May 14, 2019
Dercums Disease – A Case Report
PhD MSc BSc
THE COLLEGE OF
A case presentation describing a rare disease with multi-system involvement, resulting in non-lifestyle caused obesity and painful lipomas around the body.
A patient knowledgeable of his own disease presented at Holme Valley Memorial Hospital requesting surgery to his painful heel.
This case report discusses the assessment, imaging and surgical pathway undertaken for his care and reviews the current literature for the causes, diagnosis and management of Dercum’s Disease
Dercum’s disease is a rare, complex disorder involving multiple painful growths in subcutaneous adipose tissue.
It was eponymously named after Francis Dercum, an American neurologist, in 1888, and 130 years later it remains poorly understood. The World Health Organization has recognised it as a distinct disease entity and classes it as lipomatosis not elsewhere classified. It is also known as adiposis dolorosa, and the name
portends its clinical characteristics, the English translation being ‘painful fatty deposits.’
The aetiology of Dercum’s disease is unknown. Various causes have been suggested, including nervous system, endocrine, lymphatic and vascular dysfunction, adipose tissue dysfunction, mechanical pressure on nerves and traumainduced.
Altered lipid metabolism is championed as a cause within the literature, with authors demonstrating altered formation in long fatty-acid chains and disrupted conversion of glucose to triglycerides.5 Genetic causes have been discussed in the literature, with mixed views.
A definite hereditary element has been discussed,1 and some authors have suggested it is inherited on an autosomal dominant basis with variable penetrance, whereas others have indicated it is due to a new mutation with no relevant family history. Some studies have indicated that Dercum’s lipomas are indistinguishable from common lipomas Hansson et al compared fat samples from healthy obese control patients with fat samples from Dercum’s patients.
An inflammatory response was found in the adipose tissue but no more so than in the non-Dercum’s control group, but the study was flawed by a lack
of information on oral anti-inflammatory drug use, which may have affected the results.
Other histological findings include fat cells being larger and the ratio of monounsaturated fat and unsaturated fat being greater in Dercum’s disease. Heat created by the fat cells is greater than that of normal obese tissue.
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Anyone for Tennis?
July 10, 2018
By Kerensa McKie, Chartered Physiotherapist at Physio & Therapies Ltd, Todmorden.
Yes, it is that time of year again… the sun is out, Wimbledon is on the TV and fine weather players are blowing the dust off their tennis rackets! So, it comes as no surprise that the tennis related injuries have started to appear at Physio & Therapies.
Image above by Oliver Sjöström, Instagram: @ollivves, Website: https://ollivves.com/
Like any physical activity you need to plan ahead and get fit for the season, this means starting with general fitness and then adding some specific tennis activities and exercises. Many issues with racket sports can be negated by making sure you get your body ready for the increased level of activity 6 weeks or more before the season starts. However, there are still things you can do if you are better at enthusiasm than planning!
Oh my aching back!
June 4, 2018
With 15 million people visiting their GP each year complaining of back pain and 150 million working days lost each year in the UK due to back pain, getting prompt assessment and effective treatment for back problems is key to a fast recovery.
Back pain can be debilitating and very scary, but the good news is that most episodes of back pain resolve quickly. If however the pain hasn’t settled within two weeks research suggests that assessment and treatment by a Physical therapist is recommended.
Did you know you are probably amongst 70% of people? Why?
May 31, 2018
Did you know that 70% of the population won’t be taking over the counter or prescription medicines correctly?
Every day I see clients who have been to see their GP with various pain issues. Usually they have been prescribed anti-inflammatories; such as Ibuprofen, paracetamol or codeine phosphate. Despite being informed on a set dosage and course they are, in the majority, not following this advice. The usual comment I hear is that they “don’t like taking pills” or they “don’t want to mask the pain in case they make things worse” or they “do not want to become reliant on pills”. If people have collected the prescribed drugs they often only take some or one of the drugs issued. It is at this point I ask if the medicines are helping? Most say “No” and they only take a tablet when they feel their pain is bad enough.
And therein lies the problem. If you only take the medicines now and then or just one and not the other, you are usually wasting your time.
IS IT HOT or IS IT COLD?
April 23, 2018
Hi, I am Kerensa McKie at Physio and Therapies ltd. Today I am going to talk about a problem that has been coming up a lot recently …… what to do when or if you sprain your ankle.
Amazingly 25,000 people in the UK sprain their ankle every day!
So, I will be giving you 3 top tips for what to do to aid your recovery from this common injury.
Top tips for Gardeners
April 5, 2018
By Lynne Midwinter, Chartered Physiotherapist
With gardening listed as a hobby for over half the adult population of the UK there are a lot of people at risk of injury now that the weather is improving and the start of gardening season is here.
At Physio & Therapies the first warm weekends in the spring and early summer usually brings us a rash of injuries from back strain to stiff shoulders presenting at our clinic, so here is our advice on how to avoid unnecessary discomfort.
The most important piece of advice is to pace yourself. Rome wasn’t built in a day and your garden won’t be either! Break jobs down into manageable chunks and give yourself the reward of a break with a cup of tea when you’ve done each part. It’s best to stop every hour for at least 10 minutes.
Kim Irwin on why she thinks the world of Homeopathy is “Wonderful”
March 29, 2018
Come and join me for a one day immersion into the wonderful world of Homeopathy. Not sure what it is? How do you use it? How often do you take the remedies? Are they safe? All these themes will be explored during the day ensuring that you will go home a more confident prescriber, able to treat minor acute health problems.
Using it myself in a first-aid situation was how I discovered Homeopathy and experienced first hand its efficient and gentle capacity to restore health.
Lets go back to April 2012….I had landed a job cheffing on a yoga retreat in Greece for 3 weeks over Easter. Sounds great doesn’t it? And it was, but it was REALLY hard work. Cooking for 40 people everyday and evening is a difficult task, coupled with the Mediterranean heat it meant I wasn’t getting enough sleep and not enough sleep plus hard work takes its toll on the body.
How can tennis balls help with knots in your muscles?
March 26, 2018
In today’s post I am going to give you a few tips on how to help yourself when you have achey, tender knots in your muscles.
Muscle knots appear in various muscles in the body and are known as trigger points. You can tell if you have one because if you press or squeeze them they can hurt! Often a lot! They can also radiate pain into another part of your body, so you might squeeze your leg muscle but feel a pain in your foot, for example. Here at Physio and Therapies they are one of the most common things we find when we assess clients who come for help with a wide range of problems.
Has your New Years’ resolution broken you?
February 19, 2018
About now every year at Physio & Therapies we start to see the ‘new year resolution’ injuries. So today I am going to have a little rant about over doing it …… then I will give you some top tips on how to stay safe while you’re getting fitter!
So what is a New Year resolution injury? Well you know how it is, after the excesses of Christmas you decide to do something about your fitness, your weight, your waistline and then, after one too many drinks, you find you have signed yourself up to a fun run or a marathon for charity!
Notes from a Pelvic Health Physiotherapist
February 12, 2018
When arriving to do my ‘Women’s Health’ elective placement in 2000, I thought I’d observe Pregnancy classes, talk to ladies about bladder care, teach exercises to do after a Hysterectomy, and teach Pelvic Floor exercises. To my horror, I met my clinical educator for the next 6 weeks… coming out of fracture clinic with a BROKEN right arm! So I became her right hand, LITERALLY! That afternoon, she guided me through a vaginal examination of a new mum with weak pelvic floor muscles and leakage after having her baby; rectal Biofeedback on a 25 year old gentlemen who had been in a diving accident which left his anal sphincter weak and we examined a lady with a vaginal prolapse and taught her how to manage it. From then on I was hooked and most of my training since has centred around Pelvic Floor/Continence.
‘Women’s Health’ is now more often called ‘Pelvic Health’, in many hospitals/clinics not only because it is a more accurate description, but in sympathy with the poor men having to hide at the back of the waiting room of the ‘Women’s Health’ clinic!