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Chapter 1: What is the main topic discussed in this episode?
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Chapter 2: What is the lymphatic system and its importance?
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Hello, welcome to Doctor's Notes. I'm Dr. Chris Van Tulleken, as ever I'm here with my identical twin brother.
That's me, Dr. Zond, and we have just finished recording an interview with Professor Christiana Gordon. She's a consultant in dermatology and lymphovascular medicine and clinical lead at the National Lymphedema Clinic.
Now, Zandi, in the main ep, we talked about why everyone is talking about detoxing and hacking your lymphatic system. And certainly, once you understand it and its ability to drain toxins, there's something superficially appealing about giving it a hand, kind of get where the social media hacks come from.
Well, as always on social media, there's a sort of little kernel of truth. You know, I suppose the kernel of truth is your lymphatic system is important, but anything to do with the lymphatic system, it is not the place to go.
That is right, Zand. And luckily we had Christiana Gordon with us to help us discard a lot of those misguided bits of advice on social media. But there's so much more to explore and Christiana was good enough to stay with us a little bit longer.
Well, that's right. Now, in Doctor's Notes, we're going to talk further about what happens when the lymphatic system breaks down.
We're going to talk about how Christiana got into not just this line of work, but how she's one of the first people to develop this as a new medical discipline and her work on the genetic causes and the possible future treatments for what is currently an incurable condition.
Let's open the notes. Christiana, thanks so much for staying for a deeper dive in Doctor's Notes.
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Chapter 3: What are common misconceptions about detoxing the lymphatic system?
That's the removal of fat tissue.
The removal of fat tissue, yes. So what we're learning is that the lymph system, as well as playing a role in fluid balance, it also plays a role in inflammation and fat regulation. So what we then can do if a person is suitable for it and wants to go for it is do liposuction to debulk that limb to reduce the volume. We can try and match it to their other unaffected limb sometimes. Wow.
It doesn't come without a cost though because what we have done when we've done the liposuction is damage many of the lymph vessels that were previously working. So post-surgery for liposuction, you need to sign up to wearing your compression garments 24-7 for life, day and night. You can only take your compression garments off for a shower.
So you definitely wouldn't want to do liposuction for lymphoedema for cosmetic reasons. But if you've got functional problems with this big arm or leg stopping you from leading a normal life, it's absolutely something to consider. So the other surgical options are lymph node transfer.
That's where a surgeon says, I'm going to borrow a lymph node, perhaps from somewhere in your abdomen or somewhere else, and make a little cut and sew it into your groin where you've got lymphoedema of the leg below it. And There are some wild claims that they can grow new lymph vessels and cure lymphedema with it. I think the jury's out on that one.
The third procedure is very low risk, and that's the plumbing one, the true re-plumbing, where plastic surgeons are doing super microsurgery, identifying lymph vessels that they can sew into nearby veins and bypass any blockages or obstruction to lymph drainage.
Does it work?
The literature is not convincing for the majority of cases, but I have seen it work.
These things are perhaps not quite the width of a hair, but I mean, they're terribly, terribly tiny.
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Chapter 4: How does one become a specialist in lymphovascular medicine?
And is it the same gene affecting then the valves in other places of the body, the ureter, the heart?
We presume so.
Really?
You need an observant doctor for that, don't you? You're very, very pleased. I mean, I imagine that when you diagnosed the patient, they had never heard of this and didn't know what was going on and didn't quite understand why you were so excited. For them, that is a life changing diagnosis because you will be able to keep an eye on them for all sorts of other problems.
And I screened his son. His son has it too. So we were able to pick up that his son was at risk and get him involved with the cardiac clinic as well because father and son both have the same heart valve problem. So if you know what type of primary lymphedema that young person or that family in front of you has, you know what else to screen for. Do you need to do a heart echo scan?
Do you need to do a kidney scan? Do we need to do something else? So, you know, in our clinic, we really focus in on making an accurate diagnosis of primary lymphedema so we can support that child and the rest of the family appropriately.
Oh, that's so brilliant, Christiana. That's amazing.
At City St. George's University, we are trying to find new genes that cause primary lymphedema. And that's where the MRC grant has come in. It's supporting the work looking for new genes, but also supporting our work looking at imaging of the lymphatic system. So we're trying some new MRI techniques to image the lymph system in more detail to understand the mechanisms of disease.
Because at the moment, we treat the vast majority of lymphedema the same. But it's not the same disease. So I think people do deserve bespoke treatment for managing their condition. And one day we will have that.
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