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?????