. 

Interestingly at lunch, we met the BC Cancer librarian from Victoria, Lorraine Leitz, who shared with us how to search the BC Cancer library site to find information on Lymphedema as they have great resources to share.  

In checking out their site, I also came across a link to all the clinical trials underway for lymphedema – lots of great information.  

To find the current pre-screening measurement tools as well as links to research, check out our Resources\Health Professional Resources page on our website.

Of course, at BC Lymphedema Association, we will continue to advocate for those affected by lymphedema that have not had cancer.

Selected Research Highlights from ILF-CLF Niagara Falls 2025

Written by: Lyn Anglin

The International Lymphoedema Foundation/Canadian Lymphedema Foundation Conference (ILF/CLF) in Niagara Falls included a number of keynote talks and extended abstract sessions on various aspects of lymphedema research.  

A lot of exciting and encouraging research results were presented. I have highlighted a few here that really resonated with me because they indicate that those of us with lymphedema should not lose hope that new treatments may some day be available. In addition, a number of presentations on early diagnosis protocols also give me hope that new Standards of Care, especially for cancer patients at high risk of developing lymphedema from cancer treatment, are available to help catch lymphedema at very early stages, which can lead to early intervention which can reduce and sometimes possibly even prevent, the development of lymphedema. Now, we just need to get those Standars of Care adopted and supported in our health care system!

The first keynote lecture on opening day was presented by Dr. Wei F. Chen, titled “Supermicrosurgical Treatment of Alzheimer’s Disease, aka Brain Lymphedema – Is it a Clinical Reality?” Dr Chen presented on observations of some Alzheimer’s as a sort of primary “lymphedema of the brain” and the possible cause-effect between brain lymphatics and Alzheimer’s replicated in animals. He showed a video of the very positive impacts of lymphatic supermicrosurgery done by a Chinese colleague on an 84-year old male bedridden Alzheimer’s patient in China. He also referred us to his talk at AARS 2023 “Rewiring the Brain – Next 100 years in Plastic Surgery”. He noted that their research findings are preliminary and they are continuing their study, but he was quite optimistic about the potential for lymphatic reconstruction for treating some brain disorders. Here is a link to a related 2024 publication: Rewiring the Brain: The Next Frontier in Supermicrosurgery - PubMed which includes the video he showed in his talk.

On the second day of the conference, Dr. Stanley Rockson gave the first keynote talk of the day, titled “The Search for a Drug for Human Lymphedema”. He gave a great update on his “ongoing quest to develop a pharmacological treatment for human lymphedema”. He noted that some of his past research trials had to be redirected, but he also presented some very positive results of his recent studies. The results indicate the potential to reverse some of the effects of lymphedema in mice, and in preliminary trials on human subjects he is seeing significant reduction in limb volume over time. 

Another very interesting presentation on potential drug treatment was given by graduate student Frederik Gulmark Hansen from Odense University Hospital in Denmark. Titled “Advancing Pharmacological Treatment for Breast Cancer-Related Lymphedema: An overview and perspectives from Clinical Studies on Topical Tacrolimus”, this talk presented the results of two clinical studies that are investigating the potential therapeutic role of a drug called Tacrolimus in treating breast cancer-related lymphedema (BCRL). Early-phase clinical trials indicated that topical Tacrolimus (a drug that is presently used in treating skin conditions like eczema) “reduces inflammation, enhances lymphatic function, and mitigates fibrosis but also exerts a preventative effect on lymphedema development”, “though long-term efficacy remains to be established”. They are continuing their research with an ongoing randomized controlled trial which aims to confirm their study results to-date. I am going to stay tuned for publications of their results! 

On the third day of the conference, one of the session I attended was titled "From Assessment to Action – Innovation in BCRL Diagnosis and Management”. This was a great session, with several excellent presentations on early diagnosis and measurement techniques for lymphedema. 

Cheryl Brunelle, Massachusetts General Hospital gave a presentation titled “Agreement of Breast Cancer-Related Lymphedema Diagnosis Across Commonly Utilized Diagnostic Criteria: A Cross-Sectional Observational Cohort Study.” She noted that the “lack of standardized diagnostic criteria for … BCRL has been a longstanding impediment to research studies and clinical practice. Her research looked at analyzing BCRL diagnostics and undertook to “determine which diagnostic threshold diagnoses BCRL most frequently” and compare the time required to complete measurements using different diagnostic techniques. Measurement options investigated included BIS (bioimpedance spectroscopy), TDC (tissue dielectric constant), girth measures (tape, converted to volume), 3D camera, and perometer (noting that the last 3 measure relative volume change). TDC measures percent of water content under the skin, BIS measures extracellular fluid. She noted that both arms should be measured every time, and pre-operative measurement is critical. In their study tape measures were always converted to volume, and they used the SOZO BIS system. She noted that results depended on the diagnostic tool used. No one tool is a silver bullet. “Development of universal BCRL diagnostic criteria is imperative.” The research paper was published in Rehabilitation Oncology (2025).

Louise Kohlmeyer from the ALERT Centre at Macquarie Univ in Australia spoke about the RE-AIM Framework, “Implementing prospective surveillance and early intervention into clinical practice using the RE-AIM framework”. The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) Framework study is a retrospective analysis of results from the PREVENT Trial which looked at efficacy of surveillance, early diagnosis and early intervention. The RE-AIM results indicated that 25% of 219 patients (n= 55) triggered an early intervention, and then only 1.8% of those (n = 4) progressed to clinical lymphedema over 2 years of the study. She noted that free compression garments were available to study participants whose surveillance results triggered an early diagnosis of lymphedema. She concluded that to make this system work you need buy-in from the whole medical and health care team involved in BCRL care. She noted the challenges of implementing science, i.e. translating scientific evidence into routine clinical practice, and that it can take up to 17 years for published science to make it into clinical practice. The introduction in her abstract states “Despite international guidelines and evidence-based research advocating for prospective surveillance and early intervention model of care (PSM), its integrating into clinical practice remains challenging.” 

In response to my question about how to get early diagnosis and screening programs like this set up, Louise responded that “slow and steady” work is needed. Keep talking about it. Persevere! It took them 10 years to get the Standard of Care accepted in many surgeries, hospitals and cancer centres in Australia. She noted that it is very slow in the lymphedema world to get research results into clinics. The pace of adoption is especially slow compared to oncology research and cancer treatments. 

All in all, the conference was excellent, with lots of very informative presentations. If you are interested in more information on any of these talks, I have downloaded the abstracts and may be able to provide additional detail on the talks that I have summarized above as well as some of the others that I attended.

Lyn Anglin

BCLA – ILF Conference 2025 Highlights

Written by: Christine Chandler

New & Noteworthy Products

• PeriKit (PK): Fast, accurate limb measurements; lower-cost alternative to Perometer.

• Nanosalve: Hospital-grade wound gel now available to the public; company interested in collaborating with BCLA to introduce the product to BC.

• Linotrade Wraps: Coban-style compression with pull tabs for improved circulation design. wrapping www.lympholino.com

• Books by Jean LaMantia: Cancer Treatment Nutrition Guide & Complementary Therapies for Lymphedema. Written in 2012 is still relevant today.

 

Keynote Themes

• Dr Wei Chen Keynote address introduced the concept  that lymph system dysfunction is a significant player in many chronic diseases due to the primary function in cleansing the whole body  

• Advocacy Works: A U.S. mother’s 10-year fight for her child’s LE care highlights the power of organized, consistent advocacy team work
  Canadian takeaway: Develop a national advocacy group + unified messaging handbook.

• Presentations from Dr. Wei Chen, Dr. Melanie Thomas & Dr. Stanley Rockson emphasized early diagnosis and  need for comprehensive care team following surgical treatment.

Breakout Highlights

• Low-Resource Care Models (Uganda): Culturally adapted, low-cost diagnostic methods that could inspire approaches for Canadian Indigenous communities.

• Multidisciplinary Teams: Successful LE surgical clinics require coordinated multi disciplinary teams including-surgeons, radiology, nursing, therapists, physiatry, and social work (with dietitians increasingly essential).

• Global Experiences:

Italy: presented their 35 yr. Journey to establish national LE guidelines, diagnostic codes. And a network of treatment facilities.

Montreal: Intensive advocacy effort by an  Angry Ladies Brigade” to preserve  lymphedema services offered by the team under Dr Anna Towers.This clinic has never been funded within Quebec’s health system.

Research & Clinical Insights

• LE is increasingly understood as an inflammatory condition: research on GLP-1 blockers, beta blockers, and the importance of adequate sleep for the lymph system to work more effectively.

• Nutrition & Obesity: Rising obesity rates drive LE risk. New concepts include Sarcopenic Obesity and Mystagogs (fat infiltrating muscle).

Key Takeaways

• LE care gaps are global—patients often treated as “persona non grata.”

• Early diagnosis saves money and improves outcomes.

• Canada’s geography + provincial health systems make national standards challenging.

• Important to have contacts within the health system to collect data and have the ear of those managing the budget.

• BCLA’s initiative for early cancer-related LE screening and our collaboration with BC Cancer physiotherapists is having positive results.

Short Report from Christine

Understanding Lipedema: Insights from the International Lymphedema Framework 

The International Lymphedema Framework (ILF) and International Lipedema Association (ILA) have been instrumental in advancing the understanding and management of Lipedema—a chronic, painful, and often misunderstood adipose tissue disorder. During Session 1 of the ILF conference, experts including Gabriela Erbacher, Tobias Bertsch (Foeldi Klinik), Gunter Klose, and Melanie Thomas (Lymphoedema Wales) shared updated findings that challenge long-held misconceptions and clarify standards of care.  

A New Consensus on Lipedema 

The publication of an international consensus document on Lipedema—though controversial—was a critical step in developing a standard of care across Europe, where lipedema surgery is now recognized as a medically necessary procedure. 

Through extensive research led by the International Lipedema Association (ILA) (theila.net), one of the key findings was that no lymphatic insufficiency is found in patients with Lipedema, reshaping our understanding of the condition’s pathophysiology. 

Debunking Common Misconceptions About Lipedema 

Misconception #1: Lipedema is an edema disorder 

Unlike lymphedema—where ultrasound imaging reveals fluid accumulation—ultrasound studies in lipedema show no evidence of excess interstitial fluid. This distinction is critical in differentiating the two disorders. 

Misconception #2: Lipedema is a lymphatic disease 

Imaging and clinical studies demonstrate that women with lipedema have normal lymphatic morphology, showing no significant differences from control groups. 

Furthermore, there are no characteristic signs of venous or lymphatic dysfunction in lipedema, reaffirming that it is primarily an adipose tissue disorder. 

Misconception #3: Lipedema is progressive 

While many believe lipedema inevitably worsens over time, data show that 10% of patients actually improve. In most cases, it is obesity—not lipedema itself—that is progressive. 

Misconception #4: Lipedema causes weight gain 

Although lipedema often coexists with obesity, 85% of patients are also obese, and 50% are severely obese. This suggests that obesity is typically in the foreground, not a direct consequence of lipedema. 

Misconception #5: Lipedema can occur anywhere in the body 

Lipedema presents in characteristic patterns, typically affecting the legs and arms, and not regions such as the abdomen. This anatomical specificity aids in accurate diagnosis.  

The Role of the Certified Lymphedema Therapist (CLT) 

Gunter Klose, CLT, presented several case studies illustrating individualized approaches to lipedema management. 

Patient 1: 

• Female, 26 years, BMI 54 – Lipohypertrophy without pain or edema. 

• Plan of care: Focused on weight management education and tissue health through compression garments to prevent friction. 

Patient 2: 

Female, 32 years, BMI 27 – Mild disproportion, pain (4/10), and emotional distress (8/10). 

Plan of care: Education about lipedema, anti-inflammatory nutrition, physical activity, and compression therapy to reduce inflammation, increase oxygenation, and relieve pain. 

Patient 3: 

Female, 48 years, BMI 63 – Lipedema with pitting edema (lipolymphedema). 

Plan of care: Combination of approaches addressing both obesity and lymphedema. 

Compression Therapy vs. MLD 

Compression remains essential for tissue health and inflammation control. 

Manual Lymphatic Drainage (MLD) is not indicated for pure lipedema, though it can reduce stress and pain. Future research may explore whether MLD can improve inflammation similarly to compression through histological mechanisms. 

Lipedema as “Lipalgia Syndrome” 

Melanie Thomas (Lymphoedema Cymru) proposed reframing lipedema as “Lipalgia Syndrome”,emphasizing pain as the central feature rather than edema. 

Her findings included: 

• Little to no measurable edema in many patients. 

• Pain localization differs: 

• Lymphedema → pain below the knees 

• Lipedema → pain in the thighs 

• Sensory symptoms such as tingling, fizzing, and pins-and-needles are more common in lipedema, while lymphedema patients report heaviness and dragging sensations. 

This reclassification helps reduce diagnostic confusion and promotes a more accurateunderstanding of the condition as a neurological and adipose tissue syndrome, not simply a fluid disorder. 

Liposuction: Evidence and Myths 

Dr. Axel Baumgartner (Hanse-Klinik) addressed myths surrounding liposuction for lipedema, detailing several surgical modalities: 

• PAL: Power-Assisted Liposuction 

• WAL: Water Jet-Assisted Liposuction 

• UAL: Ultrasound-Assisted Liposuction 

• LAL: Laser-Assisted Liposuction 

Procedures are commonly performed under tumescent local anesthesia (TLA), often while the patient is awake. Other surgeons may opt for full anasthesia. 

Key Takeaways: 

• Liposuction does not cure lipedema, but it offers significant long-term improvement. 

• 30% of patients no longer need complex decongestive therapy (CDT) 8 years post-surgery 

• 60% require less therapy 

• 10% show no change 

• Liposuction outcomes are not volume-dependent; overly aggressive fat removal increases the risk of skin necrosis or secondary lymphedema. 

• For patients with concurrent obesity, bariatric treatment should precede liposuction. 

• Contrary to popular myth, fatty tissue does not regrow in treated areas. 

Conclusion 

The ILF and ILA’s research efforts are transforming the global understanding of lipedema—from redefining its pathophysiology to clarifying effective treatments. The condition is increasingly recognized as a pain-driven adipose tissue disorder rather than an edema or lymphatic disease. 

Multidisciplinary management, patient education, compression therapy, and individualized care remain cornerstones of effective treatment, while liposuction offers durable functional and symptomatic relief for many. 

Written by:
Jenna LaFleche

Building a Stronger Lymphedema Community in B.C.

After attending the International and Canadian Lymphedema Framework (ILF/CLF) Conference in Niagara Falls, I came away with a deeper understanding of what a strong, supportive lymphedema community could look like here in British Columbia.

Learning from Global Leaders

Several inspiring presentations showed how small beginnings—just one or two dedicated practitioners—can grow into comprehensive lymphedema centers that serve entire communities.

One standout example was the Lymphedema Wales Clinical Network, presented by Dr. Melanie Thomas. Their success began by identifying a clear problem, collecting data, and demonstrating how specialized services can reduce costs to the healthcare system.

Today, their multidisciplinary team includes:

• Lymphedema specialists

• Psychologists

• Physiotherapists

• Clinical leads for lymphedema and cellulitis

• Nurses

• A data analyst and dietitian

They’ve also developed excellent patient resources, such as PocketMedic films, which could be useful for us in B.C.

While Wales has a population of just 3.1 million, their level of support far exceeds what we currently have in B.C. (5.6 million)—a clear call to action for our community.

Advocacy and Awareness

Conference advocates emphasized the power of patient stories.
Encouraging patients to share their experiences, providing ready-to-use posters and templates, and gathering data on resource utilization (e.g., home visits, GP appointments, hospital admissions) can all help make the case for more robust lymphedema support services.

The LE&RN Centers of Excellence model provides a strong foundation, requiring at least three certified lymphedema therapists on-site as a minimum standard.

Building Community Services: A Case Study

Dr. Vaughan Keeley from Derby/Nottingham, UK (pop. 1.6M) shared how their lymphedema service grew from just two practitioners to a thriving multidisciplinary team offering the five key pillars of lymphedema management:

1. Compression: Bandaging, garments, and pneumatic compression devices

2. Skin care

3. Exercise

4. Patient education and support

5. Lymphatic drainage: Manual (MLD) and Simple (SLD)

Empowering Self-Management

Education remains the cornerstone of long-term success.
Ad Hendrix, PT, PhD (Netherlands) presented a model for patient empowerment built around six key questions that assess acceptance and control over one’s condition. In their program, patients spend two weeks in hospital learning personalized self-management strategies—a model worth exploring for chronic lymphedema care in B.C.

Free Learning Resources

Here are some of the excellent resources shared at the conference:

• S.T.R.I.D.E. Documents: A professional guide to compression selection, based on six factors—Shape, Texture, Refill, Issues, Dosage, Etiology.

• LymphLearn: An e-learning platform from the International Lymphoedema Framework with modules on pediatric, genital, and systemic lymphedema.

• EWMA e-Learning Courses: Wound management and compression therapy.

• Leaflets – Lymphedema Network Wales: Information for patients

Looking Ahead

The conference keynotes offered real hope for the future—research into potential cures for lymphedema is underway around the world.

As we take these insights into our upcoming B.C. Lymphedema Association Board planning meeting, we’re excited to explore how to apply these models and resources to grow lymphedema services in B.C. and build the connected, empowered community our patients deserve.

Written by:
Sandi McConnach

  

Complementary Therapies for Lymphedema - Jean Lamantia

Jean Lamantia has done it again with her newest book Complementary Therapies for Lymphedema.

This book answers questions that many people dealing with Lymphedema have wondered about. It combines scientific research for some, others are more antidotal, but both help fill in some of the blanks that we deal with in treating lymphatic disorders. 

What I liked after the technique or item is discussed then side effects are also discussed, to give both the benefits and the risks. 

The book is divided into 5 sections-Traditional therapies, Bodywork, Natural health products, High-tech devices and Final Thoughts.  I like the layout and can see already that this book will be getting used as one of my resource materials when I am looking for more information on different techniques. 

I also like the section where Lamantia breaks down the claims, research and side effects. It gives you a place to look and see the possible rewards if known plus the risks for each therapy. It helps reinforce the information presented prior to these breakdowns and in the first four sections helps compare and consider what therapies are available.

I am very impressed by the high-tech section. Many of the devices mentioned are relatively new and the information very interesting.

The whole book is great for helping sort out some of the claims we see daily on Facebook and other sites on the internet claiming great results if we buy now. This book lets us check out and sort the snake oil from those techniques that will actually help. It is nice as it also includes feed back from people who are dealing with their own Lymphedema. 

I give Complementary Therapies for Lymphedema five stars. It is definitely the best Christmas present to give yourself this year.

It is available from amazon.ca at $22.95 for the Kindle version and $34.95 for the soft cover. Well worth the price for the information contained.

> Read More 
> Visit Jean Lamantia's Website 

A Day in the Life of a Lymphedema Left Leg Patient – Janine Leitch

 I have been living with lymphedema in my left leg since 1998. A tumour was removed along with lymph nodes, an abductor muscle and a couple of veins from my upper inner thigh.

 I was never told I was at risk of getting lymphedema and little did I know that it would affect me for the rest of my life. After learning that my lymphedema wasn’t going away, I made a decision to manage it the best I could. I was determined not to let my leg get worse, swell more, or develop cellulitis.

I try to stay positive and practice self-care:

Each morning, I wake up and remove my thigh high leg compression garment before getting out of bed and hopping into the shower. Before fully dressing, I take time for self-MLD (manual lymphatic drainage), diaphragmatic breathing, and stretching exercises. Then I apply Patrick Curelle lotion to my legs and put on my clean 30–40 mmHg compression flat knit stocking before finishing getting dressed.

This has been my daily routine since my SAPL (Suction Assisted Protein Liposuction) procedure with Dr. Granzow in June 2022. I wear my compression stocking 22 hours a day—even through the night—unless I’m having MLD therapy with my therapist. I have MLD weekly unless one of us is on vacation or ill.

My ankle does need extra care as it tends to swell the most. If needed, over my compression stocking, I wrap a bandage with swell spots on either side of my ankle during the day to help with this. I also sometimes use calf and knee Ready Wrap. When I travel, I always wear 16-20 mmHg compression socks on both legs and over my compression stocking for added compression. If warranted, I will use my compression pump.

I do exercise and move at least 5 times a week:  walking, hiking, yoga, attending my weekly Pilates class and my twice a week resistance training workout at my gym.
What’s kept me going all these years is simple: I don’t want my leg to get worse or infected. That’s always been my motivation. I do everything I can to control the swelling. It’s not always easy, but I try my best. I have never had cellulitis.

I have learned you have to be your own advocate, be motivated to help yourself, to never give up and to try to be positive even though some days are hard and tedious. You need to find out what works for you. It does take diligent effort and trial and error, but well worth it in successfully managing lymphedema.

Surgery has been an option for people dealing with Lymphedema for years, but early surgeries weren’t the most humane. 

Debulking was a technique that involved opening up the skin and removing tissue on the lymphedema area down to the facia and then doing skin grafts. 

In 1912 Sir Richard Henry Havelock Charles was the first to mention using debunking surgery. He reported on 140 scrotal filariasis cases treated by debulking. By the mid twentieth  century the technique was called ‘the Charles procedure’ and it was a surgery done when the patient was stage 4.

Over the years variations of the technique were used but it was highly invasive and extremely painful for the patient.

SAPL or Liposuction

A modern technique which is used for both Lymphedema and Lipedema patients is a modified type of liposuction. This technique allows reducing the lymphatic tissue in the arms or legs. Lymphedema typically leads to an increase in adipose tissue that can be removed with liposuction.

Adipose tissue increases with Lymphedema and it doesn’t depend on the length of time you have had lymphedema.  

Variations of this technique have been in use for over 20 years now. Pioneered by Dr Hakan Brorson (Skane University Hospital, Malmo, Sweden) he has trained teams all over the world in his method. 

Both Lipedema patients and Lymphedema patients have benefitted from this technique. Again - this is not a cure. After surgery you have to remain in compression after the surgery. But Dr Brorson has followed patients for 21 years with Lymphedema and 11 years with Lipedema and they have not had any reocurrances.

Fat cells in Lymphedema patients are larger in areas with Lymphedema compared to unaffected areas. Interesting in animal studies chronic inflammation leads to increased adipose tissue. 

This is not a quick fix as it may take months to recover from the procedure and after care for patients is very important.

It has been reported that after surgery patients quality of life increases. Also with the increased blood flow the cases of cellulitis drop by up to 87%. 

Lymph Node Transfers

As imaging techniques improved more was learned about the lymphatic system. Improvements in micro surgery also brought new ideas and one was Vascularized lymph node transfer surgery (lymphovenous transplant)

The idea seemed simple. Take a section of lymph nodes from a healthy area of the body to the area that has damaged lymph nodes and restore the flow. The surgery is done in hospital and requires a few days of rest before you resume your normal activities. 

It sounds amazing and it has proven life changing for some patients that undergo this surgery. As surgeons become familiar with this technique and combine it with imaging functioning lymph nodes can be transplanted to a new location.

The drawback to this technique is that if the lymph nodes removed from the secondary location can cause lymphedema to occur in the donor location. 

The first transplant of lymph nodes from the groin flap was reported in 1982. Today the groin flap is still the most common location for getting the lymph nodes for transplant. There are other locations that provide lymph nodes suitable for transplant. The choice of location depends on the individual patient.

Although originally it was reported lymph node transfers only helped 30% of patients with the improved methods used now the number is much higher.

Dr Granzow developed a method that showed a reduction in volume of 86% in legs and 111% in arms and statistically significant reductions in the needs for lymphedema therapy and compression garment use. 

Lymphaticovenous anastomosis
(also referred to as lymphovenous bypass) 

We always refer to the lymphatic and venal system as separate, but they actually do intersect on a daily basis. When the system is running properly both systems coexist together. When the lymphatic system is damaged then swelling starts causing lymphedema. 

LVA or lymphovenous bypass uses microsurgery to connect the lymph vessel to the vein. 

LVA was actually tried in the 1960s, but microsurgical techniques using robotic surgery methods were not available then.

Now with the surgical and imaging improvements LVA has become more practised and it now considered one of the gold standard treatments for Lymphedema.

Once the blockage has been identified then using lymphangiography then the surgeon chooses the vein. 

Before the surgeon starts to cut the chosen area local anesthetic containing epinephrine for hemostasis in order to limit bleeding from the dermal edges. Isosulfan blue or Lymphazurin (Covidien) is injected distal to the incision site, which is absorbed into the lymphatic vessel and allows for visualization of the lymphatic during the dissection. 

The size of the lymphatic and venal veins are tiny, some 1 mm, other smaller mean that this is micro surgery. 

When the connection is made then the excess fluid in the lymphatic system starts to drain into the venal system. 

Patients report less heaviness in their limbs, reduction in infections and cellulitis. Studies with a minimum 1 year or longer have shown promising results for treating Lymphedema.

After having surgery patients have to wait for 4 weeks to let the bypass heal before using compression garments or manual lymph drainage.

After surgery patients notice an improvement in dealing with their lymphedema. Reducing the need to wear compression sleeves, using pneumatic pumps or needing to go for manual lymphatic drainage  or massage with Lymphedema therapists.

There is a human component in any surgery you decide to have. That is the expertise of the surgeons and their teams. You want a surgeon who is familiar with the technique that you are getting done. You also want to make sure that proper aftercare has been arranged.

Finding a lymphatic therapist is important to help dealing with lymphatic diseases. A qualified lymphatic therapist can change the trajectory of dealing with your lymphedema. According to LANA (Lymphology Association of North America) therapists need to have completed an accredited board exam after meeting training qualifications of at least 135 hours of training through a qualified school.

We often refer to our therapy sessions as massage, but this is not like a Swedish massage that you receive at a spa. This is why it is so important to go to a therapist that is trained as a certified lymphatic therapist.

There are more than one school that offers lymphatic training. If you go to the Lymphatic Education and Research website there is a list of schools that are approved by LANA. Interestingly, the only school that requires therapists to upgrade their skills to keep their LANA rating is the Vodder School.

A good place to locate a lymphatic therapist is in the BCLA Directory. This directory lists off therapists and fitters that are members of the BCLA. When they are listed you know that they are qualified and also, they are members of either the College of Physiotherapy or Massage Therapists in BC. The directory is updated yearly and BCLA members receive a copy of the updated directory as part of their membership. You can also access the directory at bclymph.org and it also contains listings for fitters for every health region in BC.

If there are no therapists listed in the directory for your area, then check on the Vodder website https://vodderschool.com/contacts/search and see if you find a therapist there.

Once you have found a therapist then don’t be afraid to ask a couple of questions. “How many patients with lymphedema or lipedema have you treated? Are you keeping current on developments coming from new research on lymphatic disorders?”

Your first appointment doubles as a meet and exchanging information with your therapist. Your therapist will evaluate not only your lymphedema (may include measurements and photos), but will also discuss complete decongestive therapy. This includes diagnosis, manual lymphatic drainage (MLD), bandaging, compression garments, therapeutic exercises, and self-care. Self-care may include learning how to bandage at home, do self MLD as well as proper skin care and exercises to help improve your lymph flow.

An important component that your therapist will help with is education. Most doctors only receive 25 minutes in medical school on the lymphatic system. Your therapist can help educate you about your lymphatic disease.

To many of us our lymphatic therapist is a very important part in our team dealing with lymphedema and lipedema. They understand what we are going through and at times provide a sympathetic shoulder to cry on. Having a trained lymphatic therapist in your corner definitely helps.

Unfortunately, it isn’t cheap to see a therapist. If you have extended medical check your plan to see what coverage you have. If you don’t have extended benefits make sure you save your receipts to include in your income tax the same way you save your garment receipts.

Your therapist will help you plan out your lymphatic journey by helping you set goals and updating those to show your progress. It may be the encouragement that you need in your lymphatic journey.

Something I have found handy is consider seeing a lymphatic therapist when you are on holidays in a different location. It gives you different insight into your condition.

Usually, Emil Vodder is given credit for creating Manual Lymph Drainage in the 1930s. But it didn’t start then. The start of MLD dates back to the 1870s to Dr. Andrew Taylor Stills, a doctor practicing in the US.

Stills had a good knowledge of anatomy, and his hypothesis of the connection into the brain of lymphatic system was proven in 2015! He was indeed a forward thinker.

Stills in 1892 founded the American School of Osteopathy (ASO), now called the Kirksville College of Osteopathic Medicine of A. T. Stills University of Health Sciences in Missouri.

Stills was one of the first, if not the first who recognized the importance of the lymphatic system. One of his graduates, Elmer D. Barber published his first book on osteopathic medicine, Osteopathy Complete, in 1898. It contained one of the first descriptions of MLD.

With research ongoing, including the impact of MLD on the spleen, the lymphatics were discussed and then debated if the spleen was part of the lymphatic system.

In the 1903s, a Danish massage practitioner working in France was also looking into the lymphatic system. This is a name which is still very familiar - Dr. Emil Vodder, PHD. It started with a patient with chronic sinusitis and acne. Vodder decided to try to drain the stagnant areas toward the neck. He realized that he was working on the lymphatic pathways.

In 1936, Vodder presented about MLD in Paris; but Vodder was not a doctor, physio therapist or a registered massage therapist and his work was met with skepticism.

In under a hundred years, Vodder has become a household name for his MLD training. Many of the therapists working in BC were trained in the Vodder method.

MLD started out from stuffed up sinuses. It is now used for relief of several diseases including lymphedema, lipedema fibromyalgia, multiple sclerosis and Parkinson's disease.