Will* is a 37-year-old male who noticed swelling in his ankles around age 20. Because of his large legs, he began a structured exercise routine and diet, resulting in a 40 pound weight loss.

Despite losing weight, his legs remained the same size.

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He eventually saw a doctor who prescribed a pill to remove fluid. The pill did not seem to make a difference; in fact, his legs continued to increase in size. Little did he know that he had a condition that would affect him for the rest of his life.

Reba* is a 68-year-old female. She was diagnosed with breast cancer in 1990. She underwent a right radical mastectomy which included lymph node removal.

Recently she developed an infection in her right arm. She also noticed her jewelry and clothing was fitting a little tighter on her right arm. Her entire arm continued to swell to the point where it was hard for her to use it anymore.

Marge* is a 73-year-old female who received chemo and radiation for breast cancer in 2000.

A few months after treatment, she bumped her arm on a sharp corner which resulted in a cut in her skin. Soon after, her arm began to swell. She informed her oncologist who referred her to a certified therapist to treat her for lymphedema.

These three individuals had cases of lymphedema. In fact, millions of other people have similar stories. Lymphedema is a build-up of protein-rich fluid that results in swelling, inflammation, and hardening of the skin. Although lymphedema affects 2.5 million Americans, it is commonly misunderstood or confused with other types of swelling.

Improved understanding and awareness of lymphedema is essential for proper medical care.

Development of Lymphedema: Lymphedema occurs when lymphatic fluid builds up in the soft tissues of your body. It most commonly occurs in the arms or legs, but can also occur in the face, neck, abdomen, and genitals.

The lymphatic system consists of lymph vessels and nodes that run throughout the body. The lymph vessels collect fluid that is made up of large protein molecules, bacteria, and waste products.

This lymph fluid is then transported to the lymph nodes where it is filtered and then returned to the blood. If the lymphatic vessels or nodes become damaged or are absent, the lymph fluid cannot move freely through the system. The fluids then build up and cause swelling in the affected regions, which is known as lymphedema.

Signs and Symptoms: The first sign of lymphedema is unusual swelling characterized by "pitting." Pitting occurs when the skin is depressed for a few seconds and the indent made by your thumb does not immediately disappear.

Other symptoms may include tightness or heaviness in the affected area or changes in the texture of the skin. Clothing and jewelry may begin to feel tight.

Who is at risk for developing lymphedema:

Researchers have been unable to predict who will develop lymphedema. People who have had treatment for cancer are at increased risk. However, just because a person had cancer therapy does not mean he/she will automatically develop lymphedema.

In some cases, lymphedema does not develop at all. In other circumstances, lymphedema can develop shortly after cancer therapy or up to 20 years after. If you travel frequently to tropical countries, you may also be at increased risk. Chronic infections also increase the chances of developing lymphedema.

Treatment of Lymphedema: Once the diagnosis of lymphedema is confirmed, a very specific treatment called Complete Decongestive Therapy (CDT) can begin.

Because there is no known cure for lymphedema, the goal of CDT is to decrease swelling and reduce the risk of complication through the following steps:

Manual Lymphatic Drainage (MLD) is a gentle hands-on technique that stimulates the lymphatic vessels to move fluid in a very specific direction. Specific bandages are applied in conjunction with MLD to remove even more fluid.

Skin care is essential as dry, cracked skin can become infected.

A special exercise program is important to stimulate the muscles to further assist in removal lymph fluid from the affected area.

Once the fluid has been removed, special compression garments are worn to preserve the reduction of swelling.

The above treatment is very complex and is best treated by a certified lymphedema therapist. Surgery or medications are typically not appropriate for lymphedema.

If you suspect lymphedema, contact your physician about your symptoms.

There are several other excellent organizations and resources that support diagnosis and treatment of lymphedema. You can learn more about these resources at www.lemarspt.com.

For more information contact Monica Aalbers, PT, ATC, CLT at Le Mars Physical Therapy (712-546-1718 or monica.aalbers@lemarspt.com).

*Individuals' names changes to protect anonymity.