The Interview with: Professor Neil Piller (Lymphologist)

How did your pathway in medicine eventually lead you to lymphoedema clinical research?    

I'd say just a natural progression. Once I'd had the lecture as indicated below - it became an interest and a focus for me. I was so interested and concerned about the lack of knowledge in the area that I then undertook a PhD looking at pharmacological treatment of lymphoedemas to see if medications could help where sometimes other treatments were not available or possible.  

In 1975, with Toni - my wife - we lived and worked in Zurich at the Kanton Hospital with Dr Leo Clodius, who was the world leader in creating shunts between the lymphatic and vascular systems. He showed they would work and help those with lymphoedema.    

Then in 1977 we worked with Professor Michael Foeldi and Dr Ethel Foeldi in Germany again looking at medications (one specifically called Venalot) to show how well they could help lymphoedemas.  They then moved on to develop the Foeldi technique of Manual Lymphatic Drainage and courses are now run around the world. They also set up the Foeldi Clinic in Hinterzarten in 1986 after a rebuild which is a massive multi-bed hospital where lymphoedema patients are treated. 

We then came back to Adelaide and lectured in anatomy/physiology to nurses before living and working in Xian, China, teaching and looking at their lymphoedema treatments. Of particular interest was a "hot box" type of treatment! 

After that a number of working visits to Sweden where we worked with Professor Iwona Swedborg at the Red Cross Hospital. She was an advocate for exercise, activity and other treatments for lymphoedemas and I still use some of her guidelines today even for myself! What a wonderful woman and leader.   

So, by the end of this time, I'd had the whole breadth of experiences in all aspects of lymphoedema detection, treatment and management. I then joined up with Flinders University School of Medicine where I initiated and coordinated the advanced studies program and through that taught many future doctors about the lymphatic system and lymphoedemas.

What ignited that passion? Was it a particular person, patient or event?   

In 1971, one of my lecturers Dr John Casley-Smith of the then Microcirculation research unit, in the third year of my Batchelor course gave a lecture on the lymphatic system and what it did and then showed some pictures of elephantiasis cases in India. I recall that he and his wife Dr Judith Casley-Smith worked there to help educate and treat those with elephantiasis - lymphoedema caused by filarial infection from mozzie bites.     

At that time treatments were poor and diagnoses very late and care very reactive. So, patients were pretty bad before they were seen and managed. But John and Judy helped to change all that!  They continued making a difference in Australia and around the world with their Casley-Smith technique and courses of lymphatic drainage. They were two of the founders of the Australasian Lymphology Association in 1994 along with me and four other people.

Do you think health professionals are taught enough about lymphoedema in their training? If not, why not?   

No, nowhere near enough. Unfortunately, since there simply are not enough experts around with knowledge in the area.  

Most schools of medicine only have one or two lectures at most on the lymphatics and lymphatic disorders and diseases.     

But thank goodness there are many courses available for therapists (nurses, occupational therapists, physiotherapists and massage therapists) to learn and help treat and mange patients. But there is still often no doctor to make a formal diagnosis of the lymphoedema!  So, a lot of pressure on the therapists.    

And thank goodness for the Australasian Lymphology Association (ALA), the National Lymphoedema Practitioners Register (NLPR) and training groups, such as the Dr Vodder School Australia and New Zealand (which offers massage and myotherapy educational programs ),the Casley-Smith International (a worldwide foundation for certified education in the field of lymphology and oncology) and Földi College (which trains therapists in manual lymphatic drainage and complete decongestive therapy).  

Very importantly, Monique Bareham - president of Lymphoedema Association SA Inc and 2022 SA Local Hero at the Australian of the Year Awards - has raised the issues facing lymphoedema sufferers around Australia and the poor care of them. She has helped enormously with improving political awareness of the issue and facilitated the introduction of the garment subsidy scheme in South Australia.

If you had a magic wand and could change the way lymphoedema is generally viewed, prioritised or known about – what would you change?   

I’d want to improve education at the GP and specialist levels through additional course information about lymphatics and lymphoedema and bring more of this type of knowledge into their Continuing Professional Development (DPD) programs.

Could you share a story or accomplishment that stands out in your work to advance knowledge, treatment and the status of lymphoedema.   

The importance of teamwork became the central story when I led a team of physiotherapists, occupational therapists and massage therapists from Adelaide to run an education program on lymphoedema management in India.  

Good communication between team members was central to running a program on an issue as complicated as lymphoedema, which we ran for three weeks at the Christian Medical College (CMC) Research in Vellore in 2011. There have been many more since organised and coordinated by others in association with the Institute of Applied Dermatology and other groups.

What advice would you give to the younger you when you started out in your medical career. Would you change anything?   

I’d say: don’t wait and see what happens. Get in and be proactive. Look for risks and deal with them. Reduce them and stop people from progressing to clinically manifest lymphoedema. It's what our screening programs are about but still many are missed, or mis-diagnosed. I’d tell the young me that educating clinicians and patients about the risk of lymphoedema is critical. And doing it earlier rather than waiting and watching the lymphoedema worsen!