Interview with Dr Michele Cazaubon
Hello. Can you please introduce yourself?
Hello, my name is Michèle Cazaubon. I have been an angiologist, that is to say a specialist in vascular diseases for… some time! I am a cardiologist by training. When I started my studies, Doppler, functional exploration, was born and nobody wanted to get started so my boss at Bichat hospital said to me “Come on Michèle! Get started! “And since then we haven’t left the Doppler and me!
I am not a phlebologist, that is to say that I do not prick varicose veins but I diagnose everything that is wrong: when there are varicose veins, where it goes, where it does not go, why there is reflux, why the veins are too big, why they are visible, why they hurt, why they can become blocked… Ditto for the arteries. My patient base is mainly represented by women and in particular since I specialized in “big legs” and in lipedema in particular.
Can you tell us more about your work with lipedema?
So I am not a “bare-handed doctor”: I have a Doppler ultrasound machine that allows me to see inside, to see what is happening in the legs, to examine the arteries, the veins, the lymphatic vessels, that is to say the vessels which also participate in the return circulation, and in addition to all the soft tissues, the subcutaneous tissue in which the vessels circulate. I noticed indeed that when the women came for big legs, with pains in the legs, bruises which appear too easily, varicose veins which increase… and when we told them “the Doppler is normal, there is nothing on the arteries and on the veins “they left very happy but on the other hand it was not very satisfactory to take care of them and offer them to improve their situation and possibly to have recourse to the appropriate specialists.
This is why I specialized in lipedema which is a disease of fat cells. That is to say of all that is fatty. When I say “a disease”: it is not recognized by the WHO for the moment, it should have been at the beginning of the year but I think they had lots of other problems and they have dropped the lipedema for next year. In any event, it is still a pathology that must be taken care of in the same way as other muscular and tendon pathologies, etc.
Can you tell us about the difference between lipedema and obesity in your opinion? And can you tell us about the percentage of your patients who have this disease? Are your patients well informed? What is the state of mind of your patients when they come to see you?
Before I specialized in lipedema, my patient base included as many women as men. Now I have a larger patient base of women, almost 99% of my patients who see for heavy legs are women. The examination begins with a precise interrogation because it is necessary to know since when these legs appeared. In general, whether it is lipedema or cellulitis, it appears around the time of puberty. It is aggravated during major hormonal upheavals, especially during pregnancy or menopause. Most often there is a family history: that is, there are fat legs from mother to daughter, and in the family all women also have fat legs.
It hurts, it bothers them. It bothers them from an aesthetic point of view as we are in a period when it is valued to have great long legs without fat it can pose a problem, even social, in the work and it can also pose a problem on the quality. of life, the impression of being treated apart because we have big legs. In short: this is a big problem and it really deserves a load that is the most judicious.
I’m not going to tell them “Tomorrow you will have thin legs” because that’s not true. Usually it is a long process, the patient has to accept certain constraints, for example putting on compression socks, doing lymphatic drainage, doing endermology, and all that 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 his attending physician and possibly the specialist surgeon doctor who will be able to help remove the fatty overload where it is needed and where it is told it is necessary. do.
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 very common question from our patients.
Absoutely. There is work being done to look for hereditary abnormalities but so far there is nothing that stands out. We have tried to find out why fat cells grow and multiply like tumors do, but nothing has been found at present that can explain all of a sudden all of the fat cells getting too big and too many.
Can they multiply extremely quickly?
Extremely quickly and gradually and we have not found a way to slow down their development. This is why it is a little disappointing sometimes because when a patient has lost 10 kilos and there is nothing in the legs. I also see patients with morbid obesity, with body mass indices over 40. Severe obesity with women weighing over 140 kilos for 1m70 and they lose half their weight… and still have big legs. So that’s good they made the first move and we will have to see what we can do to complete and make them much more suitable legs.
Do you have anything to add?
Yes. I often receive patients who are better informed than certain vascular doctors or certain general practitioners who tell them “Well, we don’t know, there is nothing to do. Play sports and lose weight. “The patients go to the sites, the discussion forums. Some doctors are not interested in lipedema because there is no really known treatment right now.
Thank you for your testimony.
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