Scary Neuro-Surgeons!

For as long as I can remember I've been obsessed with the workings of the human body (hence my career choice) and my favourite bit of anatomy has to be the brain! When I was training as a physio I loved anything to do with the brain and nervous system, and when I got the chance to do my final year elective placement with one of the UK's leading neuro-physio's I jumped at it.  My first job was at Salford Royal Hospitals NHS Trust - AKA Hope Hospital, the Neuro-surgical Centre of excellence for the North West of England and I purposefully selected my junior rotation posts so as to make the most of being in the presence of neuro experts so I could learn from them.  From the very beginning Neuro-rehab was a big part of what I did.  When I started working at the Christie Cancer Treatment Centre, I was able to tie my two passions together when I took up the post of Senior Neuro-oncology physio, a job that I loved every single second of.
Despite my love of everything 'brain-ey', I did find the neuro-surgical wards a scary place to be.  Of all the patients in the hospital, these were some of the most critically ill I would ever come across.  I learnt very quickly that the line between life and death is a very fine one. I also learnt that the phrase 'a fate worse than death' has real truth in it, when I think of some of the patients I have treated who have had massive brain injuries and have been left severely disabled and debilitated but alive.  I can remember the tangible fear of the junior doctors on the wards at rounds time as they waited for the Consultant Neuro-surgeon to arrive.  As a junior physio I remember being made to feel completely inadequate when discussing patients with neuro-surgical nurses who had years of experience in the field and probably could treat the chest of an acutely ill patient far better than I could.  If it was my night to be 'on call', I would actually pray that neuro-surgery wouldn't call me,  and if in the middle of the night the pager would bleep (before mobile phones!) and I'd see their extension number I'd almost get sick to my stomach.  I felt that neuro-surgeons where scary, egocentric genius's with a very definite God complex, but I've always been intrigued by them and I suppose in awe of them,and in 2007, when a neuro-surgeon saved my mothers life, that particular surgeon got elevated to 'Legend' status!  So when I recently came across Consultant Neuro-surgeon Mr Henry Marsh's book 'Do No Harm', I had to read it.  And I am so glad I did. It gives a fascinating insight not just into the world of neuro-surgery, it also reveals the humanity behind that 'scary' façade  - a humanity which enables them to perform what must arguably be the most difficult and risky surgical procedures for the good of their patients.  They have to have the God complex, they have to believe that they are the best because if they make a mistake someone dies or worse can suffer a 'fate worse than death'.  Please God, I never have to go under the knife of a neuro-surgeon, but if I did I want him or her to be the scariest, most egoncentric genius I have ever met.  I'd highly recommend the book!

Lipoedema Case Study

I have recently been treating a client with intensive decongestive lymphatic therapy (DLT) who has lipoedema.  The lady is 37 years of age.  Her history and examination reveals that she ticks a lot of lipoedema boxes:

• bilateral symmetrical 'big' legs, disproportionate for waist/trunk size
• history of bruising easily
• endless attempts to lose weight and when she has lost weight it hasn't gone from the legs
• 'orange peel' effect on the legs
• feet are not affected and look 'skinny' in comparison to her ankles
• non-specific achy feelings and heaviness in the legs
• strong family history of thyroid disorders
• other female relatives have similar big legs
• her legs were overly tender to light pressure
• her symptoms were exacerbated during pregnancy

The photo below shows her pre and post Delfin Moisture Metre readings along with her limb volumes. 

This is an ongoing case, I am still seeing this lady, the above post measurements are taken on day 5 of treatment. 

Subjectively the lady is feeling immense benefits from the treatment.  She says that her legs feel so much lighter than they have ever done, she doesn't have the aches and soreness that she was so used to and she is loving the fact that she herself can see her "ankle bones" and has shape in her calves.  

I sincerely hope that we can maintain these improvements as we continue to work together.  

I am plagued by questions as to what was/is going on in her legs based on the objective findings and putting that together with the knowledge I have gained during my recent Fluoroscopy Guided Manual Lymphatic Drainage (FG-MLD) training.  And I am specifically looking at area 'A' in the diagram.  On initial assessment there was definitely higher Moisture Metre readings in that are in her left leg. The left:right ratio difference in area A is averaging 1.3.  Her left leg did have a slightly higher volume and after 5 days had a reduction of 1370mls when compared to 805mls on the right.  But what interested me more is that the Moisture Meter readings were very much reduced on the left and more equal to those on the right - leading me to conclude that we had gotten rid of the excess fluid in that area.  But I then ask why was there more fluid just in that specific area?????? On assessing women with very early stage lipoedema, this area typically is where we can palpate the rubbery fat nodules, and is commonly an area that ladies identify as where they can see the abnormal fat in their legs.
So, when I think about what I learnt in my FG-MLD training recently - commonly there is an area just below the knee - roughly around area 'A' where we find our 'fill' spots.......I don't know where this is going but I am sure there is a research question in there somewhere, I just don't know what it is.  

I would love to get other therapists views on this - any thoughts?????

Lipoedema

Recently I gave a talk on Lipoedema explaining what it is, how it is diagnosed and how it is treated and managed.  Here is the slide show, a lot of it is self explanatory but I'm happy to answer any questions if you comment below.