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Joachim Zuther, Lymphedema Specialist. Read more
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Stages of Lymphedema

 

Chronic lymphedema is considered to be a progressive condition regardless if it is classified as primary or secondary and can not simply be described as an accumulation of protein-rich fluid. It is a chronic degenerative and inflammatory process affecting the soft tissues, skin, lymph vessels and nodes and may result in severe and often disabling swelling.
Lymphedema may present in the extremities, trunk, abdomen, head and neck and external genitalia and can develop anytime during the course of a lifetime in primary cases; secondary cases may occur­ immediately following the surgical procedure or trauma, within a few months, a couple of years, or twenty years or more after treatment.

Lymphedema progresses through stages, and treatment intervention in early stages (stage 0 and stage I) has been shown to result in very good treatment outcomes if managed appropriately (1).

There are four stages of lymphedema

Stage 0, also known as latent stage or subclinical stage of lymphedema

In this stage the transport capacity of the lymphatic system is reduced, but the remaining lymph vessels are sufficient to manage the flow of lymph, and swelling is not visibly present.

Examples include individuals who underwent surgeries for malignancies, such as breast cancer, cancer affecting the genitourinary and gynecologic systems, cancers in the head and neck region, melanoma or soft tissue malignancies. These procedures generally include the removal of lymph nodes with subsequent disruption of lymphatic pathways.
A condition known as lymphangiopathy is present if the reduction in the transport capacity of the lymphatic system is caused by pathology affecting the lymphatic system directly in form of a developmental abnormality (malformations, as in primary lymphedema). In this case lymphedema is not clinically present as long as the lymphatic system is able to cope. 

In stage 0 patients may experience early symptoms, such as the feeling of numbness, tingling or fullness in a limb, which is often accompanied by low-grade discomfort. It may be difficult to fit into clothing, and watches, rings or bracelets may feel tight. This subclinical stage can exist for months, or years, before any more serious signs appear. The onset of lymphedema correlates to the ability of the lymphatic system to compensate for the reduced transport capacity and any added stress to the system that may cause an increase in the volume of lymphatic fluid.

Perometer

Early diagnosis and appropriate treatment of lymphedema is of paramount importance to limit progression of the swelling and to avoid complications often associated with untreated or incorrectly treated lymphedema; several studies have shown that patients’ self-reported symptoms are very accurate indicators of early lymphedema. While subclinical lymphedema can be detected using methods such as bioimpedance (2) and perometry (3), these technologies are not yet widely available.

Treatment intervention in this early and easily manageable stage has been shown to result in very good treatment outcomes using simple, non-custom compression garments (4).

Stage I, also known as pitting or reversible stage

Body parts such as the arms or legs are visibly swollen as protein-rich fluid starts to accumulate in the tissues. In many cases, the swelling subsides with elevation and the limb may appear normal in the morning; however, as soon as the limb is in a dependent position, the swelling returns. Pitting is easily induced by pressing with the thumb, and the indentation produced by this pressure is retained for some time.

While an increase in proliferating cells (increase in fibrous connective tissue) may be present, this early stage lymphedema is considered reversible because the skin and tissues have not yet been permanently damaged. With proper management it is possible for the patient to expect reduction of the extremity to a normal size (compared with the uninvolved limb). Without proper treatment, progression to the next stage is unavoidable in the vast majority of the cases.

Stage II, also known as spontaneously-irreversible stage

It is important to point out that the stage of lymphedema is not defined by size, but rather by the consistency of the tissues. This stage is primarily identified by tissue proliferation with subsequent thickening and hardening of the soft tissues. In many cases the swelling increases and elevation of the limb rarely reduces the swelling; pitting is evident. Over time, the tissue continues to harden and excess fatty tissue begins to form and pitting becomes difficult to induce.

A reduction in volume can be expected if proper treatment is initiated in this stage. In most cases, the excess fibrotic tissue typical in this stage will not recede during the intensive phase of complete decongestive therapy (CDT). Reduction in tissue fibrosis is mainly achieved in the second phase of CDT with proper compression and good patient compliance.

Stage III, also known as lymphostatic elephantiasis

Lymphedema often stabilizes in stage II. However, if lymphedema remains untreated, protein-rich fluid continues to accumulate, leading to further increase of swelling, sometimes resulting in extreme proportions. Hardening of the tissue continues and further deposition of fat it present. In this state, pitting is absent and the swollen body part becomes a perfect culture medium for bacteria and subsequent recurrent infections (lymphangitis) are frequent. Moreover, untreated lymphedema can lead into a decrease or loss of functioning of the affected extremity, skin breakdown and sometimes irreversible complications.

Reduction can still be expected if treatment starts in this stage. In most cases the duration of the intensive phase of complete decongestive therapy has to be extended and repeated several times. In extreme cases the surgical removal of excess skin following the conservative therapy may be indicated (5).

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1. Torres Lacompa, M, Yuse Sanches, MJ, et al.(2010) Effectiveness of early physiotherapy to prevent lymphedema after surgery for breast cancer: randomized, single blinded, clinical trial, BMJ, 340:b5397.

2. The use of bioimpedance analysis to evaluate lymphedema

3. Perometry

4. Stout Gergich NL, Pfalzer LA, McGarvey C, Springer B, Gerber LH, Soballe P. (2008) Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer, 112:2809-2819.

5. Chronic Lymphedema – Treatment and Surgical Options

46 comments to Stages of Lymphedema

  • Tina

    I wasn’t taught that lymphedema was inflammatory. I was taught that is was degenerative or an insufficiency. What makes lymphedema inflammatory? I can see dx’s like CVI or vasculitis’ or wounds that may be created by lymphorea, but lymphedema is a primary or secondary defect in the lymph system.

    • Joachim Zuther

      Dear Tina: Accumulated lymphatic fluid causes macrophages to try to break down proteins. Macrophages secrete molecules (cytokines) that tell the body to begin an inflammatory response. With chronic swelling, this process goes on constantly and leads to chronic inflammation, which in the long run leads to hardening of the tissues (fibrosis). Infections also cause inflammation.
      Please also read http://www.ncbi.nlm.nih.gov/pubmed/7858154
      and
      http://www.lymphnet.org/pdfDocs/nlntreatment.pdf

      • Leeanna

        hi, I really appreciate your thorough explanations and your keen interest in assisting those with lymphedema. You are an inspiration for me. May God bless you sincerely ..
        Can you please tell me if there are any recommended pills or anything I can take to assist with the breakdown of this accumulated protein?

  • Nj Penane

    I am a 21 year old living in Lesotho(Africa).. I was diagnosed with lymphedema about 8 years ago.. I am currently on no treatment or any sort of medication as doctors informed me there was nothing else they could do for me. my bigest worry is that my leg (left leg) will continue to swell. it has already affected my life in a tremendous manner.. HELP

  • Celia

    I am a CDT practitioner working with a patient with unilateral leg lymphoedema. Seeking your advice in establishing the best drainage pathway for this patient. She had lymph node resection with carcinoma and local radiotherapy of left groin, lymph pathway is greatly impaired in entire leg, scar from groin medially to mid thigh. patient also had local radiotherapy and bilateral pulmonary lobectomies – cannot drain to axillaries. You advice much appreciated please. Many thanks in advance

    • Joachim Zuther

      Dear Celia: With pulmonary lobectomies the nodes located in the mediastinum are removed, axillary lnn. are typically not dissected. If this was indeed the case, and axillary lnn. can’t be included in the drainage area, then the primary drainage pathway would be deep pathways in the abdominal area. In this case I would recommend manipulating the contralateral inguinal lnn., both interinguinal anastomoses (AII and PII) and abdominal/deep abdominal techniques, combined with diaphragmatic breathing.
      Hope this helped.

  • John W Hovorka, MD, CLT

    Question: Can you comment on the difference between staging of lymphedema and the grading of lymphedema? I have copied the below abstract describing their grading technique.

    I have copied the abstract from the Bonn Vein study regarding the prevalence of Stemmer’s sign in the general population. The year of this abstract was 2007 and the update in November 2011 at the American College of Phlebology conference was that it was still in the 15% plus range according to this study and that Dr. Felicitas Pannier was looking to see which patients progressed in the grading of lymphedema by Stemmer Sign. This is a fairly simple tool that can be measured and followed over time. The 15% number is much higher than most lymphedema literature generally quotes although it has remained fairly stable in this cohort over the past 4-5 years.

    Phlebologie 2007 vol 36 287-342
    Prevalence of Stemmer’s sign in the general population – Results from the Bonn Vein Study
    F. Pannier1, B. Hoffmann2, A. Stang3, K.-H. Jöckel2, E. Rabe1
    1Department of Dermatology, Rheinische Friedrich-Wilhelms-University Bonn, 2Institute for Med. Informatics, Biometry and Epidemiology, University Hospital of Essen, 3Clinical Epidemiology Section, Institute of Medical Epidemiology, Biometry and Informatics, Medical Faculty, Martin-Luther- University Halle-Wittenberg, Germany
    Summary
    Lymphoedema is a disease frequently diagnosed in vascular departments, its origin being primary or secondary after cellulitis or cancer treatment. The prevalence of lower extremity lymphoedema in the general population is largely unknown. The aim of this article is to describe the prevalence of Stemmer’s sign as a diagnostic criterium for lymphoedema in an unselected adult German population. Methods: The population for this cross-sectional study was recruited from November 2000 through March 2002 from the general population of the city of Bonn and two surrounding rural communities. 3072 individuals (1145 rural and 1927 urban) could be enrolled in the study. The results of the clinical examination were categorized in four groups: grade 0 normal skin fold at the dorsum of the second toe, grade 1 skin fold enlarged measuring 0.5–1 cm, grade 2 the skin fold >1 cm and grade 3 >1 cm with severe induration or papillomatosis. Results: Among 3055 out of 3072 subjects information on all variables were available. In 15.9% of the population a positive Stemmer sign was found with a slightly higher overall prevalence in women. Most of this group presented as grade 1 Stemmer’s sign (14.1%). The more severe grades 2 and 3 were present in 1.8 % of the study population with no clear difference between sexes. We observed a considerably higher prevalence of Stemmer’s sign of all grades in the urban population. The prevalence of Stemmer’s sign increased with age from 3.2% up to 35.9% in the 70–79 year old population. Prevalence of positive Stemmer’s sign was also higher in higher C-stages of the CEAP classification (5.8% in C0 to 100% in C6). Conclusions: The prevalence of lymphoedema in the general population represented by grade 2–3 Stemmer’s sign in 1.8% and grade 1 Stemmer’s sign in 14% is high. Women have a slightly higher prevalence of positive Stemmer’s sign than men. The prevalence of positive Stemmer’s sign is associated with age and chronic venous insufficiency.
    Keywords
    Lymphoedema, prevalence, Bonn vein study, general population, Stemmer’s sign

    • Joachim Zuther

      Dear Dr. Hovorka: Extremity volume is not considered within the different stages of lymphedema. The severity of unilateral lymphedema in the extremities in relation to volume can be assessed within each stage as minimal (less than 20%), moderate (20-40% increase), or severe (more than 40%) increase in volume.
      Here the NCI’s comment on the subject: Another commonly used approach to classifying lymphedema is the Common Terminology Criteria for Adverse Events v3.0 (CTCAE), which were developed for grading adverse events in the context of clinical trials.[Cheville AL, McGarvey CL, Petrek JA, et al.: The grading of lymphedema in oncology clinical trials. Semin Radiat Oncol 13 (3): 214-25, 2003. [PUBMED Abstract: http://www.ncbi.nlm.nih.gov/pubmed/12903011?dopt=Abstract

      A key advantage of the CTCAE approach is that it includes both objective measures (interlimb discrepancy) and subjective, clinical assessments in diagnosing lymphedema. This allows for the very real possibility that a patient could have clinically meaningful, treatable lymphedema isolated to a segment of his or her limb that would not meet objective interlimb discrepancy criteria, but which could still be graded according to severity by signs and symptoms, as follows:

      •Grade 1: 5% to 10% interlimb discrepancy in volume or circumference at point of greatest visible difference; swelling or obscuration of anatomic architecture on close inspection; pitting edema.

      •Grade 2: More than 10% to 30% interlimb discrepancy in volume or circumference at point of greatest visible difference; readily apparent obscuration of anatomic architecture; obliteration of skin folds; readily apparent deviation from normal anatomic contour.

      •Grade 3: More than 30% interlimb discrepancy in volume; lymphorrhea; gross deviation from normal anatomic contour; interfering with activities of daily living.

      •Grade 4: Progression to malignancy (e.g., lymphangiosarcoma); amputation indicated; disabling lymphedema.

      Here is an excerpt from the 2009 ISL Consensus Document (http://www.u.arizona.edu/~witte/2009consensus.pdf) on the topic: “Whereas most ISL members generally rely on a three stage scale for classification of a lymphedematous limb, an increasing number recognize Stage 0 (or Ia) which refers to a latent or sub-clinical condition where swelling is not evident despite impaired lymph transport. It may exist months or years before overt edema occurs (Stages IIII). Stage I represents an early accumulation of fluid relatively high in protein content (e.g., in comparison with “venous” edema) which subsides with limb elevation. Pitting may occur. An increase in proliferating cells may also be seen. Stage II signifies that limb elevation alone rarely reduces tissue swelling and pitting is manifest. Late in Stage II, the limb may or may not pit as excess fat and fibrosis supervenes. Stage III encompasses lymphostatic elephantiasis where pitting can be absent and trophic skin changes such as acanthosis, further deposition of fat and
      fibrosis, and warty overgrowths have developed. These Stages only refer to the physical condition of the extremities. A more detailed and inclusive classification needs to be formulated in accordance with improved understanding of the pathogenetic mechanisms of lymphedema (e.g., nature and degree of lymphangiodysplasia, lymph flow perturbations and nodal dysfunction as
      defined by anatomic features and physiologic imaging and testing) and underlying genetic disturbances, which are gradually being elucidated. Recent publications incorporating both physical (phenotypic) findings with functional imaging (by LAS at this point) into a combined staging may be forecasting the future changes in staging. In addition, incorporation of genotypic information available in the future may further advance staging and classification of patients with peripheral (and other) lymphedema. Within each Stage, an inadequate but functional severity assessment has been utilized based on simple volume differences assessed as minimal (<20% increase) in limb volume, moderate (20-40% increase), or
      severe (>40% increase). Clinicians also incorporate factors such as extensiveness,
      presence of erysipelas attacks, inflammation, 54 and other complications to their own individual severity determinations. Some healthcare workers examining
      disability utilize the World Health Organization’s guidelines for the International
      Classification of Functioning, Disability, and Health (ICF). Quality of Life issues (social, emotional, physical disabilities, etc.) may also be addressed by individual clinicians and can favorably impact therapy and compliance (maintenance).”

  • Celia

    I wish to thank you most sincerely for your valuable advice regarding this patient. Celia

  • Michael

    Greetings – I have just found this site and it has great info. I have started treating some lymphedema in my legs which as dr. explained it is caused by vascular insufficiency due to morbid obesity.

    One of the issues that I experience off and on is frequent urination. Is it possible that frequent urination happens when the body is ridding itself of the lymphatic fluid. Usually the urination settles down – although I have other frequency issues which may be related to the obesity.

    I think I’m making connections to all of this but it’s somewhat complicated. Thanks.

    • Joachim Zuther

      Welcome Michael! Yes, this is quite normal. When decongesting a swollen extremity, the fluid returns into the blood stream, which in turn causes the kidneys to produce more urin.

  • Celia

    7 year old has been diagnosed with having a Bakers Cyst following ultrasounds and most recently an MRI.
    Is MLD a suitable treatment for bakers cyst in a child?

    If it is what is the protocol to follow please? With kind regards,

    • Joachim Zuther

      Celia – MLD is not contraindicated in case of Baker’s cyst and can be administered. The protocol would be the regular sequence for the lower extremity from the inguinal nodes to the location of the cyst. Pretreatment (neck, abdominal techniques) is not necessary.

  • Celia

    Dear Joachim – I am most grateful as ever for your prompt and invaluable help. Having qualified relatively recently, it is reassuring to have someone with your knowledge and expertise willing to be of such support. Many thanks

  • Celia

    Dear Joachim, this is a new area for me. A male patient is soon to undergo advanced VASER ultrasound technology to efficiently remove male breast tissue. He is looking for MLD .

    What area would you recommend manipulating after this procedure. Can drainage be performed the usual route into the axillary lnn?

    I do not want to continiously take up your time – and would like to contribute towards seeking this advice. How do I go about this. Many thanks

    • Joachim Zuther

      This modality reprsents a minimally-invasive body contouring technology useing ultrasonic energy to dislodge and emulsify fat in the area where the technique is applied. I was unable to find any evidence on the validity of this modality and it’s effects. However, if the axillary lymph nodes are intact, the regular MLD techniques for the anterior and posterior quadrants can be used.
      Hope this helped.

  • Celia

    Thank you very much indeed. Wishing you a good christmas and a very happy new year. Celia

  • Tom

    Joachim,

    My sister in-law, 69, was recently diagnosed with latter stage lymphedema where the clinic tech told her it had advanced too far to treat. She is 175 over ideal weight at 5 feet 4 inches in height. As a newcomer trying to understand this condition, what do you suggest regarding such a prognosis? Thank you.

    • Joachim Zuther

      Tom – I absolutely disagree with this prognosis. It is never tpoo late to treat lymphedema. If performed by a trained and certified therapist, the treatment will yield success, regardless of stage or age of the affected individual.The following link can assist you in locating a trained therapist in your sister-in-laws area: http://www.lymphedemablog.com/find-a-therapist/

      • Tom

        Joachim, thank you so much, this will change the approach to treating this by family members. I am so glad to have found your site. God Bless!

  • Vicky

    Hi. I have had lymphedema for five years as a result of cancer and treatment. It is in my lower extremities, particularly left leg and groin. I don’t have terrible swelling of legs but my groin is my problem. I have some swelling on my labia majora and very painful blisters! These blisters (lots of them) also are on the inside of my upper left thigh. It is almost impossible to wear undergarments due to the pain and any compression is out of the question. What can I do to eliminate or treat these blisters? I have been using Aqueaus creams and ointments and keeping the area as clean as possible but I have urinary leakage on top of it all! Any help at all is greatly appreciated!!!

  • Vicky

    Just an addition, I have been through MLD and do this but cannot wear the Jovi pad when I have the blisters. Also I haven’t found any compression that really works for the groin. Thanks again in advance for any suggestions!

    • Joachim Zuther

      Dear Vicky – it seems like the blister like formations are lymphatic cysts and lymphatic fistulas. It is very important to keep this area as clean as possible to prevent any kind of infection. I would suggest consulting with a trained and certified lymphedema therapist to decrease the swelling. Cysts and fistulas heal once the area is decongested.

  • Vicky

    Thanks so much for your reply. I have been working with a trained and certified therapist but we are having difficulties in finding anything that works to compress the groin. Now with these blisters, compression is not possible because of the blisters. I am keeping the area as clean as possible and applying aqueous ointment as well. really the only way I get that area decongested is to sit in a recliner for several days in a row but the moment I get up and around the congestion begins. Oh well, guess I will keep trying.. Thanks again.

  • Leeanna

    Dear Dr.
    I am 26 years of age and reside in Trinidad. Last year August I noticed swelling of my right foot, after numerous vein scans the doctor suggested the test on the lymphatics. The lymphoscintography has confirmed primary lymphedema stage 1. I have been using the class 3 stockings every single day since last September. Unfortunately the doctor has indicated that there is no assistance medically or surgically for this disease in Trinidad, and he told me to just continue living my life.. I am very scared about the “deterioration” of this condition, especially since there isn’t any form of assistance here. My foot swells everyday, and my beautiful leg has undergone discoloration and weakness in the skin in certain areas.. If you are aware of any product that may assist with the breakdown of protein particles (that causes the inflammation) please inform me. I am ready and willing to do whatever it takes to help myself because right now, I am very helpless, and it is a nightmare to just sit and watch my body deteriorate before my eyes. Please could advise me to do something for myself to prevent complications….currently I am using the knee high stockings, and foot socks which accommodate each toe, the socks is not a form of compression, but are actually foot warmers but as they wrap around each toe, this somewhat reduces the swelling. Also, I used the Bezide (water pills) at my own risk weekly, however I believe my body is not responding to these anymore ..I am highly anticipating your reply and I thank you for taking the time to read and understand me

    • Joachim Zuther

      Dear Leeanna: We trained several therapists in Trinidad, so there is definitely treatment available. Please click on the “Find a Therapist” button on the top of this page, then click on “Academy of Lymphatic Studies” and type Trinidad in the country field. A therapist will be able to assist you with any questions you may have.

  • Leanne

    So happy to have found this site! I was just diagnosed, 46 year old female and it is mild bilateral leg. I do not know if it is primary or secondary. I have never had cancer, surgery, radiation, parasite, or trauma. However, I have had about 5 occasions of mysterious swellings that resolved on their own over a course of a few days or weeks since age 16 (after long bus ride, c-section, and a breast surgery…). It is questionable if other female relatives may have this type of swelling (nothing confirmed, but suspicious in hindsight). I will be going to a specialist program soon and have compression socks. Right now I am absolutely mystified and frankly scared because I can’t figure out what has caused this being I have no real risk factors for the more common secondary type. Any insight is so appreciated! Information is scarce. The vascular doc who confirmed this by lymphoscintigraphy is of absolutely no help at all.

  • Leanne

    I was just diagnosed with bilateral leg lymphedema, it is mild. I am a 46 year old female and mystified as to why I have this – my vascular doctor who diagnosed it is of now help at all so happy to have found this site. I have no risk factors for secondary lymphedema but now have fears. Looking back over my life, I remember about 5 instances of mysterious swellings that resolved over a period of days or weeks (two after non-cancer-related surgeries) since age 16. There also may a couple female relatives who have unusually large/swollen legs but the cause is not known or confirmed. I am interested in ANY insight as I look for answers. I have compression socks and start a PT program in a couple of weeks. Thank you!!

    • Joachim Zuther

      It most certainly sounds like your swelling is caused by insufficient venous and/or lymphatic return. The symptoms point toward primary lymphedema

  • Cled

    I have a dear friend who weighs into 300 pounds. She is just in agony. Her left leg is split open from back of knee to almost heel. It seems her right leg is heading the same way. Vascular docs say it’s not their field, but can not recommend the proper doc with lymp speciality. Please help!!
    She lives in Maryland near DC She’s been to Johns Hopkins, Holy Cross, Suburban, Shady Grove hospitals, but they cannot help her., Is there any hope for her? Do you know of a a lymphedema doctor near her?

  • Cled

    Sorry, forgot to add that lymph fluid continually drips down her leg constantly, and her wraps must be changed many times a day or she starts dripping.

  • Lyn

    Hi, Joachim. I am a 49yr old female that has just had some tests today and was told by my OBGYN that I may have Lymphedema. He has done a CT scan and I am having a MRI next week, but the strange thing with this is that the swelling is in my Labia Minora, the left side more than the right. I had major surgery a few years ago to remove a Desmoid tumour from my upper left quadrant which also resulted in them removing my spleen and 40cm of my bowel which proved to have endometriosis in it and over the last 8 months I have noticed a lot of pain when I sit or walk and it is becoming impossible for me to have a relationship with my husband.
    Is this something that is treatable or what will this hold for me, as I can’t seem to find every much about it??
    Thanks Lyn

  • Lyn

    Thanks Joachim.
    Is there any surgery or cure for it at all??
    Thanks Lyn

  • Ron

    Hello Joachim,

    I have a very “mild” case of Primary LE. I have seen multiple therapists and was officially diagnosed by a doctor that has one of his specialization areas in LE. They have all told me that my case is one of the most “mild” that they have seen and that they do not believe that my condition should worsen. I currently wear knee high compression stockings on both legs.

    Despite the information provided by my therapists it is very discouraging to me that everything I have read online indicates that LE is a progressive condition that ALWAYS gets worse. I was curious regarding your general opinion regarding the progression of LE.

    Do some people with LE maintain “mild” LE for a long time? Even permanently? Does it “always” get worse?

    This statement is very discouraging: “It is a chronic degenerative and inflammatory process.”

    Thank you

    • Joachim Zuther

      Dear Ron:

      You are correct – lymphedema is a progressive condition, which gets worse if it remains untreated. Since your lymphedema is under control and treated, there is a very good chance of it staying mild and not getting worse.

  • Sayge

    Hello,
    My 4 month old was diagnosed with primary lymphedema in her right foot and leg. The doctor said he did not recommend treatment yet because it can affect the development of her leg. From what I read, early treatment seems very important. It’s difficult for me to find information on infants with lymphedema but I am concerned that because she is so young, as it progresses her quality of life will be greatly affected. I’m not sure who to get a second opinion from. We’re in Washington state, near Portland, Oregon. I found a therapist but they require a doctor’s order for an appointment. I don’t want to do anything harmful. Do you have recommendations for where to get more answers for pediatric lymphedema? I am very lost right now. Thank you so much.

  • Kathryn

    Hello

    I had double mastectomy and all my lymph nodes in my right arm removed. I have stage 0 according to your chart; discomfort, aching, tingling, I can’t wear the same clothes I could before as they feel tight. What are some things I should do to try to avoid any further symptoms of lymph edema

    Thank you,

    Kathryn

  • Tawanna Washington

    Hi my name is Tawanna and I’m 32years old I live in Bainbridge GA and there seems to be no help for what I’m going through can you help me find someone to treat my leg please I’m always in please I’m always in pain.

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