Her condition meant that she felt too ashamed to go out. She would feel sick of people either taking pity on her or casting disparaging looks at her legs.

The 34-year-old ended up hiding herself away at home in Phang Nga, only going out when she needed medical treatment.

Suthinee's right leg had swelled to an abnormal size, weighing many kilograms more than normal.

Living with such a disease, even common ailments such as acne or tooth decay meant time in hospital due to the infection spreading through her lymphatic system.

Despite doctors telling her that her legs would never be the same again, she remained hopeful that one day she would get back her once-slim legs, one way or another.

But time after time her hopes were raised then dashed by those promising to get her to better treatment in Bangkok. She twice visited doctors in Bangkok only to hear them reiterate that her leg would never be the same as before. She began to lose hope and went back home even more upset.

Then, early last year she met Japanese dentist Hirata Kanazawa, who was on a volunteer mission to the areas in the South affected by the devastating tsunami of 2004.

Kanazawa came across Suthinee while she was sweeping leaves from a temple floor and persuaded her to let him take her to get proper treatment in Bangkok. She agreed to give it another try.

In January she was taken to meet Dr Wichai Ekataksin, a friend of Kanazawa's working at the Hospital for Tropical Diseases.

"Honestly, at first I found the treatment rather weird, but I became more and more confident as the weight of the bulky leg decreased," Suthinee recalled about the treatment, which Wichai called "sufficiency-economy treatment".

All that is required for treatment are bed sheets and sticks. The bed sheets were substitutes for bandages, given the extraordinary size of the patient's leg.

All the same, the treatment looked simple; the doctor wrapping the sheet around the swollen leg from the ankle up. Raising and mounting the leg above the horizontal position while the patient is lying down on the bed is done in addition to the leg wrapping.

"The rule of thumb is the more the leg-wrapping is done, the better the results will be. Of course we stop whenever it feels too tight or hurts," Wichai explained.

Ten days after the treatment began, Suthinee had shed about 20kg from her right leg. The weight of the leg was measured using the water-displacement method, placing the patient's leg into to a bin full of water and then measuring the weight of the water displaced.

In contrast to how simple the treatment looks, it is actually based on advanced and complicated medical knowledge gained from years of study of the lymphatic system.

Wichai, who is an expert on liver research and was, a few years ago, recognised in the world of medicine for his success in identifying an important blood vessel in the organ, identified the "honeycomb interstitium" (a small area, space, or gap in the substance of an organ or tissue).

His findings brought about a change in the way doctors thought about this structure; that it exists everywhere in the body, Wichai said.

This sheds light on exactly how lymph (blood plasma fluid lost from the circulatory system) flows inside the body. The fluid gradually flows from one cell of the honeycomb to another.

Wichai discovered this while studying how lymph moved inside the liver. The honeycomb interstitium is clearly seen only when congested with lymph and each hole of the honeycomb structure is inflated with the fluid.

Wichai's findings were presented at a medical research conference in the United States in 2000 and once again a couple of years later in Japan. What he had learnt was applied to the treatment of Suthinee's swollen leg.

The purpose of binding the leg is to gradually squeeze the lymph out of the congested honeycomb structure.

However, the treatment is not permanent. The leg could get swollen again if Suthinee gets an infection in her lymphatic system. However, after the first treatment, the patient now knows the "sufficiency treatment" and can do it by herself at home, said Wichai.

Suthinee's legs are now equal in size, except for some fatty tissue just over the right ankle, which could be surgically corrected.

Arthit Khwankhom

The Nation