Fluid flow - lymphedema and soft robotics

Lymphedema is a debilitating, incurable condition which causes excessive swelling in the limbs, and disproportionately affects cancer patients.

In this episode, we chat to Katherine about the device she's working on to make the lives of those with lymphedema better. She also talks to us about her experience of being a British Asian woman and how she stumbled on (as you do) becoming an engineer. 

About Katherine Wang

Katherine Wang is a Research Fellow and Principle Investigator at UCL. She's a biomedical scientist by background and an engineer by training and she knows a lot about lymphedema and how to alleviate the condition using soft robotics (robots made of soft materials).

Ferdouse Akhter  00:06

Hello and welcome to Health in a Handbasket, your podcast about the sexy world of Healthcare Engineering. I'm Ferdouse Akhter and I'll be your host and the Marketing and Community Manager at UCL's Institute of Healthcare Engineering. And although I don't always understand what's written in the research papers published by academics, I know that what we're doing in the world of healthcare engineering is important and impactful. And I want to share that with you by speaking to those who know a bit more about it than me. Today, I want to pick up the topic of lymphedema from the health handbasket. So you might be wondering what this is because I wondered as well. I'm here with Katherine Wang, the best person to answer this question. Katherine's a Research Fellow and Principal Investigator at UCL. She's a biomedical scientist by background and an engineer by training and she knows a lot about lymphedema. So Katherine, what's lymphedema and why haven't I heard of it before?

Katherine Wang  01:05

So lymphedema is basically excessive swelling of the body in an area where the lymphatic system has been damaged. So for example, if you have damage to the lymphatic system in the arm, you might get swelling in the arm, and it's basically an incurable condition and it can cause pain and disfigurement in the patients. A lot of things can cause lymphedema so things like obesity, age injury, but I guess the most common is like after cancer surgery, for example, if you've had breast cancer, and you've had your lymph nodes removed, that might cause cancer, lymphedema in the arms, and there is no cure, and it can be quite debilitating and painful. Patients are often faced with lifelong mental, physical and social economic consequences. And like I said, it's really, it's it's a common complication of certain cancer, certain cancer treatments such as breast cancer or prostate cancer, so they face a lifelong risk of developing lymphedema after their treatment so be it a few months to a few years. So to give you an example, around 30 to 40% of breast cancer patients will develop lymphedema as a consequence of their treatment. So it's quite often glossed over in medical school like the lymphatic system is usually like a passing comment. So it's often very misdiagnosed and overlooked and not a lot of GPS don't even don't even know about it.

Ferdouse Akhter  02:34

That was really interesting, didn't know that about our lymphatic system. Is that what it's called? The lymphatic system.

Katherine Wang  02:41

The lymphatic system, essentially the plumbing of the body, one of the largest and most important systems in the body, but you've most likely not heard of it, and essentially is tasked with transporting fluid around your body. So it kind of gets rid of the waste and the toxins literally getting rid of the sewage in your body. And yeah, it doesn't get enough love. And it doesn't get enough attention, not like the vascular, the nervous system, which gets all the love. So I like to use like an analogy, like it's the Luke of the Hemsworth brothers, like if the vascular system was Beyonce, then lymphatics, is Michelle, and Kelly is obviously nervous. And it's really underrated. And it serves us incredibly well. It's one of the largest networks in our body and works really hard, quietly, behind the scenes, you know, ridding our bodies of toxins and waste. When the system is damaged or overloaded, it can cause problems so think an overflowing toilet that can't be flushed, because there's a pipe missing. And that kind of is what happens in Lymphodema. So you kind of remove parts of the lymphatic system, such as a lymph node and so there was a problem with your plumbing, and that causes a buildup of fluid in your tissues, and that causes excessive swelling. And it's not like the system can be regenerated. So thus, it's incurable.

Ferdouse Akhter  04:01

So sounds like a problem with the sewage system in our body causes a lot of other problems. What are you trying to do about it?

Katherine Wang  04:10

Oh, current treatment kind of involves a range of different approaches to manage the disease. So a lot of them involve things like manual compression to massage the fluid out of the body, skin care, and just like all like are all rounded, like there's a bunch of things that you have to do. But I guess the most common thing massage or compression therapy, which is basically manually massaging the fluid out of the body and a lot of it relies very heavily on visits to train therapists or special clinics and depending on the severity of your disease it it needs to be several times a week to manually massage this trapped fluid away from the affected area. And quite often it's using devices that are called pneumatic compression machines, which essentially is like a fancy massage garment or you go to a massage therapist who then massages the fluid from your body and essentially, both these things require you to go into a clinic. And that obviously can take up time because you're travelling there can take up money because often these treatments are like 40 to 60 pounds per hour. So because this is incurable, you have to go like quite frequently, which for a lot of patients, this is just not economically viable for them. And it's not sustainable either. So a lot of the patients, they don't get the treatment that they need to actually manage this disease. And a lot of the devices, the current gold standard, or like the best in the market is very outdated in design. They're very heavy, they're expensive, they're uncomfortable, and wearing it, quite frankly makes you look like Michelin man. So the lack of available services and a lack of sustainability means that a lot of patients don't have an affordable, accessible and sustainable product that allows them to self manage their disease effectively. I guess that's where I come in. And so my project that I'm working on is called Lymph Motion. And I'm developing a portable, lightweight compression garment, which allows the patient to have total freedom where they can manage their disease wherever and whenever they need, which is unlike current solutions. And because it's wireless and portable, it means that they can use it at home at work or even when they're on vacation. So it means that even if they go away from home and they don't have like a clinic that they need to go to they can still access the treatment.

Ferdouse Akhter  06:38

How did you get into this? How did you learn about lymphedema?

Katherine Wang  06:42

Back when I was doing my PhD in 2019, I went to summer school that was hosted by EIT health which is I think it's European Institute of innovation and Technology. It was kind of like a call to develop a solution to an unmet medical need. And where I went to was this Cancer Rehabilitation Centre in Sweden. You know, I thought I'd be learning a lot about cancer and like how they rehabilitate after having cancer surgery. But one of the things that came up, and it's so common, and it's a very commonly overlooked consequence, and that was kind of the recurring theme of all of the cancer specialists there was Lymphedema. So after speaking to all of the cancer specialists and the patients, that's where I came up with the idea of Lymph Motion. It's kind of like a personal thing for me as well, because my uncle, he had cancer. And as a consequence, he also developed really, like very heavy swelling in his in his legs. I just remember like, he's a pretty like skinny guy, but it was just shocking how like his legs were just two, three times the size of his normal limb. And there was not really much that the doctors could do for him. There wasn't really like any strategies they could do to kind of help manage the pain. And I guess that kind of left like a lasting impression for me. And because the thing with my uncle and the school happened so close together just felt like a calling to me. So as I was finishing writing up my PhD last year, I decided to kind of give this project a real go and while I was writing my thesis, I was also writing these funding applications. So my PhD is completely unrelated to Lymphedema. It's in medical devices and hip replacements and things like that, so Orthopaedics, so completely different. And I kind of veered off on a tangent with the lymphedema project. I basically got some funding to work on this project, which I'm really grateful for. And it's a great opportunity - and here I am.

Ferdouse Akhter  08:48

So tell me what happened before you got to the summer school? What happened in your journey? How did you get there? How did you how did you get to that stage? Because I know you did Bio Medicine. So how did you even get there? Tell me about your journey.

Katherine Wang  09:01

Yeah, so I kind of got into engineering almost by accident, really. I've kind of hopped around in disciplines over the course of my life, I suppose. I went to an all girls high school and there wasn't really a diverse range of career options for people who are a bit more like academically inclined and you kind of presented with things like medicine, law, dentistry. I wasn't really I'm not really like a people person and I have terrible bedside manner. So like medicine was out of the running, but I always knew that I was very fascinated by medicine and sciences. So I chose Biomedicine as an undergraduate degree. And I did I did enjoy it a lot. And I wanted to do like a PhD in tissue engineering because I thought it'd be cool to regrow new organs so I did a master's in biomaterials and tissue engineering here at UCL. It was really interesting because this master's programme was in the Mechanical Engineering Department and it was it was so exciting for me because it was the first time that I realised that you can use engineering to solve medical problems. So it kind of completely changed my career trajectory that I thought I'd go on, I thought I'd be doing stem cells and working in a wet lab and looking at like tiny little cells proliferating. But the handson-ness of engineering just really excited me and that kind of led to my PhD in more bio engineering, I guess. So it was a lot more mechanical engineering a lot more, I guess, mathy. But it's probably not the right word, which was more in medical designing medical devices for orthopaedic trauma. And I guess orthopaedic trauma is just dealing with things - I play with bones. Basically, when bones break, then I designed an implant that would fix that - when you kind of need a new like hip, I kind of look at what kind of stem you should like hip implant, you should look or you should use, like, you know, let surgeons know what they can use.

Ferdouse Akhter  11:15

It's a good point you raised there about like women not being given those opportunities or shown those opportunities. I don't think I ever heard about engineering being an option for myself when I was growing up, it was like, yeah, be a doctor be a lawyer. Listen, I've got Asian parents. My parents are Brown. They only knew like two career options and engineering was not one of them. So I think it's really interesting that you are an Asian female, in engineering. And I think that's amazing. But also kind of like how you don't have to be, you don't have to fit this mould of engineering to be in engineering, like, you don't have to be this, put it in a box. Yeah, put in the box, you don't have to be this maths whiz, or this physics whiz or whatever, to be an engineering.

Katherine Wang  11:59

I think, when you're in high school, there is a lot of boxes that you are putting, there's not really you're not really shown the things that you can do. And I think there's a lot of stereotypes about engineering, like, even when I was doing my master's I thought I'd have to be really good at maths or something like that. I look, I'm Asian, okay and I failed maths, which is, quite frankly, really disgraceful and I'm not ashamed to say, but I thought you'd have to be really good at maths to do engineering and all of this, but you kind of don't, because it's such a broad discipline, and there's like so many things you can do with it. And it's not necessarily that you have to be genius at mathematics to be able to do it. And I think that's kind of what intimidated me away from it at the beginning, because I thought I couldn't do it. But actually, like, you kind of can.

Ferdouse Akhter  12:49

Yeah, I've kind of feel like it's like, if you have a passion, then definitely go with it and go for it. And things like having a maths a level or GCSE.

Katherine Wang  12:58

Ah, I failed maths A levels. I think the only thing that I passed was like statistics, which is, you know, I mean, I guess statistics kind of all you need, right? Like if I wanted to be an accountant, because that's very in line with with Asians do. ,

Ferdouse Akhter  13:12

No, I mean, you're here now. So clearly, you don't need Maths -not to say Maths isn't important

Katherine Wang  13:17

One of the things that I was really excited and really fascinated about was how engineering can come from, like come in all forms and backgrounds. It can be such a multidisciplinary subject. I said before that I didn't know that you could use engineering to solve medical problems but it's not just medical problems. It can come together with like computer science, electrical engineering, mathematics can all come together and solve certain problems. Like for example, in healthcare, that things that I didn't even realise before doing my PhD and even this project, and that's, I think that's what's kind of the crux of what Healthcare Engineering is, right? It's like all of these disciplines coming together and kind of solving problems, like kind of like the G7 summit. Can I can I say a little like, I don't know, the European Union. Well, the European Union felt like, yeah, kind of like the European Union.

Ferdouse Akhter  14:13

Back when it was united. That's a good analogy.

Katherine Wang  14:18

Wait, no. What's that? United Nations, I guess? Yeah. The United Nations of healthcare. Or the Avengers of healthcare.

Ferdouse Akhter  14:32

Yeah. Saving the world from like, asteroids and lymphedema. Yeah, that kind of thing. So you've been on a pretty good journey, I think. I'm pretty impressed. But what does the future hold for Dr. Katherine Wang.

Katherine Wang  14:47

So I guess in the context of Lymph Motion, I'd like it to become like an enterprise like a startup or a spin out eventually I think I've always been quite entrepreneurial even from like a young kid, but I Just thought I'd create like a nonprofit startup. So for example, it using engineering to solve medical problems that might not have current solutions, it would be like creating solutions for medical problems that might not actually be on the market so maybe that would be what would come come next. But I guess like in the context of Lymph Motion, I would like for it to become an enterprise one day. But it's not just the enterprise part. For me. For me, it's kind of more I want to create more awareness to what lymphedema is, because it is so overlooked and misunderstood, especially in things like policy. So it doesn't get as much love and funding as some of the other the other medical problems such as cancer or cardiovascular disease, because I guess, in the scale of what government wants to spend its money on, I guess, they're looking at solving the problem of like, what's going to kill you first, versus what's gonna cause you pain for the rest of your life, right? But like, it's really, for lymphedema, it's really important that you can diagnose it earlier, because that means you can manage it earlier, which means that it doesn't get to a stage where it gets so bad. Like, you know, the swelling is like 2,3, 4 times the size of your normal limb. And it's, it's really common, there's a big misconception, like even amongst GPS that they will probably just pass it off as like, Oh, you're just fat, but actually, you've got lymphedema, for lymphedema it like you're kind of cured, you're kind of cured of a deadly disease like cancer, but you are kind of left to survive with an incurable condition. And that kind of work, at the crux of it is like what when I said about, the government wants to save your life, but it doesn't really think about the chronic pain that it could cause you for the rest of your life. And I think that often is overlooked. And another thing is like create awareness of the lymphatic system, it's a really like underrated system, and it doesn't get enough love. And it's not really even taught in medical school. So there's a lack of education about the lymphatic system, even amongst clinicians, because usually, it's like a passing comment. Like in the school curriculums, you get entire chapters about the cardiovascular system, you get entire chapters, about the nervous system, but you, you get maybe like one sentence about the lymphatic system.

Ferdouse Akhter  17:25

So your vision of Lymph Motion, that's what it's called? So hopefully it makes scenes in the healthcare world. And also, the stuff about awareness is really, really key because without it, there won't be people working on lymphedema or other lymphatic system issues. So that's really key and with a lot of things, awarenesses is so important. So thank you, and hopefully this podcast raises a bit of awareness about lymphedema.

Katherine Wang  17:48

I mean, with lymphedema, it's a lot of people don't know it and don't recognise it. But once you know what it is, it's so common to spot on the street, like when you're walking on the street, you can just spot it once you know what it is. And actually, like obviously, it's to do with removing fluid from your body, right? So it's really like you can't even see for yourself when you go home tonight. So if you've got a bit of puffiness on your face, it's usually because the lymphatic system hasn't like removed the fluid from your body. So it's like the reason why your face might get a bit puffy when you've had bit too many salts, too much salted food. So you know like me when I've added a bit too much soy sauce and msg to my egg fried rice.

Ferdouse Akhter  18:30

MSG is so good.

Katherine Wang  18:31

Yeah so good. Yeah, like once you kind of noticed, when you even when your fingers swell during the summer, he can be like, oh, yeah, that's my lymphatic system. Like, you know, it's a slow day to day. Or, like, you know, when your face gets a bit puffy, it's like, oh, it's less slow day for the lymphatic system.

Ferdouse Akhter  18:47

I guess a bit of self care though. Like for people who like to do some massages. Yeah, this is all places where you have a bit of swelling.

Katherine Wang  18:54

Yeah, you know, it's actually really common. I'm really surprised that the West hasn't caught on to this but in China where my parents, I guess, where I'm ethnically from, it's really common to use a tool called guasha to massage your face.

Ferdouse Akhter  19:07

I have one at home but I'm so lazy so I don't use it!

Katherine Wang  19:12

You should definitely use it because you use the guasha to kind of like move the fluid away from your face right to kind of depuff. That's makes me look so much better. Yeah, that's you massaging your lymphatic system, removing the fluid and stuff so like you know, you see it a lot in like everyday stuff but you don't even think about it because you know it doesn't get all the love and attention it deserves.

Ferdouse Akhter  19:34

I just saw a YouTube video on like how it's like good for your face and it slims your face and I was like yeah, I'm gonna do this.

Katherine Wang  19:40

Yes, because it's all water weight that's getting rid of.

Ferdouse Akhter  19:44

Okay, that's interesting. And a little bit of advice for people at home is  massage!

Katherine Wang  19:49

Massages, dry brushing or something.

Ferdouse Akhter  19:52

Yeah, exactly. So we're called to health in a handbasket. So it would be a little remiss if I didn't ask you what was in your handbasket today.

Katherine Wang  20:10

So like, do you want like a list or like just the top three items?

Ferdouse Akhter  20:14

Give me the top three.

Katherine Wang  20:15

Top three. Okay. So I guess the most important thing, which I guess like shocks a lot of people is my miniature swiss army knife.

Ferdouse Akhter  20:23

Shocking me right now. Why do you have a Swiss army knife?

Katherine Wang  20:26

It's just so useful. I mean, it's like what is the miniature ones, but it's so useful for a lot of things like it has a little flashlight, has a pen, a mini knife. It's really cute and it's like about three inches long. It's got scissors and screwdriver. I use it a lot during my day to day for like lab for opening boxes and things like that. Highly recommend. And I guess the second one would be my iPad, which I use a lot for, like designing and taking notes and things like that. And the third I guess, is my current Book of the Week. I suppose I'm reading a really fantastic book called Dopamine Nation, which I highly recommend should go read it. If you are interested.

Ferdouse Akhter  21:09

I'll add it to my book list. Yeah. That's it from us today. So we hope you enjoy the episode. Katherine's doing some amazing work so and give her a follow on LinkedIn. She's KatherineWang03, is that right? Yeah, yes. And on Twitter where she is?

Katherine Wang  21:29

Yeah, so Twitter. It's Katana Wang. K A E T A N A w a n g.

Ferdouse Akhter  21:37

Yeah, there you go. Thank you for listening in and join us next time on health in a handbasket. Health in a Handbasket is produced by UCL's Institute of Healthcare Engineering and edited by Cerys Bradley. The Institute of Healthcare Engineering brings together leading researchers to develop the tools and devices that will make your life better. We're using this podcast to share all their amazing work taking place. You can learn more by searching UCL Health in a Handbasket or following the link in the show notes. So share with your friends and family if you found this interesting, we're available everywhere, especially where you just listened to us