Angiologist specialising in lipedema
Interview with Dr. Michèle Cazaubon
Hello. Could you please introduce yourself?
Hello, my name is Michèle Cazaubon. I am an angiologist, that is to say a specialist in vascular diseases since… Some time!
I am a cardiologist by training. When I started my studies, the Doppler, the functional exploration, was just being developed and nobody wanted to do it, so my boss at the Bichat Hospital said to me “Come on Michèle! You start!”
And since then, the Doppler and I have never left each other!
I am not a phlebologist, that is to say that I do not lance varicose veins but I diagnose everything that is wrong:
- when there are varicose veins, where they go, where they don’t go,
- why there is reflux,
- why the veins are too big,
- why they are visible,
- why they hurt,
- why they can become blocked…
- The same goes for the arteries
The questioning is very important. Among the questions asked by the angiologist :
- Is there pain on pressure and the slightest touch?
- Are there spontaneous bruises?
- Do the legs remain strong despite diet and exercise?
Can you tell us more about your work with lipedema?
So I’m not a ‘bare hands doctor’:
I have a Doppler ultrasound machine that allows me to see inside, to see what is going on in the legs, to examine the arteries, the veins, the lymphatic vessels, that is to say the vessels that also participate in the return circulation, and in addition all the soft tissue, the subcutaneous tissue in which the vessels circulate.
I noticed that when women came for big legs, with pain in the legs, bruises that appeared too easily, varicose veins that increased…
And when we told them “the Doppler is normal, there is nothing on the arteries and veins” they left very happy but on the other hand it was not very satisfactory to take care of them and suggest them to improve their situation and possibly to resort to the adapted specialists.
That’s why I specialised in lipedema, which is a disease of the fat cells. That is to say, of everything that is fat. When I say “a disease”: it is not recognised by the WHO for the moment, it was supposed to be at the beginning of the year but I think they had a lot of other problems and they dropped lipedema for next year. In any case, it is a pathology that must be treated in the same way as other muscular pathologies, tendons, etc.
Dr Michèle Cazaubon can you tell us about the percentage of your patients who have this disease?
My patients are mainly women, especially since I have specialised in “fat legs” and in lipoedema in particular.
Before I specialised in lipedema, my patient base was equally made up of women and men. Now I have a larger female patient base, almost 99% of my patients who consult for heavy legs are women.
The examination starts with a precise questioning because we need to know how long these legs have been there. In general, whether it is lipedema or cellulite, it appears at the time of puberty. It is aggravated at the time of major hormonal upheavals, in particular during pregnancy or the menopause. Most often there is a family history: that is to say that there are fat legs from mother to daughter, and in the family all the women also have fat legs.
How do your patients feel when they come to see you?
It hurts, it hinders them aesthetically as we are in a period where it is valued to have long legs without fat, it can pose a problem, even a social problem, in the workplace and it can also pose a problem on the quality of life, the impression of being treated differently because we have big legs. In short: it’s a big problem and it really deserves the best possible treatment.
I’m not going to say to them “Tomorrow you’ll have thin legs” because that’s not true. In general, it’s a long term work, the patient has to accept certain constraints, for example putting on compression socks, doing lymphatic drainage, doing endermology, and all this with highly competent people. And not go to an institute and go under a machine and wait for the result without doing anything. It is really a complete collaboration between the vascular doctor, the patient, of course her doctor and possibly the specialist surgeon who will be able to help remove the excess fat where it is needed and where he is told it should be done.
Can you give us more details on the fact that, according to you, the pathology is transmitted from mother to daughter, there would be a hereditary transmission?
Because this is a recurring question from our patients.
Absolutely. There is work being done to look for hereditary abnormalities but so far nothing has come to light. We have tried to find out why fat cells grow and multiply as tumours do, but we have not found anything at the moment that can explain this sudden disorder of fat cells that become too big and too numerous.
They can multiply extremely quickly?
Extremely quickly and progressively and we haven’t found a way to stop them. That’s why it’s a little disappointing sometimes because when a patient has lost 10 kilos and there’s nothing in the legs. I also see patients with morbid obesity, with body mass indexes of over 40. Severe obesity with women who weigh over 140 kilos for 1m70 and they lose half their weight…
And they still have big legs. 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. Do sports and lose weight.
Patients go to websites and discussion forums. Some doctors are not interested in lipedema because there is no really known treatment at the moment.
Thank you for this interview.
For more information please contact Dr. Michèle Cazaubon and visit her website. Dr. Michèle Cazaubon welcomes you in her vascular explorations center in Paris in the 16th district.
We invite you to make an appointment with Doctor Michèle Cazaubon, to perform your pre and post-op echo-doppler. During an appointment, she can also diagnose lipedema.