Klose Training Medical Director
Managing Patients with Multicausal Edema
Saturday, May 4, 10:30am – 11:00am
Lymphedema has traditionally been divided purely into primary and secondary types, but clinical experience, especially over the past 20 years, has demonstrated that the majority of lymphedema patients now fall into a category best described as “multi-causal lymphedema,” a category that blurs the lines between primary and secondary lymphedema. Patients with multi-causal lymphedema all share the defining characteristic of obesity. This presentation will discuss how obesity impacts the lymphatic system directly and indirectly and how it increases a person’s risk for lymphedema. Treatment options for multi-causal lymphedema will also be presented.
- Discuss multi-causal lymphedema and identify ways in which it blurs the boundaries between purely primary and secondary lymphedema.
- Describe the ways in which excess adiposity affects the lymphatic system.
- List at least three components of an appropriate treatment for multi-causal lymphedema.
Savetsky, et al. Obesity increases inflammation and impairs lymphatic function in in a mouse model of lymphedema. Am J Physiol Heart Circ Physiol. 2014 Jul 15;307(2):H165-72.
Levi, et al. Molecular analysis and differentiation capacity of adipose derived stem cells from lymphedema tissue. Plast Reconstr Surg. 2013 Sep;132(3):580-9.
Artero A, et al. Anthropometric parameters and permanent remission of comorbidities 10 years after open gastric bypass in a cohort with high prevalence of super-obesity. Endocrinol Diabetes Nutr. 2017 Jun – Jul;64(6):310-316.
Sirtori A, et al. Patients with obesity-related comorbidities have higher disability compared with those without obesity-related comorbidities: results from a cross-sectional study. Int J Rehabil Res. 2016 Mar;39(1):63-9.
Peytremann-Bridevaux I, Santos-Eggimann B. Health correlates of overweight and obesity in adults aged 50 years and over: results from the Survey of ealth, Ageing and Retirement in Europe (SHARE). Obesity and health in Europeans aged > or = 50 years. Swiss Med Wkly. 2008 May 3;138(17-18):261-6.
About the Presenter
Dr. Francis retired from Lymphedema Physician Services, her private practice specializing in lymphedema, in September, 2018, but beginning in January, 2019, she will serve as the Lymphedema Specialist in the Center for Breast Health and Disease Management at the St. Barnabas Ambulatory Care Center. There, she will see patients with, or at risk for, breast cancer-related lymphedema.
Dr. Francis’ past clinical positions include Director of Outreach Services, Kessler Institute for Rehabilitation, 1996–2004; Clinical Director, Kessler-Lerner Lymphedema Services, 1997–2004; Clinical Director, ALS Clinic Kessler Institute for Rehabilitation, 1994–2004; Clinical Director, Lymphedema Treatment Center, St. Barnabas Ambulatory Care Center, 2004 – 2008.
Dr. Francis is a member of the St. Barnabas Breast Program Leadership Committee and the Cancer Committee. Until 2016, she was a member of the Medical Advisory Committee of the National Lymphedema Network.
Dr. Francis draws from many years’ experience treating patients with lymphedema. Among her numerous awards and honors, she was selected for “Best Doctors of New York”, New York magazine, “New Jersey’s Best Doctors” NJ Monthly magazine, Castle Connolly New York Metro Area Top Doctors, Inside New Jersey magazine Top Doctors, and Best Doctors in America database. She was named by U.S. News & World Report as among the top 1% of physicians in her specialty.
Dr. Francis has lectured extensively in numerous clinical and academic settings across the nation, including at hospitals, patient seminars, webinars, and numerous medical conferences including the biennial National Lymphedema Network conferences.
Dr. Francis is a member of the International Society of Lymphology, the American Lymphedema Framework Project, the American Academy of Physical Medicine & Rehabilitation, and the American Medical Association. She is also a Fellow with the American Association of Electrodiagnostic Medicine.