Swollen, Bloated, and Puffy with Kathleen Lisson

Speaker 1:
You're listening to The La Jolla Cosmetic Podcast.

Monique Ramsey:
(00:14) Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. Today, we have a very special guest who is also a patient, but today we're going to talk with her about lymphatic massage therapy. And specifically, after having a plastic surgery procedure, what is it? How does it help? Who is it for? Who needs it? How do you find somebody who's qualified? So Kathleen Lisson, welcome to the podcast.

Kathleen Lisson:
(00:43) Hi, it's so wonderful to be here.

Monique Ramsey:
(00:45) So you're known nationally, you've written several books, but you teach people how to do this type of massage. Is that correct?

Kathleen Lisson:
(00:55) Yes. So I'm the author of books and I'm also a NCBTMB approved provider. So I'm a board certified massage therapist. So the place that you get your board certification from, they will also approve providers of continuing education. So my CEs carry that seal on them. And so I don't teach manual lymphatic drainage, I guide people like, if you want to learn lymphatic drainage, you should go to the place that I learned, and learn it from someone who has a doctorate in physical therapy or one of the teachers there. But if you want to learn post-op massage, if you already know MLD, and you're starting to get these phone calls of people who are like, "Oh, I see you do lymphatic massage. I just had liposuction. I hear that's a good thing. Like, can you help me?" MLD will help. And then when you start getting hardness or tightness, a type of massage called postoperative post-op massage and fibrosis treatments will help soften that up and get those proteins back into the lymphatic circulation.

Monique Ramsey:
(01:58) So how would you describe lymphatic massage to somebody who's unfamiliar with that technique?

Kathleen Lisson:
(02:03) It's fantastic. It's amazing. So the difficulty is a lot, anyone can use the words, lymphatic massage, or manual lymphatic drainage, and it is a buzzword. So people will definitely try to charge you money who don't have training in it because they know you're desperate after surgery and you're going to pay for it. So it is not pushing fluid out of your incisions, and it's not deep tissue massage. It's a gentle skin stretching movement. We're just on the dermis itself, and we're opening up by stretching the skin, we're opening up that initial lymphatic capillary to be able to take fluid inside because we're mimicking the natural action of the body, the initial lymphatic capillaries do not have muscles around them. The heart is a pump for all our blood circulation, but the initial lymphatics are moved around by joint movement.

Kathleen Lisson:
(03:03) So that's how you will see some people will get swollen ankles if they sit at the computer for a long time, or if they stand for a long time and they're not walking, because that calf muscle is a second pump that can help move that lymph up and move it around. So people will see the more sedentary you are after surgery, you're kind of like puffy everywhere. So we're just helping the body along to help get that lymphatic system balanced again. And the fluid's always moving, but we're getting it moving in the right direction.

Monique Ramsey:
(03:36) Now how many lymph nodes are in the body and where can we find them?

Kathleen Lisson:
(03:41) Oh, there's 700 to 800 lymph nodes in the body.

Monique Ramsey:
(03:43) Really? I thought you were going to say like 12 or something.

Kathleen Lisson:
(03:46) No, no, this totally classic. So you'll see the big ones. You've definitely felt, they're in the neck. They're right underneath that angle of the jaw. And when you get sick, those get big. And then if you have like a really, really old school doctor or you're an old person like us, if you're an older person like us, you may have had a doctor that actually touches you during your exam. Those younger doctors don't touch, they just look at the reports. It's crazy. But do you remember where the doctor will like tap, tap, tap on the jaw and tap, tap on the side of the neck, and then tap top, top on the clavicles. That's the doctor feeling the lymph nodes in the neck to see if there's any swollen lymph nodes. There's also a lot of lymph nodes underneath the axilla, underneath the armpit. And then in the inguinal, underneath the inguinal ligament where the body meets the leg, the body and the leg meet. So right underneath where your underwear is.

Kathleen Lisson:
(04:40) And then there's the most of our lymph nodes in the body are in the neck area. And then in and around the intestines, in the abdomen. Because like we said before, the lymph nodes are part of the immune system. So they're screening, they get those white blood cells in there. So every opportunity that your body gives you to try to kill it and grab bacteria, you're going to put it in your mouth, it's going to go up your nose, it's going to go in your ears, it's going to go in your eyes. You're going to try to eat something and it's going to go into your digestive system. We need lymph nodes there to be like, oh look, we ate bacteria. Let's go ... Oh, there's a virus, let's go out. So that's why we do, I do a lot of neck work and then some deep abdominal breathing. Most all my clients, we are doing deep breaths at the beginning of their session.

Monique Ramsey:
(05:27) And what is the deep breath, that gets that, the lymph nodes in that area kind of engaged?

Kathleen Lisson:
(05:33) Yeah. And it's very interesting. This is like a review. I should send this to the person who taught me. CLT school, look at all this stuff on the test that actually, I need to regurgitate it six years later. It's great. So the largest lymphatic vessel in the body is the thoracic duct. So it goes from the cisterna chyli, which is around deep inside the body kind of close to the spine, but near the belly button area. And then it goes up to connect with the circulatory system right underneath the clavicle. So right there at the midline. And so what's there perpendicular right there is that diaphragm. So it actually runs through the diaphragm. So when you do deep diaphragmatic breathing, you're actually moving the flow of the fluid up in that thoracic duct. And then the diaphragm is also as you're inhaling and exhaling, you can feel your intestines, like your large and small intestine are moving as the diaphragm is coming up and down.

Kathleen Lisson:
(06:30) So this is how everything in the body has this rhythm and our movement is helping us to move our lymphatic system. So the more we deep breathe, the more we move in all different planes of motion, the better. And this rotational like shoulder rolls feel really good. Like, hip rolls feel really good because we're kind of moving around those lymph nodes and clearing them out so they can take more fluid.

Monique Ramsey:
(06:58) Interesting. Now, how long have you been doing this?

Kathleen Lisson:
(07:01) Six years, I actually had a career. I used to work for the New York State Legislature and then my husband got a job offer that we couldn't refuse. So we moved out to San Diego and I went to massage school and I heard about oncology massage, which was just an eye opening event for me because my mom was diagnosed with cancer when I was nine years old. She had a very advanced cancer. They thought that she was going to die. And as a child, I had tiny little hands, I couldn't help. But what I did see in the hospital were all those doctors, and all the therapists, and all the nurses that did help my mom get better. So back in the 80s, when you get like a radical mastectomy, they didn't know what spread the cancer. So this was back in the time when you couldn't exercise, you couldn't lift more than five pounds and you definitely probably could never get a massage because they didn't want to "move the cancer around."

Kathleen Lisson:
(08:06) So knowing that not only was that not true anymore, people are recommended to exercise and they're recommended to get massage because it helps reduce the symptoms that you get during cancer treatment. So I was obsessed with oncology massage so much too, I was a very good student and very forward as you know I am. So I wanted to take the oncology massage class and learn about it. Because I was on fire, I was going to finish massage school, but I really wanted to learn about this. So I managed to be very convincing and I let the lady let me sit in the class and take notes, even though I didn't have my license yet. And she's like, "You can sit in the class and take the notes, but you can't actually go to Moores Cancer Center and work on people in the infusion room until you get your license."

Kathleen Lisson:
(08:58) I got my license and then two weeks later I was helping people. I was giving hand massage to people in the infusion room at Moores Cancer Center. And so that has kind of been the beginning. I've always worked on people after surgery. I've always been educated from the very beginning to know about chronic disease and to keep people safe. You can do the massage but if someone has lymphedema is at risk for lymphedema, you have to know this other type of massage called manual lymphatic drainage and do that on the area so you don't accidentally exacerbate someone's lymphedema. You should understand the lymphatic system. So then I took the MLD class, and I went to take the CLT class, and then I wanted to know so much more about it so we talked about earlier, that I went to the Földi Clinic, which is the number one lymphology clinic in Europe, which is in The Black Forest in Germany. So you take like a plane and a train and a bus and you're like deep inside this imposing forest and there's this place that's like a castle, it's like a hotel.

Kathleen Lisson:
(10:02) And then it's the clinic where the clients stay overnight and then they get treatment twice a day for three or four weeks. And the things that those therapists were doing over the space of five days, would've taken two weeks in America without patient treatment. I'm stunned at some of the fast results you can get on people if they're in a fairytale castle in The Black Forest in Germany. But they're very holistic there, they have them bandage them and they have nutrition, you eat at the Földi Clinic and you do your exercises and you get your massages. And so that really inspired me to continue looking holistically at the client at all aspects of it and being open to answer or get them the referral to the expert on all questions because you can't just only deliver a massage. You have to take care of the whole person.

Monique Ramsey:
(10:57) So what's the difference between lymphatic massage and lymphedema?

Kathleen Lisson:
(11:03) Yep. So lymphedema is a disease. It's often a side effect of cancer therapy where the arm or leg will swell up because they've either irradiated or done surgery to the lymph nodes or other things like the chemotherapy drugs during cancer therapy. So the arm or the leg will swell in lymphedema therapy. My training is in lymphedema therapy and I'm a lymphedema therapist because I have the training required to help those people reduce their swelling and fibrosis after cancer surgery. The most common way that you get lymphedema in America is also chronic venous insufficiency in the legs. So that's you'll have leg swelling because of chronic venous insufficiency. And you can also have primary lymphedema, which is a genetic disorder.

Monique Ramsey:
(11:53) Oh, okay. And you were talking about fibrosis. So tell us what fibrosis is.

Kathleen Lisson:
(11:57) Yes. So fibrosis, we can begin with the swelling in the body or the body, how I introduce it to people is we start with the circulation. So your blood has a pump, the heart, and the heart pumps all the blood, which delivers all the nutrients to each and every cell through the capillaries. And then we have a lymphatic system that takes all the waste products, and fluids, and bacterias, and everything away from the cells out of the interstitial fluid. So the immune system is part of the lymphatic system. So your lymph nodes will have part of the immune system in them. So if you get some kind of bacteria or a virus, then your lymphatic system will see it. And the lymph node will see it. And then your immune system will send out the calvary to help.

Kathleen Lisson:
(12:47) So when you have a backup and you have more fluid, the interstitial fluid in between each and every cell and that fluid starts kind of filling up and gunking up with proteins, it starts to settle and get firmer, kind of like jello firms up. And then that firmness eventually becomes fibrosis if the lymphatic system doesn't take it out. So the manual lymphatic drainage is a type of massage technique that encourages that interstitial fluid to enter into the lymphatic system.

Monique Ramsey:
)13:24) What could go wrong if somebody tries to do lymphatic massage, let's say on a person who's had surgery, let's say lipo, and they go to somebody who pretends like they know what they're doing, but they don't really, and what could go wrong?

Kathleen Lisson:
(13:42) That's a scary question.

Monique Ramsey:
A lot.

Kathleen Lisson:
(13:45) A question like you don't want to ask a doctor. So I want to say two different things because I don't want to scare you off from doing it yourself. And there's videos. I have a website that I send people to that has videos of a trained lymphedema therapist showing you how to do the MLD on your arm and your leg. So if you're following a video, and you know that that's the proper thing, you pretty much can't hurt yourself because you can tell your own pain levels. But honestly you are going to get bored of doing it before it really hurts, before you can really hurt yourself.

Monique Ramsey:
(14:23) It's like do 40 pulses, now do that 5 times on the left side and then you're just like, oh, now I got to do the right side. Wait a minute.

Kathleen Lisson:
(14:31) Yeah. Yeah. So I'm not so much scared of you doing it, but the difficulty is what will happen to someone who doesn't have the education or they have education from somewhere and their teacher taught them incorrectly. And they honestly believe that you should do a deep tissue massage on someone four days after surgery, or you should try to push open. So the worst thing that you will see overseas is they will take a non-sterile instrument and open up the incision where ...

Monique Ramsey:
(15:06) She looks at my face, I can't hide my emotions very well. My mouth is like straight open. Oh my gosh.

Kathleen Lisson:
(15:17) So they'll use a non-sterile instrument and they'll cut you back open and they'll try their best to push the fluid out. That is very painful for people. I give presentations to or nurses. I give presentations to other lymphedema therapists. So I have quotes from people on the internet who have told me about it afterwards and said, "Kathleen, you're on the internet all the time saying this isn't painful. Like why do I have PTSD?" And people will say like the level of pain is, she said like I had my child naturally without any medication. This was worse.

Monique Ramsey:
Wow.

Kathleen Lisson:
(15:53) This was worse. Why do I have PTSD? I can't go back. And then that's really frustrating because they're still swollen, and they have pain, and they have this bad experience after surgery and they don't know where to turn because they don't want that to happen again. And it's every two weeks, every month, I want to get out there with a post on social media and just continue to inform people that that is not actually manual lymphatic drainage. It's a gentle skin stretching stroke. I also do some post-op massage, which again is gentle. The level of pain that I get to is if you have a good workout, you're the kind of person that likes to work out at the gym and you have this, like that hurts so good. Like you're getting in there and I like the feeling. I could tell that you're doing something, but like it hurts so good is the only thing. As soon as you flinch.

Kathleen Lisson:
(16:48) And then also if you're gritting your teeth, if you're flinching, your nervous system is going into fight or flight mode, and things are happening, and chemicals are being released into your system that is stopping you from healing. Much better to be in a parasympathetic nervous system where people are relaxing, people, if they want to ask me questions, they ask me questions. If they stop asking questions and that beautiful spa music is on, people will fall asleep. That's how peaceful it is. And then they'll wake up and they'll be like, "I have to pee. And I feel thinner. My compression garment is coming on and it's looser, like I was able to get it to the next tighter hook." And that's the kind of experience you need and that's the experience you will get with a trained therapist.

Monique Ramsey:
(17:37) What happens when you have surgery, how does that affect the lymph system?

Kathleen Lisson:
(17:44) So it depends on which surgery you have. The bigger surgeries, like a tummy tuck in that section when you're actually like removing skin and stuff, that's a little overwhelming to the lymphatic system. So we just do the lymphatic massage and then we're gently guiding the excess lymphatic fluid. And we're just helping the lymphatic system, the [inaudible 00:18:12] increases, the level of pumping in the lymphatic system gets faster so more fluid can enter the system and get pumped in through the system. So what it eventually will go, like we said, the thoracic duct, and then it goes back into the circulatory system, and then it'll go to your kidneys, and your bladder and then you'll urinate it out. If I feel like we did a lot of good work in this session, particularly the first session, you might get up in the middle of the night to pee again. And this is your body naturally pushing that swelling out.

Monique Ramsey:
(18:42) Would there be any warning signs? Let's say you've had surgery and then all of a sudden something's sort of not ... Like, I guess if you had excess swelling in an area, would that be because the lymph system is not working properly?

Kathleen Lisson:
(19:00) Or there's just a lot of swelling because it's surgery. So I'm a big lymphatic system apologist. Like there's nothing wrong with your lymphatic system. Like I like to say it's at the 5, at 4:30 or 5:30 at night, there's just a lot of cars on Interstate 5. The highway itself isn't broken. All the people just decided to leave. So surgery is like all the people just decided to leave and maybe like there's some cones on one side, so there's like one less lane. But what happens is we're just letting the traffic move faster is what we're doing with lymphatic massage.

Monique Ramsey:
That is a genius analogy.

Kathleen Lisson:
(19:42) It's backed up. Yeah. But you can't push the traffic forward from the back. Those first cars have to start going faster. So that's why we start with the deep breathing, we start with the lymph nodes, we're getting those cars out in front to start going faster, and then all of a sudden space is opening up, and then all the other cars can start traveling faster.

Monique Ramsey:
(20:01) Does it depend on the type of surgery when they could first have a lymphatic drainage massage, like 5 days over, or 10 days? Are there any rules or does it sort of depend on what procedure they're having?

Kathleen Lisson:
(20:17) Yeah. So there's no hard and fast rules. The equation that I'm doing in my head is when can I give them this treatment that it's not going to be painful for them. So for liposuction, I like to see them like five to seven days out, depending on how super sensitive they are. Usually the MLD has been proven in research that the first touch that I do in the first five minutes of the massage can be sensitive. But by the time at the end of the massage, the sensitivity is dampened so it's less sensitive. And also their threshold to pain is higher. Tummy tucks, I will go in if the surgeon wants me to do MLD when there's a drain there, but I like it to be the day after the drain comes out, because the drain is helping the lymphatic system. And once you take the drain out, all the stuff that was going to go into that drain is now in the interstitium. So we can take it into the lymphatic system. So usually they really like it the day or two after the drains out for their first appointment.

Monique Ramsey:
(21:20) I have to ask you, I've seen celebrities like Paris Hilton, or J.Lo, or Chrissy Teigen, Lady Gaga. They're mentioning something called the Balancer Pro on their Instagram lately. Do you know anything about it? What is it? And does it help?

Kathleen Lisson:
(21:35) I believe it's a pump, an intermittent pneumatic compression. So there's pumps, which I want to give an official answer since I'm a lymphedema therapist. If you have lymphedema, your medical provider is going to give you a specific intermittent pneumatic compression pump that has been tested on clients that have lymphedema, which is a side effect of cancer treatment. So we have to be very serious about exactly what you're doing. I don't just want you to buy something off of the internet.

Kathleen Lisson:
(22:09) I have heard of plastic surgeons in Beverly Hills are using it. So I would defer to the plastic surgeon. They have to decide where they want their client to use that and I'm very intrigued in it. I'm interested in what's going to happen in the next five years because I won't really work on someone early in the first week. But surgeons have said that they're putting the clients in the Balancer Pro and they're having a good experience, the client is having a good experience with it. I don't think it'll ever replace the hands and eyes of a massage therapist, but we do use intermittent pneumatic compression in the ongoing care of people with lymphedema.

Monique Ramsey:
(22:53) Now I remember hearing at one point that as a plastic surgery patient, if you were prepping for surgery, that you could have lymphatic drainage before surgery to sort of get your body optimized, or cleansed, or I'm not sure the right word. And so do you think that's a good idea? And if so, sort of how much before surgery would you recommend?

Kathleen Lisson:
(23:18) That's like the crazy secret that I think no one's talking about. And I think usually because I don't think we can tease it out, it would be nice if we could possibly do a study on it because I think the people who will actually come to me for lymphatic massage beforehand is that type of client who is going to do everything. So they're not just going to eat junk food and never exercise, but come for a lymphatic massage and then have great results. So it's usually a fantastically prepared client and they, I would say, come to me like 48, 72 hours, 24 hours beforehand. We want it kind of close to surgery because we have two goals.

Kathleen Lisson:
(23:59) One is I'm going to move if there's extra, like if you have bloating or puffiness or anything, we're just going to move that out. So there's not extra fluid there even before the surgery. And then also this is going to be like, it's relaxing, it's an amazing experience. So the stress really increases. The stress is there in the week. And if you can get that last touch where you have, I would say, I wouldn't just do lymphatic massage on you. I would also do like, does your neck hurt? Does your lower back hurt? Let's hit everything so you get a good night's sleep as best as possible the night before surgery.

Monique Ramsey:
(24:38) So the last thing I think is I wanted to just touch on the books you've written and how you kind of explained that. We could put those in the show notes for anybody who's interested because not only are you an expert and doing it all the time, but then also trying to help patients through the things that you've written, and helping them have a better experience, have a better outcome. So tell us about your books.

Kathleen Lisson:
(25:05) Yeah. The books came out of when I had people after plastic surgery was they wanted to stay awake, because this was an hour that they had, and they had a lot of questions, and they wanted to ask me everything. They wanted to know all about the lymphatic system. They wanted to know about how to treat their scars. When the tape is this, this, that, the other. And just like 28 questions. So I started with the social media, answering the questions online that I got a lot and it really struck a nerve with people, like people were really helpful. And I got the idea that these aren't just my clients that have questions. It's overall, everyone has these questions. This is a common experience, common questions.

Kathleen Lisson:
(25:48) So my first book is Swollen, Bloated and Puffy. And I wrote that for anyone who wants to optimize their lymphatic system and my clients that had lymphedema. And it's a wide variety. It's like how to poop correctly, and how meditation, and what's going on in the lymphatic system, kind of like a holistic treatment way of ideas. But all of them are well researched. So this is the beginning of a conversation. So you read this book, I've cited the journal articles and then the journal articles, the URLs in the back. So you can print out the journal articles and then bring it to your medical expert and say, "Oh this is the proof for this. Should we do this in my treatment?"

Kathleen Lisson:
(26:27 I had a client that had liposuction for lipedema, which is a loose connective tissue disease, where the bottom half of the person is like a larger size than the top half. And they have a lot of extra fat deposition and pain and bruising. So when I got my first client with lipedema, I thought it would be easy. And I thought, well, like I don't have a book for her, but I'll just go somewhere really quick on the internet and print something out and guess what? There was nothing.

Monique Ramsey:
Oh my gosh.

Kathleen Lisson:
(26:58) Nothing. Quality on the internet. The research in lipedema has really increased over the last five years. But at that time, I had nothing for her and I felt like this is something that people need to know. So I wrote The Lipedema Treatment Guide, which is a lot of non-surgical treatments for lipedema all backed by science. And again, the journal articles that you can take it to your doctor and be like, "Hey, what do you think of me trying this? What do you think of me trying that?" And then also a guide, if someone is having surgery for lipedema liposuction, this is the guide and some information on it, and then how you can prepare for it and stuff. Then my third book was a Plastic Surgery Recovery Handbook. And that's the big one that everyone likes.

Monique Ramsey:
I have a copy.

Kathleen Lisson:
(26:58) Yeah. So that is the one that I wanted to speak directly to the people who were having plastic surgery. I wanted to talk about the lymphatic system, but I also wanted to talk about your compression garment and the types of foams that I was using. A lot of people have a question about scars. They have a question about fibrosis and hardness of the tissue and thickness of the tissue. And then I wanted to have the first part of that book is a couple pages on questions to ask your surgeon so you can get an exact idea of what your recovery's going to be like.

Kathleen Lisson:
(28:13) And then in the back of the book is at least a month of little lines and days so you can write a sentence or two about how you're improving every day. Because what I see, and even personally at two weeks, at three weeks, at four weeks, you can definitely wake up and be like, I think my recovery stalled, I don't think I'm healing. I just feel like this is a nightmare I can't wake up from. And at that point, I want you to go back to this diary that you have, this journal that you have in the back of the book and be like, oh yeah, like a week ago, I couldn't even walk a mile. And now I'm doing this and it kind of just gives you that optimism that you need in that very vulnerable time after surgery.

Monique Ramsey:
(29:01) And then didn't you recently have a diet book, not diet, but like ...

Kathleen Lisson:
Cookbook.

Monique Ramsey:
Cookbook, like eating right for optimal outcomes.

Kathleen Lisson:
(29:11) So it's called The Southern California Plastic Surgery Cookbook. So it's a cookbook. There are several interesting questions that I kept on getting like, "is there any herbs that could help reduce swelling? And what are these enzymes people hear about that can help reduce fibrosis?" And the focus I had was you should also focus on what your grandparents ate, and what people from your culture eat because the emotional part of eating and healing are very important. And I asked around for some recipes for people, what would you eat when you were sick in your family? What really made you feel cared for and nourished emotionally as well as nutritionally? And that is what really helped.

Monique Ramsey:
( 30:00) I have to check out the cookbook because it's a really unique thing. Like nobody's ever made one for this reason. And you having that, the building blocks of that nutrition in your body so that when you're walking, literally walking into that OR, that you are ready to go.

Kathleen Lisson:
(30:19) And there's some delicious three and four ingredient smoothie recipes which are a big hit in the summer. Yeah, because sometimes eating is exhausting, or you want comfort food, or you can eat eight bites and then you're just done. So a smoothie is something like you can drink the nutrition and get those vegetables, and nutrients, and then have a little bit of it now and take a nap and have a little bit of it later. And yeah, people really love those smoothies.

Monique Ramsey:
(30:47) Well, I remember looking at your plates, you would share sometimes your breakfast or your lunch prior to your surgery. And, oh my gosh, they were gorgeous. They were cookbook worthy for sure. But you were representing all the colors because of all the nutrients on the plate. And I just love that. And we'll put your Instagram in the show notes also because it's great to follow Kathleen because she's always got interesting questions from people who write into her and she'll answer the question live and not live, but live.

Kathleen Lisson:
In a video.

Monique Ramsey:
In a video.

Kathleen Lisson:
And some of the language is saucy.

Monique Ramsey:
(31:23) She's a little bit saucy. I think that's really cute.

Kathleen Lisson:
Make sure you're okay with saucy.

Monique Ramsey:
(31:29) Now, if somebody, let's say they're outside of the San Diego area, they're listening, how would you suggest they find a qualified lymphatic massage provider?

Kathleen Lisson:
(31:41) Yep. So I would start with, they should have some kind of license ... It's sad that I have to say this, but shouldn't they have a license to actually practice business in the city that you're in and then they could be a physical therapist, occupational therapist, nurse, massage therapist, physician assistant, nurse practitioner. So they need to have some kind of medical background. If there was a shortcut, which is one interesting shortcut, if I would say, do you have an NPI? And if they have a national provider number, that means you can check their national provider number and see what they're classified as on that website. So I have an NPI which allows me to take health savings and flex spending accounts. I can issue an invoice, which you can take for if you have a health savings or a flex spending account.

Monique Ramsey:
(32:32) That's good to know. Last thing is, is there a ballpark range for the cost of this service?

Kathleen Lisson:
(32:42) Okay. So number one, should be on their website. That's another big red flag if you can't even figure out how much it is or they should definitely tell you, but it's not even that they should tell you. This should be public on their website. I charge $120 an hour. Wherever you are, it should be about the price of the massage at that nice spa. I would be a little concerned if it was very cheap because it takes a lot of education the same way as I would be very concerned if someone was offering a $500 discount for liposuction or their liposuction prices were significantly cheaper than anyone else. Because school is an investment and I've made an investment in my education, and you are making an investment in your surgery, and your surgeons made an investment in their education so that's going to show in the price that you pay.

Monique Ramsey:
(33:31) It's not something to get cheap about. That's for sure. It's good to think as you're approaching a plastic surgery procedure to sort of build in that cost of, I would like to see a lymphatic drainage therapist three times, or four times or whatever. That's part of my healing. You want to give yourself the best chance to heal. I like to think about this as part of the surgery, even though it's maybe mostly post-op, but if it's going to help you recover, then it's worth it, and kind of good in your mind to think of it as part of the whole package.

Kathleen Lisson:
(34:10) Yep. And so in my hands with the surgeons that I work with, usually I need two hours of massage for every liter removed. So if you had four liters, I'll probably need to see you eight times. For tummy tucks, I'll only really need to see people three or four times.

Monique Ramsey:
(34:29) And Kathleen, anything else? Is there any other expert advice that we didn't cover?

Kathleen Lisson:
(34:35) Yeah. Never be afraid to ask your doctor anything. The doctor wakes up and goes to sleep and has this passion. Passion, particularly the doctors in this practice, a passion to help you succeed. And the whole staff at La Jolla Cosmetic is always going to be in your corner. They're eager to hear your concerns and get them taken care of sooner rather than later so you can have an excellent recovery experience.

Monique Ramsey:
(35:00) Well, thank you. That's nice. That's a nice compliment that I wasn't fishing for, but I'll take. Our practice, they do really care.

Kathleen Lisson:
(35:05) And that's why I work with these doctors because I want to know that I'm a part of a team and that the whole team is working to give this client the best experience possible.

Monique Ramsey:
(35:19) Well, thank you Kathleen for coming and giving all your expert advice and sharing your knowledge with everyone. And if you guys haven't heard her other episode about her surgery that she had, definitely check that out because it's full of great information as well. And so if you're listening today and you have any questions, check our show notes, we'll have links to everything we covered today. All right, everyone. Well, thanks all of you for listening and we'll see you on the next show.

Kathleen Lisson:
(35:48) Thank you.

Speaker 1:
(35:54) Take a screenshot of this podcast episode with your phone and show it at your consultation, or appointment, or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I5 San Diego freeway in the XIMED building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com or follow the team on Instagram @ljscs. The La Jolla Cosmetic Podcast is a production of The Axis. the axis.io.