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Deborah: For those who have been diagnosed with lymphedema, there are therapies that can help. And now, there's new technology that can help track and even prevent lymphedema. Today, we're going to learn a little bit more about Sozo.

This is the podcast series from Deaconess The Women's Hospital, a place for all your life. I'm Deborah Howell and our guest today is Keri Claybourn, a physical therapist and certified lymphedema therapist at High Pointe Therapy at The Women's Hospital. And today, we're going to take a deep dive into Sozo. Welcome back, Keri.

Keri Claybourn: Hello, Deborah. How are you doing today?

Deborah: Great. So nice to be talking to you again. If it's okay with you, let's jump right in, shall we?

Keri Claybourn: That sounds perfect.

Deborah: I am dying to know what is Sozo.

Keri Claybourn: Sozo is the name of a digital health platform that provides technology that allows a fast, non-invasive, easy to use test. And this test can tell if patients are at risk for lymphedema. And what's so cool about it is if we're able to see patients before they even have surgeries like breast surgery, gynecological surgeries, prostate surgeries, anything like that, we can get a pretreatment test and establish a baseline. And then we can recheck post-surgically, following chemoradiation, all the different treatments that can happen with our cancer patients.

And so this machine, which I'll go into more details about how it works, but it's just awesome. It looks like a scale that patients are going to stand on. And you're going to have bare hands, and feet. You want to make sure to remove jewelry, any metal or anything like that. And then you stand on it and it just scans you. And the test takes about 30 seconds. If you're not able to stand, you can actually sit and we can bring the platform down to you, so you can just place your hands on your lap. And the way it works is it sends an electrical current through you, but you don't feel anything, so don't worry about, "Oh my gosh, you're sending an electrical current."

Deborah: Right.

Keri Claybourn: The only thing is we don't do this if you have a pacemaker defibrillator, because we don't want to mess with any electrical currents there. And a lot of times people ask what if I had a total knee or a total hip, that is completely fine. We just make note of that because sometimes that can change the readings, but then we've got that to keep track of. So you don't feel anything and it's a fast, easy way to check for lymphedema before we can actually visually see it, the patient can visually feel it, or we could even measure it.

There's lots of ways, standard ways, to measure lymphedema. The way that we use here is doing circumferential measurements. And so this is going to be able to pick up changes in fluid before we could even notice anything with us physically measuring. And so the goal of this then is to be able to get this test and then we can repeat these tests, which they recommend like in the first one to three years following your diagnosis and surgeries, doing the test every three months. And then at years four to five following surgery, doing every six months. Six years out survivor, checking annually, because we know lymphedema can happen at any point in our life. It doesn't matter if you're a couple months out or 30 years out, it could happen.

And so we're just always looking at how can we reduce and improve things before it becomes the chronic issue where you're having to wear compression every day and all of that. And I mean, we may still run into that, but the goal of it is we can test, it'll trigger a reading. And when it triggers that, then we know, "Hey, let's go into compression, and then provide treatment before that lymphedema becomes chronic. So we could still improve it and reverse it."

Deborah: Wow. And what about someone who just has lymphedema? Is there any reversing it through this Sozo technology?

Keri Claybourn: There is not any reversing of it through the Sozo technology, but I have been using it in some of my coworkers. Our team has too with patients that we've currently been treating for lymphedema. And what's great about that is these patients were able to get measurements and then they'll come back and say, "Oh, I haven't been as compliant with my compression or my pneumatic pump," and be able to see where their readings are and then they come back and they're like, "I've been really compliant like I should be," and we can get the readings back to more normal. So I think that's a good way for them to measure too why it's important for them to be compliant with their treatments when they need that. But for those people, they have already progressed past the point of us being able to reverse it. We're looking at long-term management.

Deborah: Okay. And what is bioimpedance?.

Keri Claybourn: So what the Sozo is measuring in order to give us the score and test to know about lymphedema is bioimpedance. And it's a weird thing to describe, but it's an electrical analysis for estimating body composition. So when that electrical current is going through, you're getting a mixture of high frequency and low frequency electrical currents. So in particular, like body fat and muscle mass, like where there's a weak electrical current flows through the body and then that voltage is measured. And this is used in order to calculate the ability of the fluid to move through the body. That's a tongue twister, isn't it? Like most body water is stored in muscle. So if there's more muscle in a person, there's a high chance that person will also have more body water, which also means they have lower flows through. So as these are going through, these frequencies through your muscle fat and bone, that's what the reading is giving us. And I don't have a simpler way of explaining. I have like gone through it and I guess you could always Google it, what is that bioimpedance? But if you're thinking of it, it's how things are traveling through our body and that flow and how fast it is. And the more swollen areas where more water, it's not going to travel as fast. So that's going to make a difference in your score.

Deborah: Sure. Sure. And these scores are very important. Also we have L-Dex. What is an L-Dex score?

Keri Claybourn: So what the Sozo does is it sends that bioimpedance electrical current through, and then it gives you this L-Dex score. So this is a lymphedema dexterity score, okay? And this is unique only to the Sozo machine itself. What happens when you're standing there, and they said that current goes through in that 30 seconds, measurement of each limb is taken, and then they calculate a ratio of your healthy limb compared to the limb that is at risk for lymphedema. So that could be the arms or it could be the legs if you're dealing with the gynecological cancers.

So as the fluid increases, that impedance or ability to travel through is slowed down. And that increases this ratio. So this ratio then is converted to a score and that score is what the L-Dex score is. So it can detect at its earliest subclinical stage. So as I was saying earlier, it can detect up to 2.4 tablespoons of fluid, that small of a change, which is crazy. So that's not something we can visibly see, that's nothing we can visibly measure. So this early detection helps to reduce the progression of lymphedema to the chronic stages. So with doing that, it's like we can actually catch lymphedema when it's still at its subclinical stage, which is awesome.

Deborah: That's quite impressive. Yeah, very impressive.

Keri Claybourn: I know. And I think that probably explains the bioimpedance a little bit more there too. So when we get this score, we are looking at, "Okay, what is it normal?" So let's say for example, breast cancer, right side is what is at risk, left side is not, so it's going to compare right arm to left. And let's say your score prior to having surgery is a zero, okay? That's awesome. So now, we know you're zero. Let's say you come back three months after surgery and now your score is seven. So that puts us in the caution area, which indicates the beginning stages, a stage zero lymphedema, where we would recommend compression.

And because of that then, that kind of is that trigger portion that we were talking about. So that makes us say, "Hey. You're swelling. You don't even realize you're swelling. We can't even measure this, but this is picking up these changes in fluid and we know what's happening. So let's go ahead and wear a compression garment. And get up in the morning, put it on, wear it during the day, take it off at nighttime. And let's do this for one month and then repeat the scan." And then after one month, the goal is that that should be normal again. So now, we don't need to wear compression all the time. We prevented it from progressing and now we just use that as needed.

Deborah: Got it. I have one more result question for you. What can the body composition results mean?

Keri Claybourn: So the Sozo also has a unique ability besides the L-Dex score. It can also give us body composition results. And so we're hoping to be able to use these in dealing a lot with our cancer patients. We're treating them for osteoporosis prevention, chemotherapy-induced neuropathy, nutrition on our head and neck cancers. They're working closely with dieticians. There's a whole bunch of things. But this, we can pull back anytime we scan someone, we can always go back and add their body comp. So it could say what their BMI is, and if they have a higher BMI, they are at increased risk for developing lymphedema over someone that has a lower BMI.

We can also look at the analysis of their fluids, including like their total body water. How much hydration they have? Are they dehydrated or not hydrated enough? Their skeletal muscle mass, their fat mass, proteins intake. So there's a lot of things that we're looking at. How can we incorporate that into other types of patients as well and some of the other diagnosis we're seeing, not just our cancer population.

Deborah: And now, what I'd love to talk to you about for a little bit is the prehab prevention program at High Pointe.

Keri Claybourn: So the whole point of kind of the Sozo is the number one thing that we hear from our patients is "I wish someone would have told me about therapy sooner. I wish somebody would've told me what I could do, that there were treatments to be done." And so the goal of our prehab prevention program is to see patients sooner before things become chronic, before it's limiting their function, their ADL's and their quality of life. So we really want to see patients prior to diagnosis, establish that baseline measurement and then schedule them following their surgeries and then help them through chemo, help them through radiation and knowing what to expect and the side effects that comes with that.

Obviously, that's the ideal situation. We realize that's not going to always happen, so the sooner, the better. I mean, even if it's not before surgery, but soon after so that we can identify any issues that are going to affect their function and help with any lymphedema prevention. The sooner that we can get them in for that prehab, we can help them on what to expect with the upcoming surgeries and treatments. We can answer any questions. We can go ahead and start talking to them about what exercises they can expect post-surgery, safe to do, what things we should avoid. There's a lot of misconceptions out there of, "Oh my gosh. I can never pick up something again over five pounds," which is not true. So we can really help educate them and knowing to ease their fears and anxieties before they're leading into everything.

So the sooner we can see them, like I said, we can prevent those long-term concerns from happening, which should mean less visits on our end, getting them back to the things, their normalcy that they're wanting sooner. So we're hoping that by establishing that relationship with these patients and their cancer oncology team, that we can prevent and offer services to these patients so that we can just get them back to living life.

Deborah: Amazing. And we want to thank you so much, Keri, for opening our eyes to the benefits of Sozo for patients who are looking to help track their lymphedema. It's been great to have you on with us.

Keri Claybourn: Thank you. Thank you so much for having me again. And I know some of the stuff is a little complicated, so I hope that I did my best explaining it.

Deborah: I close my eyes and I could see the fluids running through the body. You did a great job again.

Keri Claybourn: Oh boy. Okay.

Deborah: Thanks again.

Keri Claybourn: Thank you so much. Have a great day.

Deborah: You too. And for more information, you can visit deaconess.com/highpointe or call (812) 842-0283. And for more health tips and updates, you can follow us on your social channels. I'm Deborah Howell. Thanks for listening and have yourself a great day.