Angiologist specializing in lipedema
Interview with Dr Michele Cazaubon
Hello. Could you please introduce yourself?
Hello, my name is Michèle Cazaubon. I’ve been an angiologist, or vascular disease specialist, for… quite some time!
I trained as a cardiologist. When I started my studies, Doppler, functional exploration, was just emerging and nobody wanted to get involved, so my boss at Hôpital Bichat said to me, “Come on, Michèle! Get on with it!”
And the Doppler and I have been together ever since!
I’m not a phlebologist, which means I don’t lance varicose veins, but I do diagnose everything that’s wrong:
- when there are varicose veins, where it goes, where it doesn’t,
- why there is reflux,
- why the veins are too large,
- why they are visible,
- why they hurt,
- why they can clog…
- The same goes for arteries.
Questioning is very important. Among the questions asked by the angiologist :
- Does it hurt to apply pressure or the slightest touch?
- Are there any spontaneous hematomas?
- Do legs stay strong despite diet and exercise?
Can you tell us more about your work with lipedema?
So I’m not a “doctor with bare hands”:
I have a Doppler ultrasound machine that allows me to see inside, to see what’s going on in the legs, to examine the arteries, veins, lymphatic vessels, i.e. the vessels that also participate in return circulation, and also all the soft tissue, the subcutaneous tissue in which the vessels circulate.
I noticed that when women came in with big legs, leg pain, bruises that appeared too easily, varicose veins that increased…
And when we told them “the Doppler is normal, there’s nothing on the arteries or veins”, they left very happy, but on the other hand it wasn’t very satisfactory for us to take charge of them and suggest that they improve their situation and possibly seek help from the appropriate specialists.
That’s why I specialize in lipedema, which is a disease of the fat cells. In other words, everything fatty. When I say “a disease”, I mean it’s not yet recognized by the WHO. It was supposed to be at the beginning of the year, but I think they’ve had a lot of other problems and have dropped lipedema for next year. In any case, it’s a pathology that needs to be treated in the same way as other muscular, tendinous and other pathologies.
Can you tell us about the difference between lipedema and obesity?
Dr Michèle Cazaubon, can you tell us about the percentage of your patients with this disease?
Most of my patients are women, especially since I specialize in “fat legs” and lipedema in particular.
Before I specialized in lipedema, my patient base was made up of as many women as men. Now I have a larger female patient base, with almost 99% of my patients who consult me for heavy legs being women.
The examination begins with a detailed questioning, as we need to know how long these legs have been present. In general, whether it’s lipedema or cellulite, it appears around the time of puberty. It is aggravated by major hormonal upheavals, particularly during pregnancy or the menopause. Most often, there’s a family history: in other words, fat legs are passed down from mother to daughter, and all the women in the family also have fat legs.
How do your patients feel when they come to see you?
It hurts, it’s aesthetically embarrassing, and since we’re living in a time when it’s valued to have long, fat-free legs, it can pose a problem, even a social one, in the workplace, and it can also pose a problem in terms of quality of life, the feeling of being treated differently because you’ve got big legs. In short: it’s a big problem, and one that really deserves the most judicious treatment.
I’m not going to tell them “Tomorrow you’ll have slim legs”, because that’s not true. In general, it’s a long-term process, and the patient has to accept certain constraints, such as putting on compression socks, doing lymphatic drainage, endermology, and all that with highly competent people. And not go to an institute, pass under a machine and wait for the result without doing anything. It’s really a complete collaboration between the vascular physician, the patient, of course her attending physician and possibly the specialist surgeon who will be able to help remove the excess fat where it needs to be and where we tell him it needs to be done.
Can you give us more details on the fact that, according to you, the pathology is transmitted from mother to daughter, that it is hereditary?
Because this is a recurring question from our patients.
Absolutely. Work is being done to look for hereditary abnormalities, but so far nothing has come to light. We’ve tried to find out why fat cells grow and multiply the way tumors do, but we haven’t found anything yet to explain why fat cells suddenly become too big and too numerous.
They can multiply extremely quickly?
Extremely rapidly and progressively, and we haven’t found a way of slowing their progress. That’s why it’s a little disappointing sometimes, when a patient has lost 10 kilos and there’s nothing in her legs. I also see morbidly obese patients, with body mass indexes of over 40; severely obese women weighing over 140 kilos for 1m70 and losing half their weight…
And they still have big legs. So it’s good that they’ve taken the first step, and we’ll have to see what we can do to complete the process and give them much more suitable legs.
Dr Michèle Cazaubon, do you have anything to add?
Yes. I often see patients who are better informed than some vascular doctors or general practitioners, who say, “Well, we don’t know, there’s nothing you can do. Take up sport and lose weight.”
Patients go to websites and discussion forums. Some doctors aren’t interested in lipedema because there’s no really known treatment at present.
Thank you for this interview.
For further information, please contact Madame Cazaubon or visit her website. Doctor Michèle Cazaubon welcomes you to her vascular explorations center in the 16th arrondissement of Paris.
We invite you to make an appointment with Dr. Cazaubon, for your pre- and post-operative echo-doppler. During an appointment, she can also diagnose lipedema.
0 Comments