Interview with Dr Nicole Gerlach
During puberty, she noticed that she was different: somewhat sturdier in the legs, constant bruises, severe pain when touched and pressed, and an increasing feeling of heaviness. In her practical year as a trainee doctor, her symptoms increased. Her then boss of vascular surgery made the diagnosis – lipoedema. Today, Dr Nicole Gerlach would like to offer information in her dual role as a patient and physician, and share her expert knowledge and experiences. In an interview, she talks about the importance of medical compression stockings (MCS), individual advice and self-management, and offers answers to many of the questions discussed relating to lipoedema therapy.
Dr Gerlach, to what extent has lipoedema affected your everyday life?
“It was very stressful for me in every life situation – especially in the beginning as a young woman. The sudden, uncontrollable weight gain and the comprehensive treatment measures turned my world upside down.”
What therapy did you receive?
“At the start, I was wrapped in supports until the swelling subsided, before I then got my flat-knit MCS and went for lymph drainage several times a week. As I became busier in my job, I looked for alternatives: massages, aqua aerobics, exercise on a mini stepper – I now have a Lymphomat machine for time reasons and continue to wear flat-knit MCS every day. It’s important to me to be active consistently – also in terms of comprehensive self-management. When the psychological strain due to daily pain increased, despite all the measures, I decided to undergo liposuction.”
How important are medical compression stockings (MCS) after this operation?
“The importance of MCS is equally high, both before and after liposuction. Wearing them continuously is hugely important, especially as a conservative treatment measure to alleviate pain. It is wishful thinking and rarely actually possible that you no longer need medical compression following liposuction – the reality is different as the diseased tissue cannot be completely removed.
The tissue needs to reshape itself following the surgical intervention – optimally adapted compression care is very important for healing. Following liposuction, you should wear MCS for at least six months, ideally a year, I also recommend it permanently.”
What do you consider important when it comes to medical compression care?
“The MCS must be adapted individually to suit the patient and their needs, and the material and fit play a major role. The variety of patterns and colours also has a positive influence on acceptance and compliance (therapy adherence).”
Alongside medical efficacy, does appearance also play an important role?
“Definitely, the different colours and motifs are great! The MCS don’t stand out at first glance in everyday life, but instead look like normal socks and stockings. This makes you feel good – the bright colours are a great option, especially for young girls.”
You are active on social media. What prompted you to share your everyday life and expert medical knowledge?
“My family and friends encouraged me to become active as a physician and affected patient. I am passionate about using my experience and my knowledge to do something good for others. I provide information about the relationships and backgrounds of the illness and keep up to date with new content. There is often still a lack of knowledge, even among doctors, and my patients feel like they are not understood – as a patient myself, I can understand that only too well.”
We observe great support in the lipoedema community. In your view, what contributes to the success of treatment?
“Everyone decides individually what information they want and in what depth and what they enjoy. The community is steadily growing, you can interact with people who you wouldn’t see on the street, and you realise that you are not alone with your diagnosis. I find it appealing when there are channels with personalities who offer a genuine insight and also openly say when they don’t feel well – that’s real life.”
What role does good self-management play?
“A very big one – with lots of exclamation marks (laughs)! Instead of relying on the diagnosis and conservative measures, you naturally also have to play an active role yourself. An example: Most lipoedema patients are overweight. Unlike what people are often told, you can also lose weight with lipoedema. However, lipoedema cannot be combatted with weight loss regimes. Nevertheless, individual weight management in conjunction with exercise and compression therapy achieves very positive results and can alleviate symptoms. In any case, patients should strictly avoid gaining any weight and try to reduce their weight if they are already overweight. But your head has to want to this itself first.”
What role do experts from specialist retailers play?
“You should have a good medical supply store to hand, as advice from specialist retailers is very important for patients’ treatment adherence. It’s important that the compression stockings are fitted perfectly to requirements during the first appointment, so that patients wear the MCS consistently.”
You are a specialist in nutrition medicine. What tips can you offer?
“The diet influences lipoedema. With any weight gain, the lymphatic channels and capillaries are narrowed by an increase in fatty tissue. If you go overboard, most patients have a kind of “carbohydrate hangover” the next day – you feel groggy, have more pain and water retention. Having plenty to drink, including with drinks such as oat herb tea, is important to activate the lymphatic system. Avoid ready meals, additives and preservatives, and hormone-sensitive substances from tinned foods and plastic bottles, reduce animal products, and instead switch to plant-based substitutes. Lipoedema patients should also avoid eating sugar, refined carbohydrates and white flour products. Carbohydrates with a low glycaemic index, such as wholemeal bread or pulses, can be added to your diet as alternatives. Lipoedema patients should avoid dairy products or switch to high-quality hay milk from grass-fed cows without fattening feed/cereals. The oestrogen content in conventional milk is raised, but this hormone promotes the growth of the lipoedema tissue and can cause the illness to progress. It’s important to talk to the physician treating you because individual therapy should be closely coordinated, especially if you have other concomitant diseases.”
There’s a link, then, between lipoedema and hormones?
“Yes, the female sex hormone oestrogen promotes surges and the progression of the illness. The first tissue & touch sensitivities and bruising often occur during puberty. The “pill” can exacerbate this. It’s thus important to have a good gynaecologist on hand. During pregnancy, the hormonal changes can cause another surge.”
Besides diet and regularly wearing MCS, what factors influence lipoedema pain?
“Exercise! This also applies to seated activities – calf and vein pump action is activated by rocking movements in the legs and feet. Not forgetting: you should also wear MCS during physical activity and raise your legs up now and then. Another tip: breathing exercises. Deliberate, deep breathing into the abdomen promotes the reverse flow of blood to the heart and thus, as a secondary element, the transportation of lymphatic fluid due to the negative pressure that it creates.”
What advice would you like to give lipoedema patients?
“Get active yourself and make use of all the therapy options individually! Your own will is important because you can do a lot to help yourself. Exercise in everyday life is the key thing, there are always alternatives: For people who can’t manage 10,000 steps a day, a home trainer for the arms or feet could help, or small dumbbells to strengthen the muscles. Collaborate with your doctor to find out what works and is fun. This way, everyone can find the ideal therapy for them!”
Dear Ms Gerlach, thank you very much for the lovely interview and the exciting insights from your perspective as a doctor and patient!